Why are repeat teenage births on the rise?

At 16, Sylvia Musoga gave birth to a bouncing baby boy. 

Since she was not ready take care of her child, Musoga left her village in Nsomba, Buyenda District and took on a job as a hairdresser in Mukono.

Unfortunately, she became pregnant again before she made 20. 

“Our father struggled to pay fees until I completed Primary Seven. My mother then connected me to a local saloon to learn hairdressing,” Musoga says.

After the second pregnancy in 2018, she lost her job and sought refuge back in Nsomba.

 Musoga is one of the 45 per cent adolescents who have experienced repeat births before 20 years. 

According to a study conducted by Dr Dinah Amongin, three in every 10 (31 per cent) adolescent girls aged 15-19 have begun child bearing in eastern Uganda and over half of these will go on to have second births before 20 years.

Dr Amongin is a Training of Health Researchers into Vocational Excellence (THRiVE) PhD scholar.

The study shows 55.6 per cent of the mothers that got their first baby at the age of between 15 and 19 years got a second baby before celebrating their 20th birthday, a figure that has only reduced slightly from 58.9 per cent 30 years ago. 

“Girls below 18 years are at the most vulnerable stage because they are not yet economically empowered, physiologically their bodies are not yet developed and their cognitive ability is still developing and must be protected so that we do not have children mothering children as well,” Dr Amongin pointed out at a press conference organised to disseminate results from her study.  

Following an analysis of retrospective data from the Uganda Demographic and Health Surveys (UDHS) of 1988, 1995, 2000, 2006, 2011 and 2016, Dr Amongin found that among women aged 20 -24 years for whom the first birth occurred before the age of 18 years, the percentage reporting a repeat birth before 20 years has remained almost stable for 28 years despite the fact that teenage pregnancy rates have fallen from 41.7 per cent in 1988 to 28.4 per cent in 2016. 

The statistics imply that teen mothers’ subsequent births account for one out of five teen births in Uganda.

“Consequently, girls who have a second birth before 20 years are at a greater risk of school discontinuation, greater likelihood of poverty, end up with spouses that are more than ten years older than them, are deprived of the right to choose partners of their choice, impaired health for the baby and end up with an average of seven children compared to those that gave birth to their second babies after 20years,” says Dr Amongin.

Many women of about 40 years that were in their 20s by the time UBOS was conducting their research before 2016 said they would have wished to delay that repeat birth but different circumstances robbed them of their reproductive autonomy, according to the research findings. 

Unlike Musoga’s case where the disappointed father did not chase her from home, many of the girls that were interviewed during the study said their parents asked them to leave home.

Other parents rushed to collect bride price and marry off the girls, and in some case other men took advantage of these girls sexually for exchange of the much needed financial help.

Dr Amongin recommends that government, healthcare providers and communities help mother’s gain information about the use of effective types of birth control, alleviate household poverty and domestic violence. 

“Some of the girls experienced violence from the men upon discovering that they are using contraceptives to try and prevent a pregnancy before they were ready and were forced to stop, ending up with another baby before 18years,” Dr Amongin says which calls for the involvement of the men in the planned interventions by all stake holders .

Dr Amongin also calls for implementation of a school continuation policy or providing alternative forms of education for adolescent mothers and strengthening legislation against early marriage.

Intervention 

According to the assistant commissioner, health service Ministry of Health, Dr Richard Mugahi, in 2018, the Ministry of Health assigned a separate independent division to Adolescent Health, with a mandate to unlock and dig deep into the issues of adolescents.

“There is regional variations in terms of adolescent pregnancies across the country the highest prevalence in Tooro sub region, Kalangala and Eastern Uganda with above 30 per cent. The Covid-19 situation has aggravated the already existing problem,” Dr Mugahi says. 

Way forward

The Ministry of Education is preparing a policy that enables teenagers to be easily incorporated back into school due to the high numbers of teenagers reported to have got pregnant during the lockdown. 

In the long run, the Ministry of Health has an ambitious target for a service delivery model for adolescent health to bring the numbers of pregnancies down from 25 per cent to 10 per cent by 2030.

“We have developed standard structures for all health facilities under the control of the ministry and want the entire country to adopt them,” Dr Mugahi says. 

According to Dr Mugahi, the ministry is paying closer attention to the content of the school sexuality education framework housed by the Ministry of Education to avail information about post abortion family planning, and postnatal family planning.

“We have a serious concern that the leading cause of death among teenage mothers is sepsis resulting from unsafe abortions, unsafe abortions coming from unwanted pregnancies, these coming from inadequate information and inadequate access to services. We can actually do something about this. 

Twenty seven per cent of deaths of mothers we receive are adolescent mothers and these are preventable deaths,” Dr Mugahi says, adding that Ministry of Health will use the data in making decisions of what programmes will best to solve this challenge.

Importance of research 

Practices and policies must be informed by real time evidence from research if the country must move forward and develop faster than it’s moving, according to Prof. Nelson Sewankambo, the director THRiVE.

Prof. Sewankambo argues that if the public and all the stakeholders get to know what exactly is happening and how it is affecting lives, everybody will take the initiative to do their part in this case all parents would know the negative impact on the pregnant adolescent and the generation to come if they do not support and help rehabilitate them back into the path for a brighter future after their first baby. 

“We cannot overestimate the importance of research and the utilisation of the finding to inform policy and practises,” says Dr Sewankambo.