Pregnant and parenting adolescents in sub-Saharan Africa

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Adolescent pregnancy is a significant health and social challenge in sub-Saharan Africa. The region has the highest adolescent fertility rate—over a quarter of adolescents begin childbearing before the age of 18 years compared to 13% globally. Early childbearing puts adolescents on a trajectory of poor health and social outcomes. Adolescent mothers are at higher risk for morbidity and mortality than women who give birth in their 20s. Their children are also at higher risk for poor health and social outcomes.

The high burden of adolescent pregnancy in the region has led (understandably) to a focus on interventions and programs to delay sexual activity and childbearing. One consequence of the emphasis on pregnancy prevention is a limited focus on research to understand the experiences of pregnant and parenting adolescents in sub-Saharan Africa or to develop and test appropriate interventions to improve health and social outcomes for these adolescents and their children.

To draw attention to the relatively small, but growing, body of research focused on pregnant and parenting adolescents in the region, we recently co-edited a special collection of the Reproductive Health journal that brings together a set of nine articles that report on research on pregnant and parenting adolescents in sub-Saharan Africa. Four key issues emerge from this body of work.

First, the research underscores the need to integrate pregnancy prevention and interventions to support adolescents who become parents. As described by Chamdimba and her colleagues, who draw on data from pregnant and parenting adolescents in Malawi, as well as their parents or guardians, girls’ vulnerability to early pregnancy stems from multiple factors. These factors include adolescents’ limited knowledge, their restricted access to contraceptives, poverty, and sexual violence. However, parents often blame adolescents for being stubborn and ignoring guidance about the value of abstinence. Blaming pregnant adolescents for their “deviance” is also reported by Alex-Ojei and her colleagues in their article, which reports on data from Nigeria. Unfortunately, as highlighted by Adedini and Omisakin, once girls become pregnant, they are at significant risk for repeat pregnancy because they often do not use contraceptives or discontinue use.

Second, the research documents a significant burden of intimate partner violence among pregnant and parenting adolescents, with younger adolescents and those who engage in transactional sex being at higher risk for violence. Gebrekristos’ and colleagues’ study points to the strong association between intimate partner violence during pregnancy and the risk for postpartum depression among adolescent mothers in South Africa.

Third, pregnant and parenting adolescents, particularly those who are unmarried, face high levels of stigma from the community, as well as providers. As highlighted by Undie and Birungi, these adolescents and their parents may live with deep psychological trauma. For some girls, the psychological trauma arises from the sexual violence that led to their pregnancies. For parents, the disappointment, anger and hurt experienced when they learn of their daughter’s pregnancy can lead to psychological trauma that can result in them forcing their daughters to leave home. Ajayi and colleagues also highlight the association between probable depression and paternity denial, as well as the lack of parental support among pregnant and parenting girls in Burkina Faso and Malawi. Taken together, the findings around the interpersonal violence, stigma, and psychological trauma faced by adolescent parents and their own parents highlights the need for violence prevention and mental health interventions targeting them.

Fourth, living in poverty may increase the risk for adolescent pregnancy. However, pregnancy may also exacerbate adolescents’ vulnerability to poverty, because adolescent parents are largely financially dependent on their families, but may be expelled from the family home following their pregnancies. Their exclusion from schooling further increases their socioeconomic precarity as they are denied the opportunity to gain critical skills.

Moving forward, increased investment in research on this sub-population is critical given evidence showing that research on pregnant and parenting adolescents in sub-Saharan Africa is skewed towards a few countries and, with few exceptions, is primarily observational research. Yet, research on this sub-population is needed to inform context-relevant interventions to support them and their families such as the PROMOTE Project being piloted in Burkina Faso and Malawi.  The PROMOTE project seeks to test three interventions targeting adolescent mothers: cash transfers conditioned on schooling, childcare support and life skills training.

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