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Remember the Mob
Lesotho is facing an alarming child pregnancy crisis, especially in remote rural areas, with maternity wards at some health centres admitting more adolescents aged 13 to 19 than older women.
According to the Sexual Reproductive Health (SRH) tutor at Quthing Hospital, in the first quarter of 2024, they had 66 pregnant teenagers receiving antenatal care (ANC).
In addition, between April and July 2024, 37 adolescent births were delivered at the Bobete Health Center in Tabacheka, with mothers aged between 15 and 21 years old.
This is due to the reluctance of these young girls to access and use contraceptives as the practice is considered taboo in rural areas. This is despite the government’s stepped-up efforts over the past four years to improve sexual and reproductive health by providing family planning services.
Family planning empowers individuals to choose when and whether to have children using the resources, tools and technologies at their disposal. Family planning includes a wide range of contraceptive methods, including pills, implants, intrauterine devices, birth control surgeries and barrier technologies such as condoms.
A 2020 study by the United Nations Population Fund (UNFPA) showed that a key strategy to reduce maternal mortality in Lesotho is to ensure women have access to and use contraceptives.
Additionally, it supports government initiatives to reduce the unmet need for family planning.
UNFPA supports family planning by ensuring a continuous and reliable supply of high-quality contraceptives, strengthening national health systems, advocating for policies that support family planning, and collecting data to support the impact of programmes.
The issue came to the fore during a week-long workshop for journalists organized by UNFPA, where they gained a deeper understanding of family planning, early and unplanned pregnancies, menstrual health/poverty, child marriage, gender-based violence and maternal health. The event was held from July 15 to 20, 2024 in Quthing and Thaba Tseka.
According to a 2020 report by the United Nations Population Fund, access to and use of contraception remains an important strategy to reduce maternal mortality in the country and support the government’s plans to address the unmet need for family planning.
Despite some commendable progress since 2020, health workers and nurses in Guting say family planning education still needs to be strengthened to reach more people.
Ms Tinyane told the workshop that the lack of youth corners in the area has resulted in youths being reluctant to access and use contraceptives.
“In the first quarter (January to March), we had 66 pregnant teenage mothers aged between 15 and 19 years who attended the ANC clinic, including 10 in the first trimester, 37 in the second trimester and 19 in the third trimester,” Ms Thinyane said.
Ms Tinian explained that they are working with partners such as UNFPA, Lesotho Family Planning Association (LPPA), Protectors and Baylor University to serve young people through village outreach programmes.
She said they have trained peer educators to create awareness among young people and encourage them to access and use contraceptives.
“The aim is to make them aware of these services and their importance. We have peer educators who encourage young people to access and use contraceptives. Village health workers also play a key role in educating young people about contraceptive methods and providing these services.”
However, Ms Thinyane noted that areas such as Mpaki and Morosi Hills lack family planning services as church-run clinics such as St Matthews and Villa Maria do not provide these services. This is because the church prefers natural methods of contraception.
“In remote areas such as Sinksundo and Dili Dili, communication barriers pose a problem as people speak different languages such as Xhosa,” she added.
She also attributed some of the pregnancies to sexual assault, saying the hospital had handled 34 cases of sexual assault on girls aged between 2 and 22 in the past three months.
She said this was due to the high level of food insecurity in Guthin.
“Most of the children are left alone at home while their parents try to find means of survival in neighbouring countries. So, they have a lot of freedom while other children have to sleep with older men to get food due to hunger,” Ms Thinyane said.
Furthermore, Mookho Molete, a nursing assistant in Dili, said most pregnant teenagers come late for antenatal care services because they are afraid to come without consulting their parents, while some do not have transportation to get antenatal care and they do not want to let their peers know they are pregnant.
“Pregnant teenagers don’t want to go to antenatal care because they face stigma. Sometimes they don’t want to miss classes because they are still in school.”
“Because their bodies are not fully developed, pregnant adolescent girls are at greater risk of birth complications such as cephalopelvic disproportion (CPD), which can complicate the birth process,” she said. This often leads to a caesarean section.
“Pregnant teenagers often fail to follow childbirth instructions due to a lower level of understanding. For example, young mothers may start pushing the baby out before the cervix is fully dilated, resulting in cervical tearing,” she said.
A 16-year-old girl who was nine months pregnant expressed her disappointment after discovering she was pregnant earlier this year and decided to drop out of school out of fear of the challenges and stigma she would face.
She told the seminar that the shame and pain she had brought to her family was unbearable because she was afraid she would ruin her future.
She said she is now in eighth grade and wants to continue her education after having her baby. Her goal, she said, is to become a nurse one day.
She said the baby’s father is 17 years old but does not attend school.
UNFPA Communications Manager Violet Malesane said Lesotho is in the process of developing a policy on prevention and management of learner pregnancies which will focus on prevention and management of early and unintended pregnancies (EUP) among learners.
The process is led by the Ministry of Education and Training, with financial support from the United Nations Population Fund.
Ms. Malesane said the decision was based on Education Management Information System (EMIS) data and research findings which showed that early and unwanted pregnancies and child marriages were the main reasons why girls dropped out of school.
“For example, the Lesotho Demographic Health Survey shows that in Lesotho, 19% of women aged 15 to 19 have started childbearing, 15% of them have had a live birth and 4% were pregnant at the time of the interview.
“The study further shows that the proportion of adolescents who have started childbearing increases rapidly with age, from 3% at age 15 to 40% at age 19, and that rural adolescents and those in the poorest quintile tend to start childbearing earlier than other adolescents,” said Ms. Malesane.
She said as part of the mitigation measures, the Ministry of Education and Training, with support from UNFPA, had started work on the EUP policy.
She said UNFPA has supported life skills sex education in schools and comprehensive out-of-school sex education programmes, as well as access to modern contraceptives for adolescents, including comprehensive condom programmes.
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