Black teenage pregnancy in South Africa: some considerations

Adolescence, Fall, 1996 by Peter W. Cunningham, Brenda E. Boult

INTRODUCTION

The swinging sixties left an echo that would lead to extensive research into adolescent sexuality. What adults were accepting as their rights, all too soon became during the process of socialization and imitation, what the young felt was "okay" to emulate - an exploration of the delights of unrestricted and unrestrained sexual activity. A recent newspaper report noted that most adolescents, irrespective of their culture, are sexually active before the age of twenty - even if their parents are reluctant to admit it (Eastern Province Herald, 1994).

The consequences have been an upsurge in the incidence of sexually transmitted diseases (Masters, Johnson, & Kolodny, 1988; Hacker, 1989; Duncan et al., 1990) and in the number of unplanned and unwanted pregnancies among adolescents too young to assume the psychological and physical burden of parenthood (Jones et al., 1987). The medical literature of the late sixties and early seventies (Utian, 1967) shows that concern and, that the medical profession was relatively unprepared for the challenge. Subsequent studies show that with appropriate medical surveillance, teenage pregnancy need be no more physiologically hazardous than it is for the older primipara (the first time pregnant) (Blumental, Merrel, & Langer, 1982; Goldberg & Craig, 1983; Frisancho, Matos, & Flegel, 1983; Ncayiyana & Ter Haar, 1989). While the medical profession has coped with problems attendant upon childbearing by the very young, neither the family nor society has solved the problem of how to cope with "children having children."

How do we define "the very young" or "teenagers" or "adolescents"? In physiological terms, the definition would depend on the age of menarche. This would further depend on a definition of the time lapse between age of menarche and gestational age (Felice, James, Shragg, & Hollingsworth, 1984; Scholl et al., 1989). Medically, the optimum time lapse between the two should be two years so as to obviate the physiological problems that could arise as a consequence of lack of physical readiness. The "punch line" is that should a girl begin to menstruate at age nine, after the age of eleven, statistically she should encounter no medical problems during her pregnancy at age eleven-and-a-half. She is thus not likely to fall prey to those problems commonly associated with "teenage pregnancy" such as gestational proteinuric hypertension, anemia, spontaneous premature labor or, run the risk of having a low birth-mass baby.

Research, however, does not fully support this contention. The pregnant teenager is "at risk," as is her unborn infant. There are serious physical and neurological problems of development associated with low birth-mass infants, and several reports show an association between early maturation and foetal growth (Scholl et al., 1989).

Infant Mortality and Low Birth-mass Infants

Infant mortality is significantly linked to birth-mass. The lower the birth-mass, the less likely the infant is to survive, and there is an undisputed tendency for teenagers (and younger teenagers in particular) to give birth to low birth-mass infants (Boult & Cunningham, 1993).

Infants weighing less than 2,500 grams are more at risk for neurological and other developmental deficiencies (including cerebral palsy. Their nursing care also presents more problems for medical personnel, their young and inexperienced mothers, her family, and the state. The latter has to provide the services for their survival (Van de Elst, 1990).

Maternal Mortality

It is in the developing countries that teenage pregnancy has become a primary cause for concern as a result of its contribution to higher maternal mortality rates. It is in these countries where industrialization and Westernization have led to the adoption by adolescents of the practices of their Western counterparts, that the price has been highest (Oronsaye, Ogbeide, & Unuigbe, 1982; Oppong, 1987; Kulin, 1988). School drop-out, illegal abortion, medical problems such as vaginal or rectal fistula resulting in social ostracism, child neglect and child abandonment, are but some of the problems referred to (World Bank Policy Study, 1986; Kulin, 1988).

SOCIAL CONSEQUENCES OF TEENAGE PREGNANCY

The most salient social consequences of teenage pregnancy are: school drop-out or interrupted education; vulnerability to or participation in criminal activity; abortion; social ostracism; child neglect and abandonment; school adjustment difficulties for their children; rape, abuse, and incest; adoption; lack of social security; poverty; repeat pregnancies before age 20; and negative effects on "domestic life."

School drop-out or interrupted education. We found, in our 1991 study of 145 pregnant black teenagers under the age of 18, that in about 50% of cases the teenager is unlikely to return to school. This finding corroborates other research findings in Africa (Oppong, 1987) and the United States (Clarke, 1986; Height, 1986). There is lack of provision at schools to facilitate resumption of her education, and if she does so, she is forced to leave her baby at home and discontinue breast feeding which may affect mother-child bonding.