David Harrison 1. NAILING MY COLOURS TO THE MAST
I believe that we need to substantially reduce the rate of pregnancy among 16-19 year olds and that there are ways to achieve this goal within five to ten years. For some, this assertion should go without saying. But it could be argued that - like total fertility rates - the incidence of teen pregnancy is inversely linked to socio-economic development and not amenable to behavioral intervention. Although this relationship generally holds true, there is still significant variability across countries of similar economic standing, suggesting that public policy is able to influence rates of teen pregnancy.1 Others argue that ‘teenage-hood’ is a social construct, not recognized by cultures like the amaXhosa, for example.2 Certainly it is true that social mores swarm like angry bees around adolescence, because it is an intense period of sexual change. In dealing with issues of fertility, moral positioning often trumps demographic logic. That said, pregnancy rates among 15-19 years olds must be reduced significantly, for two reasons: First, teen pregnancy increases the risk of HIV infection. Biological factors seem to lead to higher rates of HIV transmission among younger girls, but there is also evidence that the physiological condition of pregnancy and lactation may predispose to HIV transmission. A prospective randomized control study conducted in Rakai, Uganda found an increased risk of incident HIV during pregnancy. Adjusted odds ratios of HIV transmission – relative to nonpregnancy – were 2.16 [95% CI 1.39 – 3.37] for pregnancy and 1.16 [95% CI 0.82 – 1.63] for lactation. These findings could not be explained away by changes in sexual behaviour during pregnancy.3 In South Africa, pregnancy is a far stronger predictor of HIV infection among 15-24 year olds than sexual activity per sé [Figure 1]. Figure 1 Ratios of sexual activity and pregnancy to HIV prevalence, by age
Pregnancy is a stronger predictor of HIV infection than sexual activity 10 8 Ratio 6 4 2 0 15 16 17 18 19 20 21 22 23 24 Age
Source: Reproductive Health Research Unit (2004) National HIV and Sexual Behavior Survey of 15-24 year olds, 2003
Ever had sex: HIV prevalence Ever pregnant/HIV prevalence
Singh S & Darroch J (1999). Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries. Family Planning Perspectives. Volume 32, Number 1, January/February 1999 2 Mkhwanazi N (2006). Teenage pregnancy and gender identities in the making in a post-apartheid South African township. PhD dissertation, Department of Anthropology, University of Cambridge (unpublished) 3 Gray RH et al (2005). Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study. The Lancet 2005; 366:1182-1188. DOI:10.1016/S0140-6736(05)67481-8
The second reason why teen pregnancy should be reduced is that we need to keep young people in school until Grade 12. Again, probably the most compelling reason is to avoid HIV infection, as higher levels of education protect against HIV.4 In the context of high unemployment, it is difficult to make the case that school completion confers economic advantage for the individual. At the same time, economic growth and redistribution both depend on a more educated population. There may be other reasons for public policy intervention to reduce teen pregnancy. The two above are good enough for me.
DEFINING THE PROBLEM
Every year, following parliamentary questions from the opposition, there is a flurry of media reports about teen pregnancy in schools. In this way, we ignore the bigger problem. In fact, the main problem is not being at school, not being at school. Figure 2 shows that pregnancy among 15-16 year olds account for 7% of all teen pregnancy, while 17- 19 yr olds account for 93% of teen pregnancies. Clearly then, strategies aimed at achieving greater abstinence among 15-16 year...