Teenage Pregnancy in SA

1. Teenage Pregnancy in SA Saadhna Panday and Hleki Mabunda Department of Basic Education for the Portfolio Committee on Basic Education 1 September 2009

2. Outline of presentation • Background • Methods • Trends in Fertility • EMIS Data • Conceptual Framework • Determinants • Interventions • Recommendations • Conclusions • Response of the Department

3. Background • High teen fertility subject of concern in research & policy circles • Available data suggests progress has been made since democracy • Longer period spent in education coincides with sexual development • DOE adopted a rights-based approach • Introduced guidelines to prevent & manage teen fertility • Policy & practice must be informed by the context of teenage pregnancy

4. Methods • Purpose: critical analysis & review of data - focus on learner pregnancy • Desktop review of literature • 2003 RHRU Survey, 2006 Kaiser/SABC Survey, 2002, 2005 SABSMM Surveys • Trends in fertility • 1996, 2001 Census data, 1998 SADHS, 2007 Community Survey, DSS • Secondary analysis • EMIS data 2004-2008 • HSRC 2003 Status of Youth Survey

5. Fertility • Definition: fertility vs. pregnancy • Lack of vital statistics in SA • Overall fertility declining for 50 years • SA lowest fertility rate in mainland SSA • Teenage fertility has declined in SA • But at a slower pace, due to spikes in fertility related to national epochs • Fertility declined by 10% between 1996 (78/1000) and 2001 (65/1000) & by further 10% by 2007 (54/1000)

6. Declining teen fertility Source: Moultrie & Timaeus, 2003; Statistics South Africa, 2008; Udjo, 2003

7. Why perception of an upsurge? • Increased visibility of teenage pregnancy - seen at schools, in communities, collecting CSG • Proportionally, teen contribution to overall fertility has increased • Confluence between issues of: • morality • strategies to reduce teenage pregnancy, • enforcement of responsibilities of young mothers • assistance given by society to children of teen mothers

8. Rates higher in some groups Source: Harrison, 2008b

9. Rates higher in some groups continued Source: Moultrie & McGrath, 2007

10. Rates higher in some groups continued Source: Pettifor et al., 2004

11. EMIS Data • Caution – missing data in some provinces • Rise in learner pregnancy – most likely result of improved reporting rather than a real increase • Rates higher in schools: • Located in poor neighbourhoods (no fee schools, farm schools) • Involving age mixing (combined schools) • Poorly resourced (lower in specialised schools)

12. The CSG Myth • No empirical evidence of link between teen fertility & CSG • Teenage fertility has been declining through out the period that CSG has been available • Termination of pregnancy by teens has been increasing throughout the period • Low uptake of CSG among teenagers • Evidence of higher school enrollment and better nutrition to children who receive CSG

13. Rates higher in some groups continued • Increase in education → decrease in fertility • Pregnancy results from rather than causes dropout • Dropout & pregnancy share common causes: • poor school performance • poverty • Dropout is a significant risk factor for early pregnancy & HIV • Despite SA’s liberal policy, only about 1/3 of teen mothers return to school • For every year that teen mothers are out of school, their chances of returning decreases

14. Termination of pregnancy • Legalised since 1996 • Conflicting data • Survey data – low levels of use (3%) • DOH data – suggests ↑ use (30%) • Girls apply ‘relative morality’ to protect education & avoid social & financial hardships • High use of illegal services • Barriers to using legal services • Poor knowledge about legality, costs & period for safe termination • Stigma from community & health care setting • Families & partners often decision-makers

15. Reasons for decline in fertility • Decline in fertility related to: • ↑ in access to family planning services (dramatic ↑ in contraceptive use) • ↑ in access to education • Shift in attitudes to pregnancy in late 1990s • ⅔ of pregnancy unwanted because of educational aspirations • But rates remain unacceptably high • High levels of knowledge of contraception • But incorrect & inconsistent use persists

16. Increase in condom use Source: SABSMM Survey, 2008

17. Main reason for pregnancy Source: Kaiser/SABC Survey, 2006

18. Individual Sexual behaviour Age mixing Contraceptive use Knowledge, beliefs, attitudes Risk perception Substance use Childhood abuse Interpersonal Family (structure, monitoring, communication, bonding) Partners (gender relations) Peers, Communities Institutional Schools Health care services Structural Cultural context SES & poverty Residential area Education (drop out) Public policy Family planning services Sex education Access to education Social grants An ecological approach

19. Determinants continued • Teen fertility results from complex set of factors related to the social conditions under which teens grow up. These include: • School dropout • Growing up in poor areas (informal & rural) • Absence of parents in the home • Stigma limits: • open communication with parents & partners • access to health services • results in gaps in knowledge & poor access to contraception

20. Determinants continued • Imbalanced gender relations that often involves coerced or forced sex • Poverty that results in trade-offs between health & economic security e.g., • reciprocity of sex in exchange for material goods, • remaining in dysfunctional relationships • involvement with multiple partners & with older men • Poverty stacks risk factors among some youth limiting access to information & incentives to protect against pregnancy

21. Young Fathers • Paucity of research on young fathers • But same profile as young mothers • Strong emotional response to fatherhood • Express deep sense of responsibility • Motivated by absence of own fathers • Identify caring & financial roles • But providing overtakes caring • Barriers to fatherhood • Unemployment • Negotiation of paternity • Breakdown of relationship

22. Interventions • Limits of empirical evidence • Comprehensive & integrated approaches • SA mainly focused on sexual risk factors • Yet relational & structural factors are key determinants • A strong focus on young men is required • Primary focus must be on prevention • But second chances needed to prevent the loss of human potential

23. Recommendations Prevention • Universal implementation of sex education • Distinct focus on pregnancy • Focuses on both abstinence & safe sex • Address biological and social risk factors • Address barriers to implementation • Involve peer educators & NGOs as a support • Evaluate programmes

24. Recommendations continued • Targeted interventions for high risk groups • e.g., those repeating grades, abused, substance use, living in poverty • schools in poor areas & involving age mixing • Interventions to retain learners in school • e.g. conditional cash transfers • Re-enrolment in alternative education system • Service learning: involvement in community work

25. Recommendations continued Second chances • Flexible school policies must be consistently implemented • Address barriers to learning • advocacy & rights vs. demand • ensure prompt return post-pregnancy • catch-up academic programmes • Strong referral systems to social services • child care support • access to social grants • health services

26. Recommendations continued Communities: Community-based interventions focusing on reproductive health, gender relations, & livelihood strategies Health: Roll out of adolescent friendly services & access to contraception including emergency contraception Parents: Promoting open communication, parent-child bonds & setting & enforcing rules Mass media: Increase the intensity & coverage with distinct focus on pregnancy

27. Conclusions • Teen fertility has been declining in SA • Largely due to legislative & biomedical interventions • But rates remain unacceptably high • Focus required on relational & structural risk factors • Drop out is a key risk factor • Best social protection that the education system can offer is to retain learners in school

28. Way Forward for the DoBE • Drawing on recommendations, must address holistically, using gender-sensitive and rights-based approaches • Taking into account social context within which girls fall pregnant, recognising determinants of poverty and social relationships • Developing strategies that are responsive, and avoid individual blame and one size fits all approaches

29. Way Forward • Reduction and prevention strategies must involve other role players and stakeholders • Sector-wide partnership approach essential • Intra-governmental work, working with community based and non-governmental organisations and crucially parents. • Constructive partnerships with parents and school communities will ensure realisation of vision where all learners can reach their full potential

30. Seminar • Seminar held on 28 August 2009 at Constitution Hill. Attended by representatives from government departments, NGOs working in the area of adolescent sexuality and health, teacher unions, school governing body associations, provincial education departments, amongst others. • Report was presented and responses from learners (G/BEM members), DSD, DOH, and the Department of Basic Education.

31. Seminar • Discussions at the seminar focused on key findings of the report, and included: • Poverty and social relationships • Peer pressure and lack of information • Parenting skills and importance of parents in prevention programmes • Influence of mass media on young people’s behaviour • Importance of peer education and other intervention programmes • Self-esteem and self-respect of young people

32. Seminar • Opportunities for young people and extra-curricular activities • Second chances for teenage mothers • Empowering educators in sexuality education • Managing prejudice in clinics towards young people • Importance of inter-sectoral management of challenges • A robust monitoring and evaluation strategy needed.

33. What Happens Next • Study presented to the Cluster and to Cabinet • A Series of provincial discussions on the research report, bringing together key education and social stakeholders, in partnership with provincial education departments • These will include particular groups with interest in adolescent health and sexuality issues, including religious leaders, traditional leadership groups, teacher unions, amongst others

34. What Happens Next • Development of a comprehensive strategy for the management and prevention of schoolgirl pregnancy, focusing on communication and prevention programmes, policy, inter-sectoral collaboration and support for management of pregnancy in the education system • This will include exploration of policy options relating to teenage pregnancy in education.

35. What Happens Next • Strategy will include number of interventions: • Developing tools to identify high risk schools for targeted support • Developing early warning systems for schools to identify those who are vulnerable or likely to drop out • Developing monitoring and evaluation tools to track effectiveness of policy in addressing learner pregnancy

36. What Happens Next • Improving lifeskills programmes and formal sexuality education in schools • Strengthening and supporting existing peer education and school-based programmes, including GEM/BEM • Continuing and improving focus on advocacy and communication

37. What Happens Next • Intra-governmental task team on adolescent health and sexuality to focus on partnerships for the reduction of teenage pregnancy, further research necessary, key areas for collaboration, improved referral and support systems, and necessary data collection • Will draw on support from key non-governmental partners