[LETTER FROM ACCRA]
Sabria, a 17-year-old young woman from the Northern Region, came to Accra in early 2013 to make some money to provide for herself and her then one-year-old baby, Rashid. She now works as a head porter at Agbogloshie market, one of the major trading centers in the city.
After becoming pregnant at 15, Sabria decided to abandon school because she felt ashamed of her condition. While her parents helped her care for the baby during his first year of life, Rashid’s father refused to take responsibility for the baby, she said.
Sabria is only one of the estimated 750,000 teenagers aged between 15 and 19 that, according to the Ghana’s Coalition of NGOs in Health (GCNH), become pregnant nationally every year.
The phenomenon of teenage pregnancy in Ghana has gradually scaled down over the last decade; in 1994 it affected 17.9 percent of adolescents, while in 2012 a smaller 12.7 percent of Ghanaian teenagers became pregnant, according to a report by the Ghana National Health and Development Programme (GNHDP).
In spite of this decline, teenage pregnancy remains an issue that generates poverty, poses health risks, and limits access to education. The Ghana Health Service (GHS) in collaboration with the Ghana Education Service (GES) and several non-governmental organizations are currently implementing programs that aim at both preventing and managing the issue of teenage pregnancy. Financial constraints as well as cultural resistance, however, are limiting the impact of those projects.
A Multi-Faceted Issue
According to Jemilla Ariori, Project Manager at the Human Rights Advocacy Centre (HRAC), an NGO based in Accra, financial hardship is among the main causes of teenage pregnancy in Ghana. “When a child is not being maintained by her parents, they would find a boy who gives them money to feed or take care of themselves,” Ariori said. “And obviously the boy would want sexual favors back.”
Places like Agbogloshie market swarm with young teenagers who, having left home to escape poverty, have no means to provide for themselves and are therefore prone to fall victims of this kind of situation.
A 16-year-old woman from Tamale, Ayisha came to Accra with her older sister at the beginning of July this year. She said that she completed school in her hometown before leaving her family in search of money. A head porter, Ayisha now lives with other adolescents in the same situation as her; no adult is caring for them.
Ariori added that rape, forced marriages, and the lack of sexual education in schools are other major factors of teenage pregnancy, making it a complex problem. “Teachers are not taking the time to tell children to use protection,” she said. “They’re rather binding on abstinence, abstinence, abstinence.”
Speaking of the 2012 increase in the teenage pregnancy rate in the Central Region, one of the highest in the country, Deputy Director of Family Health at GHS Patrick Aboagye said that the large presence of refugees contributed to such increase. Because of their poorer material and social conditions, refugee teenagers are more at risk of unwanted pregnancies.
According to Aboagye, however, the rural nature of the Central Region remains the main reason for the traditionally high teenage pregnancy rate, for the median age of sexual debut is traditionally lower in the countryside.
The “Bad Girl”
Ghanaian communities and religious institutions often frown upon early pregnancies, which have adverse medical and social implications for pregnant teenagers. “People advise children not to mingle with the pregnant child,” Ariori said, adding that the local religious culture also contributes to social stigmatization. “There are examples when a child gets pregnant and the church would either say ‘sit at the back so that you’re not seen’ or ‘don’t come to the church’ at all.”
According to Ariori, an early pregnancy often results in the child deliberately abandoning school or being pressured to leave by her teachers. Most of these adolescents never go back to school after giving birth, which affects their life prospects and the ones of the baby who is to be born, she added.
Aboagye said that the society’s perception of teenage pregnancy affects also the adolescent’s ability to access medical care. “Stigma leads to abortion and its complications,” he said, adding that because their bodies are not fully developed and susceptible to anemia and fistula, pregnant teenagers need medical support to ensure their health and that of the baby.
Ariori adds that the strict abortion law leads pregnant adolescents to resort to unsafe methods of abortion such as drinking broken glasses. Aboagye, however, said that the Ghanaian abortion law is one of the most liberal in Africa, but that most young women are not familiar with it. “For those who know the law, it’s fairly accessible,” he said. The law itself lists the following as conditions in which abortion is permissible: to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, and fetal impairment.
A Gradual Process
In 2011, the HRAC started a project against gender-based violence in schools that included the prevention and management of teenage pregnancy. As part of the project, HRAC representatives held forums and workshops in over 80 elementary and junior high schools, targeting students and teachers separately. Ariori said that the project is scheduled to end this year, and that a conclusive report will be launched after the summer.
According to her, even though the programme allowed HRAC to gather a significant amount of information, because of financial constraints the project could not include the higher levels of education within its scope. “We have the need to extend the project to senior high schools, but we do not have enough funds,” she said.
Another challenge was the teachers’ resistance to the HRAC’s focus on children rights rather than responsibilities as far as teenage pregnancy is concerned. “We would inform children that there is no law that says that you should leave school when you get pregnant, and teachers would frown upon this kind of information,” she said.
In 2001, the GHS launched the Adolescent Health and Development Programme, a body with regional teams across the country that aims to provide health education, counseling, and special care services and facilities to youth. The coordinator of the Adolescent Health and Development Programme (AHDP), Rejoice Nutakor, said the organization launched a school health project in collaboration with GES as well as Time with Grandma, a community-based project that engages queen mothers—senior figureheads in the Ghanaian tribal hierarchy—and young teenagers in conversations about sexual and reproductive health. “We want to ensure that the traditional authorities are part of the change,” Aboagye said. “Queen mothers are mobilized to provide information to young girls to make sure that they stay in school.
In spite of these programs, Nutakor said that more could be done to prevent teenage pregnancy and assist pregnant adolescents. “We need to sustain the programme and scale it up,” she said. According to Nutakor, a more effective collaboration with GES would strengthen the efforts to reduce the issue of teenage pregnancy. “We are working with GES but that synergy has not been as productive as we thought,” she said. Aboagye said that a challenge comes from the fact that health has never been introduced in the school curriculum in spite of the Ministry of Health having advocated for it.
Funding has also been an issue for the GHS and its AHDP sector. According to Aboagye, in the years 2005 and 2006 the European Union (EU) and the United Nations Population Funds supported some of the adolescent health programs in Ghana, but since then there have not been significant external investments in the sector. However, Aboagye said that the AHDP needed to look for internal sources of funding. “External help is important, but funding from within is more sustainable.
Looking Forward
According to Ariori, a key development in the management of teenage pregnancy would be the adoption on the part of the Ministry of Education of an expressed law that regulates the treatment of pregnant teenagers in schools. “It should be spelled out so that it’s not left to the school to decide whether the child who gets pregnant is expelled or stays,” she said. Aboagye calls for policy reviews concerning the age of consent in order to better regulate the provision of appropriate care to minors. According to Nutakor, the GHS should focus on more sustainable resource planning and look for donors to support the cause of teenage health.
Ariori added that the advocacy and education work by civil society organizations should continue in order for the phenomenon of teenage pregnancy to be reduced. A similar role is to be played by the media, Aboagye said. “The media is able to mobilize the youth significantly, so it allow us to use it as a forum to educate the youth,” he said.
Photo Credit: Wikimedia Commons