Teenage pregnancy in the Seychelles |08 March 2023
One Thursday night a couple of years ago while I was on call, we had 6 patients on our Labour and Delivery unit. The mean maternal age was 17.
The following day, I was covering our ultrasound unit and three of the last patients I saw were aged 14 and 15 (2). I had seen a couple of 16-year-olds earlier in the day. None knew when they had gotten pregnant, how many weeks gestation they might be, or even what that meant. All were “late entries to prenatal care” or “late bookers” with estimates of gestational age between 22 and 34 weeks, thus missing any benefit of early counselling, screening, and medical care.
Within the past year, I saw a 13 and a half-year-old who also presented at 28 weeks gestation. Her mother was excited that her daughter was having a girl – all I could think about (while tactfully suppressing my blind rage!) was finding the criminal who had gotten her pregnant.
Not long ago, I saw a 16-year-old who presented for her initial visit and ultrasound at 33 weeks gestation. The baby had acranial defect called anencephaly in which the back part of the head of the foetus and the brain fail to develop. When I tried to explain what the condition was all about to the patient and her mother, she demanded to know what she could “do about it” (in the context of terminating the pregnancy) and then told me that she was going to go outside and have a smoke before she would discuss it further.
In almost every instance above, the father of the baby was significantly older than the mother.
While I was discussing these observations with one of our nurses, I was told that “six girls in her daughter’s high school are currently pregnant”.
The children are not to blame; we have failed them! We have all failed them – parents, social services, schools, counsellors, religious leaders, government leaders, the criminal justice system, and health care providers. The annual summary from the National Bureau of Statistics data 2021 (most recent data) supports my simple observations that began a few years back. Teenage pregnancy rose more than 8% in 2021, to 63 per 1000 females aged 15 to 19 years, not counting those that ended in abortions/miscarriages. And there were 5 pregnancies in children under 15! From what we have seen recently in our own practice, I anticipate now that the rates for 2022 and 2023 could be even higher!
We live in times when there is a great disparity between the age of puberty and the social and economic demands that allow us to survive productively in this world. That also means children are now reaching the age of ‘reproductive maturity’ when they are least likely to be in a position to control impulses, to understand the consequences of, and to make sensible decisions (or to resist sexual overtures of older and more experienced males) related to sexual activity. The consequences are not only pregnancies and sexually transmitted disease but, in most cases, as has been shown repeatedly in the past, a loss of a lifetime of opportunities for success, probably a life spent in poverty, poor health, a long history of dependency on social welfare, limited access to an adequate health care system, and the high likelihood that their inheritance to their children will be a life similar to theirs.
To state that “it is the parents’ responsibility” is much too simplistic. Parents have failed, but most ‘parents’ do not themselves have the necessary skill sets to deal with this problem. Two-wage earner households, high divorce rates, and times of a poor economy have left many parents struggling to cope themselves and too easily tempted to turn their children over to the internet as a poor substitute for distraction, nurturing, attention, and sustenance.
Abstinence-alone efforts have also failed as a widespread approach and are practically meaningless anyway to children at the age at which they are now reaching puberty. There is growing data to support that teaching about contraception is “not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education (Kohler, et al., J Adolesc Health 2008;42:344-51).”
But, all this needs to be presented in a program of ongoing education and practical incentivization. “The most expedient way to strengthen the impact of pregnancy prevention programs on adolescent childbearing, is to shift the focus of intervention …to helping young women develop goals that make adolescent childbearing a threat to what they want in life. This means intervening actively enough to ensure that goal setting translates into an internal desire to postpone childbearing beyond adolescence (Sheeder, et al., Maternal Child Health J 2008:epub May 16).”
Responsible living, grade-appropriate sex education, nutritional counselling, and physical education need to be a part of every school curriculum starting in early grades. These need to be integrated into programs that address responsibility by teaching not only the consequences of shirking responsibility but also the meaning of the word itself in terms of what is necessary to survive. Group support systems conducted by trained and objective educators may be the way of reducing first-time pregnancies as well as repetition among adolescents (Key, et al., J Adolesc Health 2008;42:394-400). Perhaps it may even be time to reconsider going to a system of separate education for girls and boys! These programs are going to require a mandate and funding from the government, but what could be more important than the legacy that could provide? It is a small investment to make… The future not only of our children, but the country, as a whole is at stake here!
Dr Zia Rizvi
