Baby steps in bringing down teen pregnancy

In the last two weeks, Kebogo Kesenye, a social worker at a community clinic in Bontleng, a poor township in Gaborone, Botswana's capital, has seen and counselled three pregnant teenagers. "All were pregnant by older men, all were deserted by the men, and one man is married," said Kesenye. "We have lots of such cases here." This is borne out in the findings of the Ministry of Health's Adolescent Sexual and Reproductive Health Implementation Strategy 2003, which commented: "A very small number (of teenage pregnancies) is [caused] by peers." The good news, however, is that teenage pregnancy rates are declining. In 1996, six out of 10 teenage girls had been pregnant at least once, but only two out of 10 in 2003, according to the UN Population Fund (UNFPA). Nevertheless, teenage pregnancy remains a leading cause of school dropouts and can result in HIV infection. The country's 2003 sentinel surveillance study reported that 18 percent of pregnant women surveyed at antenatal clinics were younger than 20 years. Among them, HIV prevalence was nearly 23 percent, while the national rate was 37.4 percent. FATHERS NOT IDENTIFIED Until recently, pregnant students were expelled from school but they are now allowed to return after six months. If a male student is identified as the father, he is also suspended for six months. Although Botswana has strict child support laws and maintenance payments are deducted from the father's wages, Kesenye said most girls refuse to identify the father. Similar reactions are reported by the Young Christian Women's Association, which helps teenage mothers return to school by providing transport and day care. "Very rarely do young women tell us who is the father," said Loatile Seboni, YWCA national executive director. Poor girls and their parents don't dare challenge older, wealthier men. Some are unfamiliar with the law and the legal system; some fear an adultery law that allows a spouse to sue the lover of his or her unfaithful spouse. One recent case of adultery by a member Botswana's rich and famous involved a fine of 10 cattle, and another Pula 33,000 (US $5,800). Virginia Moribi fell pregnant the first time she had sex at 19 and quit high school, as was then the rule. She did not take the father of her child to court, as she feared he would use muti (witchcraft) to harm the baby. This reticence to name the father has allowed men to avoid responsibility. "Patterns of braggadocio, denial and abandonment emerge as typical male responses to unintended pregnancy and childbearing," noted the Ministry of Health's Adolescent Sexual and Reproductive Health Implementation Strategy 2003. Parental reactions have varied from blaming the school system for introducing life skills in the curriculum to refusing to talk about the problem. It is taboo for parents to talk about sex to their children, and aunts and uncles have traditionally assumed the responsibility, but urbanisation and migration have fragmented the extended family. "Research shows that both groups - parents and children - want to communicate but don't know how," said Ludo Letebele, of Population Services International. Meeting the demands of both a modern and a traditional lifestyle can be onerous: besides working in formal or informal jobs, adults often travel between rural and urban homes to attend funerals, weddings and rituals, and respond to the needs of the extended family, which have been multiplied by the AIDS epidemic. "Children are left to their own devices," said Waheeda Lottering, adolescent sexual and reproductive health officer with UN Children's Fund (UNICEF). The disintegration of the nuclear family and the emergence of single-parent families overburdens parents, in a context where one-third of families live in poverty and almost four out of ten adults are HIV positive. "Our parents are too busy with their jobs for mothering us. If I had talked with my mother, it would have made a difference," Moribi, who is HIV positive, told PlusNews. In a study of teenage pregnancy in the town of Maun, teachers linked it to adolescent insecurity, peer pressure to have sex, lack of parental guidance, poverty, unemployment, low levels of education, alcohol and marijuana abuse, ignorance of contraception and safer sex, and disempowerment in relation to older men. The average age at first sex is 17 years. But three out of 10 girls aged 10-14, and one out of 10 boys aged 10-14 has had sex, said a 2001 study on knowledge, attitudes, behaviour and practices. By age 19, half the boys and girls are sexually active. Among girls between the ages of 15 and 19 who have had sex, four out of 10 have been pregnant. Contraception is free without parental authorisation, yet is not often used. Young people perceive clinics as unfriendly and lacking privacy, their hours inconvenient, and the nurses judgmental. According to government figures, two out of 10 teenagers have had a sexually transmitted infection (STI). Unhappy with clinics, many turn to self-medication or traditional healers. Themba Armish Dubane, 27, soft-spoken and street-smart, his hair in fashionable dreadlocks, is an unemployed musician and a peer educator with the Urban Youth Project of the United Nations Fund. He is excited that a youth-friendly clinic is opening soon in Bontleng. "Young people can't come to the clinic and be seen by their auntie," he told PlusNews. "To have our own space will be cool." Botswana TV, radio and print media promote abstinence, faithfulness and condoms. Yet on satellite TV the music videos are all about sex, with scantily dressed young women vying for the rich male singer's attention. "Youth get conflicting messages at school and at home," said UNICEF's Lottering. "We are losing the traditional stuff and picking up negative western values." The National Youth Policy reports high rates of alcohol and drug abuse among youth. A 2003 study links teenage pregnancy "to excessive drinking, leading to unprotected sex." In turn, alcohol abuse is caused by poverty, unemployment and lack of recreational facilities, the study observed. Dubane agreed: "There is little to do in the townships except drink, smoke, play cards and have sex."