Public health experts say there is an urgent need for effective sex education and support for adolescent girls in light of the staggering 26,515 pregnancies recorded for girls aged 10 to 19 over eight months last year in KwaZulu-Natal.
Provincial health MEC Nomagugu Simelane described the figures as a “disgrace” and pleaded with parents to take responsibility for raising their children — 1,254 of the pregnancies involved girls aged 10 to 14.
Conversely the country’s largest medical scheme Discovery Health has released a research study showing teen pregnancy in decline among its members.
Cape Town midwife and reproductive health policy expert Marion Stevens said the huge gaps in fertility rates between the haves and have-nots mirrored growing social and structural inequalities in South Africa.
“We need to implement comprehensive sexuality education. This is not happening and when it happens it's about damage, disease and danger ... not about feelings, how your body works and consent. Girls and young women have poor access to contraception options. There have been (public sector) stockouts and when they do have access there are only injectables available,” said Stevens.
Discovery analysed claims data for 464,752 deliveries between 2008 and 2022 which indicated a birth rate decline over the 14 years across most age groups. Over the past three years since the pandemic began the birth rate of 20- to 24-year-old patients fell by nearly half (47.2%) while teen births hit an all-time low, declining by more than 60%. Only members above 40 showed a slight increase in births during the pandemic.
Stevens said the realities of poorer women were complex: “What is disturbing is that there are no conversations about this being about statutory rape and sexual assault, and what power relations are being transacted over who and why.”
Stats SA data released in February showed that across all provinces 90,037 adolescents aged 10 to 19 gave birth between March 2021 and April 2022.
The data recorded 33,899 births by mothers aged 17 years and younger in 2020.
Western Cape health spokesperson Mark van der Heever said teen births had declined over the past three years in the province from 11,690 in 2020 to 10,686 in 2022. About 4,000 teenage births have been recorded in 2023.
Last week DA MPL Jack Bloom said thousands of women in Gauteng lost out on a popular contraceptive device when the province was hit with a shortage of 29,000 contraceptive implants for the first three months of this year.
This was revealed by Gauteng health MEC Nomantu Nkomo-Ralehoko in a written reply to Bloom.
According to the MEC, only 2,000 Implanon subdermal implant devices were received from a total 31,000 orders in January, February and March 2023. The device is a small plastic rod inserted under the skin that releases a synthetic hormone that prevents pregnancy over a three-year period.
Bloom said: “It is unfortunate that a supplier failure prevented thousands of women from using their preferred long-range contraceptive method. This follows the drastic shortage of male and female condoms because of long-running supply problems with a national contract.”
He said the Gauteng health department should be “more adept at detecting shortages of key items and getting alternative suppliers to fill orders speedily”.
Dr Nisha Jacob, a public health specialist from the University of Cape Town’s school of public health, said: “Access to reproductive healthcare services such as contraception has a notable impact on teenage pregnancy. Limited resources and long waiting times are examples of factors in the public sector that may limit adolescents' access to health care. Young people from lower socioeconomic backgrounds may face challenges such as poverty and unemployment which may contribute towards teenage pregnancies. They may also face increased vulnerability to gender-based violence and have less access to support services for victims of gender-based violence,” she said.
Differing access to effective sex education programmes may also contribute to teenage pregnancy.
Jacob said increases in teenage pregnancy not only worsened the cycle of poverty and inequality but might also have a negative knock-on effect on health systems.
“Just as the causes of teenage pregnancy are multifactorial, the interventions are not at all limited to the healthcare system in isolation. Rather than looking at the NHI as a solution, broader systemic interventions are needed to address inequality, poverty and unemployment.
“Limiting the issue of teenage pregnancy to only the healthcare system is short-sighted. Addressing the social determinants of health is imperative.”
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