Teenage Pregnancy
THREE WAYS TO REDUCE TEEN PREGNANCY IN SOUTH AFRICA
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
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