The United Nations Children's Fund (UNICEF) defines teenage pregnancy as conceiving between the ages of 13–19 years old. In low- and middle-income countries (LMICs) of which South Africa is one, girls between the ages of 15 and 19 had an estimated 21 million pregnancies annually as of 2019, almost 50% of which were unplanned and led to an estimated 12 million births (WHO, 2022).
Teenage pregnancy is common in South Africa (prevalence of 68 births per 1 000 girls aged 15–19 per annum) and has a high mortality (institutional maternal mortality rate [iMMR] of 76.9. deaths per 100 000 live births) (Sewpaul, 2021). Between 2021 and 2022 the rate of teenage pregnancies across provinces in South Africa showed Northern Cape as having the highest rate with 74.3 (pregnant pupils per 1 000 registered) followed by Mpumalanga with 72.8 and KwaZulu Natal with 71 (Barron et al., 2022). The lowest pregnancy rate was observed in Gauteng province with 39 and the Western Cape with 43.7 (Barron et al., 2022).
South Africa recorded increased rates of teenage pregnancies in the country between 2018 and 2019 and more recently during the COVID-19 pandemic. This was partly due to the difficulty of accessing contraceptives, which was greater during the COVID-19 lockdown (Jonas, 2021). The number of terminations recorded decreased during the COVID-19 pandemic from over sixteen thousand (16301) between 2019 and 2020 to just below fourteen thousand (13972) between 2020 and 2021. Prior to the COVID pandemic, data from 2017 indicates that termination of teenage pregnancies in South Africa was on the rise (Barron et al., 2022). This decrease in terminations is probably due to a decrease in access to public sector services as a result of COVID-19, and the disruption it caused to service delivery (Barron et al, 2022). Between April 2021 and March 2022 over ninety thousand teenage pregnancies were recorded in South African healthcare facilities (Statistics SA, 2022).
Teenage pregnancy results from unprotected sexual activity, the sexual activity can be consensual between two teenagers, coerced by an older or more powerful male figure or a result of rape (Thobejane, 2015). Therefore when health professionals get in contact with a pregnant teenager they are potentially being confronted with crime in terms of coercion (which is understood as statutory rape) and rape. The first points of contact for most pregnant teenagers are nurses and midwives. As such, nurses and midwives have to be well-trained and prepared to address and care for pregnant teenagers.
The HSRC (2015) found that nurses and midwives working in obstetric care at clinics and hospitals had less-than optimal knowledge. The study also found low levels of continuous professional development (CPD) training among nurses and midwives. During the preceding 12 months, less than half (44.4%) had attended CPD training in antenatal care; 38.8% received training in hypertensive disorders of pregnancy (which is one of the leading causes of maternal mortality in teenagers); 26.2% received training in pregnancy problems; 56.3% received training on prevention of mother-to-child transmission (PMTCT) and HIV training; and 37% received training on the implementation of the Department of Health (DoH) guidelines on child and maternal services. The study also found that a small proportion (under 5%) of healthcare professionals had negative attitudes towards providing family planning services to teenagers (HSRC, 2015).
Pregnancy is the primary push factor for girls dropping out of school. 30% of girls between the ages of 10 and 19 fall pregnant in South Africa, with 1 out of 3 of these girls not returning to school (Payne et al., 2022). In addition to providing adequate healthcare during pregnancy, healthcare professionals together with other professionals have to aid the pregnant teenager to stay in school during pregnancy and get back to school after delivery (Payne et al., 2022; Reddy, Sewpaul & Jonas, 2016). Intervention programmes should focus on encouraging abstenance as well as emphasise safer sexual behaviour, such as correct and consistent condom use. Contraception should be made available to those who are already sexually active. Additionally, better prenatal care should be provided (Reddy, Sewpaul & Jonas, 2016) in order to reduce the high mortality rate recorded in teenage pregnancies. Better prenatal care can be achieved through continuous professional development of healthcare professionals so that they are well prepared to provide care for teenagers who are pregnant.
Reference
Barron, P., Subedar, H., Letsoko, M., Makua, M., & Pillay, Y. (2022). Teenage births and pregnancies in South Africa, 2017-2021–a reflection of a troubled country: Analysis of public sector data. South African Medical Journal, 112(4), 252-258.
HSRC (Human Sciences Research Council) (2015) Healthcare worker behaviour in maternal and infant care: Findings from the study of the Maternal and Infant Morbidity and Mortality Surveillance System of South Africa. Unpublished report.
Jonas, K. (2021). Teenage pregnancy during COVID-19 in South Africa: A double pandemic. The Conversation.
Payne, A., Kreuser, C., Feldman, J., & McIntosh, J. (2022). Submissiom to the office of the high commissioner for human rights on the impact of the COVID-19 pandemic on the realization of the equal enjoyment of the right to education by every girl. Legal Recsorces Center: Cape Town.
Reddy, P., Sewpaul, R., & Jonas, K. (2016). Teenage pregnancy in South Africa: Reducing prevalence and lowering maternal mortality rates.
Sewpaul, R., Crutzen, R., Dukhi, N., Sekgala, D., & Reddy, P. (2021). A mixed reception: perceptions of pregnant adolescents’ experiences with health care workers in Cape Town, South Africa. Reproductive Health, 18, 1-12.
Thobejane, T. D. (2015). Factors contributing to teenage pregnancy in South Africa: The case of Matjitjileng Village. Journal of Sociology and Social Anthropology, 6(2), 273-277.
WHO. (2022). Adolescent pregnancy. https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy