“IF only I had easy access to modern contraceptives, I wasn’t going to become pregnant at a tender age. Being a mother and raising a child is not something I expected to happen so soon.”
These were the sentiments of a teenage mother after undergoing a Cesarean delivery procedure at Ndola Central Hospital in the Copperbelt recently.
Just like many other girls, Jane (not real name) of Kamilili settlement in the rural part of Ndola became sexually active as early as 13 years old and at 15, she was already expecting her first child.
She recalls that it was an all consuming little experience of ‘love in the air’ that forced her into a sexual encounter with her 20 year-old boyfriend early this year and she fell pregnant.
Jane subsequently dropped out of school in the fifth grade.
“My dream has always been to complete school and become a nurse so that I can contribute to the well-being of my community. I didn’t want to be pregnant and I know about condoms but such are not common for girls of my age in our community,” she said.
At the time of this interview, the visibly tense young girl had not yet come to terms with the reality of motherhood.
Geographically, Kamilili is a mountainous settlement approximately 30 kilometres away from Ndola town and lies on Sakania border with neighbouring Democratic Republic of Congo (DRC).
Public Service Vehicles (PSVs) shun transporting passengers to the area because the road is impassable, leaving bicycles as the only mode of transport for some, but for those without bicycles, the only option is a three to four hours trek to the nearest clinic in Kaniki farm bloc to access medical services.
With the onset of the rains, the Kamilili greenery becomes extremely dense, thereby unsafe for sexually active girls like Jane to cover the 8 km journey to Kaniki Clinic to access reproductive health services.
This transport challenge has also resulted in a little avenue for adolescents to access the necessary sexual and reproductive health information because even Kaniki clinic is fully equipped to provide this service; they can only hold sensitisation sessions once in weeks.
Besides the logistical challenge to Kamilili, a silent disapproval for contraceptive use amongst adolescents further complicates the young people’s decision making in as far as access to reproductive health services is concerned.
Informed discussions on issues of sexuality between parents and children are often seen as a taboo.
Parents feel preaching sex education and the use of contraceptives to their teenage children could be misconstrued as permission to engage in sexual activities.
Jane’s mother admits that parents are doing very little in discussing issues of with her daughters because she holds the view that doing so is against the norms of society. She said learning about her daughter’s pregnancy was a shocking experience.
“It is always difficult to talk about issues of sex with children especially the young ones because of our culture. I was very surprised and shaken to discover that my daughter was four months pregnant. It was not easy for me to believe because she was still too young to know anything about sex.”
“Now that the worst has happened, I will take it upon myself to ensure that she gets a long-term contraceptive so that she doesn’t fall pregnant again in order to go back to school,” she says.
These are some of the views that are hampering access to sexual and reproductive health information by adolescents in Kamilili and further escalating early, unplanned and unwanted pregnancies.
This year alone, Kaniki clinic handled 43 cases of deliveries involving adolescents with some of them referred to NCH.
The clinic has enough contraceptives in stock and qualified personnel to provide family planning services, but midwife in-charge Bernadette Mwamba says demand for the commodity is enormously low.
About 12 settlements on Sakania border with a population of nearly 11, 000 residents depend on Kaniki clinic for their health care needs.
Ms Mwamba says outreach programmes to provide information on sexual and reproductive health and contraceptives are conducted in all the 12 settlements that are within the clinic’s coverage, but is quick to add that the exercise is challenging.
“This place is vast and the biggest challenge here is that areas where young people are found are far apart and we have to cover extensively long distances to access the areas during our outreach sessions which we conduct every weekend.”
“Because of the distance problem, we end up reaching out to only one settlement per week and this has made it difficult for them to consistently access the services,” Ms Mwamba said.
What this implies is that once sensitisation is carried out in a particular settlement, it takes 12 weeks for service providers to return to that area because they have to cover other areas too.
Zambia is a signatory to international instruments such as the United Nations Covenant on the Rights of the Child (UNCRC), which was developed for children, including adolescents, mandates states to guarantee their right to the highest attainable standard of health and provide access to family planning and education services.
The UNCRC whose ideals are further emphasised in the African Charter on the Rights of the Child, also calls on countries to ensure Children’s survival and development, and undertake appropriate measures, including legislative and administrative, to ensure they (children) have the protection and care that is required for their well-being.
The Kamilili case is a clear testimony that despite the extensive attention given to adolescent sexuality and teenage pregnancy in the country, there are still gaps that need to be addressed promptly as many young people are still susceptible to pregnancies.
Government has shown political will in promoting adolescent sexual reproductive health in the country by formulating various policies such as the national strategy on ending child marriage, adolescent health communication strategy, and the youth policy.
However, some legislative, economic, and socio-cultural factors are inhibiting tremendous progress in that regard.
This indeed demands affirmative action from all stakeholders to face obstacles head on, and come up with workable interventions in supplying adequate information about sexual behaviours and contraceptives to teenagers.
For parents, it is time to break the silence on discussing issues of sexuality with the children. Adolescence is a very tricky stage in life and whether we like it or not, thousands of teenagers are engaging in sex at a tender age regardless of the strict rules that we put in place to deter them.
The initiative of Community Based Distributors (CBDs) providing Depo-Provera method of contraception in hard-to-reach areas like Kamilili is a very progressive one, and could be the answer to some of the challenges being faced by young people.
Studies have shown that the long acting Depo-Provera is feasible, safe, and effective in preventing unwanted pregnancy as it also offers some privacy for the user.
In as much as the CBD provision of Depo-Provera and other methods of contraceptives are ideal for the Kamilili community, the lack of clarity in the law on age of consent is a huge setback.
Article 50 of the penal code provides that only adolescents aged 16 years and above can enjoy adult rights of medical consent. This means that even if contraceptives were easily accessible in Kamilili, Jane wouldn’t have been eligible as she was below the legal age despite being sexually active.
Limiting adolescents’ access to contraceptive services under this law does not in any way reduce sexual activity amongst them, but it increases the risk of unintended pregnancy and sexually transmitted infections (STIs).
It is important to bear in mind that the lack of access to contraceptives does not stop adolescents from indulging in sex, just as the ability to obtain contraception does not mean that they will start engaging sex.
A coalition of parliamentarians recently made serious commitments towards the promotion of adolescent sexual and reproductive health and family planning during a forum organised by Marie Stopes Zambia in Chisamba recently.
Some of the critical issues which lawmakers pledged to pursue include support for an increased budgetary allocation towards sexual and reproductive health, reviewing the age of consent law, and carrying out sensitisation programmes in their respective constituencies.
Centre for Reproductive Health and Education (CREHE) executive director Amos Mwale says these commitments, once fulfilled, would greatly contribute to the reduction of teenage pregnancies and HIV infection in the country.
Mr Mwale, however, placed emphasis on Comprehensive Sexuality Education (CSE) as critical tool in achieving a society that is knowledgeable about sexual reproductive health and the importance of contraceptives.
He has since called on parliamentarians to use their influence and work in collaboration with Non Governmental Organisations (NGOs) providing CSE to break the myths and misconceptions surrounding family planning.
“MPs should work towards urging parents to start discussing issues of sexuality because parents don’t want to talk about things to do with sex with their children and this has been one of the major setbacks in the fight to reduce teenage pregnancy.”
“The other challenge is that people are trying to use religious backgrounds to prevent adolescents from accessing family planning services, we need to work on that as well,” he says.
The plight of adolescents in Kamilili settlement needs serious introspection from all stakeholders. The level of teenage pregnancy in the area may be catastrophic if left unchecked.
Jane’s narrative is just one of the many stories that teenage girls in this area can articulate, but the bottom-line is that they need help.
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