Social Dynamics of Adolescent Fertility in Sub-Saharan Africa (1993) / Chapter Skim
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7 CONSEQUENCES OF ADOLESCENT SEXUALITY AND CHILDBEARING FOR MOTHERS...
7 CONSEQUENCES OF ADOLESCENT SEXUALITY AND CHILDBEARING FOR MOTHERS...
Pages 142-167
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From page 142... ...
. However, there is little direct evidence on the relationship between age at first marriage and completed family size in sub-Saharan Africa.
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From page 143... ...
However, because their risks extend through their education or training, women in this group are probably slightly older, on average, than their counterparts in the early-marriage group. Yet in the case of urban schoolgirls, social condemnation makes them reluctant to seek health services; hence, they suffer additional risks from lack of prenatal care and from
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From page 144... ...
That is, age itself may cause fewer health risks for either the mother or her offspring than the perceived legitimacy of the pregnancy, low socioeconomic status, poor nutrition, inadequate prenatal care, or primiparity. First births, for example, are typically more complicated than higher-order ones are.
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From page 145... ...
Many clinics stock only a few medicines; drugs are perpetually "on order." Equipment is minimal. A rural clinic may have an examining bed with a thin covering blanket, a table and chair, a scale, a few syringes, a large roll of cotton bandaging, and some suture material.
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From page 146... ...
Anyway I told her there was none and informed her by the way that if I knew her parents I'd close the pharmacy and follow her home." Not surprisingly, such social pressures make young women extremely reluctant to utilize medical facilities of which they may have considerable need. But although they are reluctant to come to public clinics to obtain contraceptives, it is clear from numerous surveys, including the Demographic and Health Survey (DHS)
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From page 147... ...
Despite the lack of precise data, there is little doubt that high birth rates in the absence of adequate health care produce high maternal mortality rates. In parts of Africa, difficult living conditions and inadequate nutrition
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From page 148... ...
The maternal mortality rate (the number of women who die during pregnancy or childbearing for each 100,000 live births) is estimated to be 655 in sub-Saharan Africa, one-and-a-half times greater than the rate in Asia and over thirty times greater than that in northern Europe.
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From page 149... ...
There is some evidence to suggest that women who suffer severe infections later face higher risks of pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain (Lettenmaier et al., 1988~. Women with uncomplicated vaginal deliveries usually do not become infected unless they have sexually transmitted diseases; but very young mothers, because they have more complicated deliveries, suffer greater risks of sepsis.
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From page 150... ...
It can be caused by prolonged labor, early separation of the placenta from the uterine wall, a rupture or tear in the cervix or the vagina, or a poorly performed abortion; many of these are conditions to which young mothers are most susceptible (Lettenmaier et al., 19881. In some African countries, patients fortunate enough to receive a blood transfusion face the added risk of contracting HIV (human immunodeficiency virus)
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From page 151... ...
A study at Lagos University Teaching Hospital in Nigeria found that 51 percent of maternal deaths were attributable to abortion complications (Akingba, 1971~. In studies conducted in Addis Ababa, Ethiopia, and Lusaka, Zambia, abortion was identified as the cause of a quarter of all maternal deaths (Lettenmaier et al., 1988~.
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From page 152... ...
152 car to Ct Cal ._ ¢ 50 Ct Ct V)
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From page 153... ...
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From page 154... ...
154 to Do Ct C)
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From page 155... ...
Adolescents may seek out trained health care workers who, fearing legal repercussions, may try to create dangerous medical emergencies that warrant a legal abortion. In Zambia, at least one-quarter of all the women with abortion complications in the University Teaching Hospital in Lusaka, Zambia, had tried to induce abortions by inserting objects in the cervix such as plants or twigs, drinking detergents or gasoline, or taking large overdoses of aspirin, chloroquine, and other toxic substances (Castle et al., 1990~.
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From page 156... ...
Using responses from 264 women requesting termination of pregnancy or treatment of abortion complications at the University Teaching Hospital in Zambia in 1985 and 1986, Likwa and Whittaker (no date) found that 60 percent were aged 15-19.
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From page 157... ...
A high incidence of STDs underlies the historically high levels of infertility in many parts of Central Africa (Frank, 1983~. If sexual contacts outside the marriage process are becoming more prevalent, then larger numbers of adolescents may be exposed to the risk of sexually transmitted diseases, including AIDS.
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From page 158... ...
Certainly adolescents who begin sexual relations at an early age and have multiple partners expose themselves to great risks. A recent survey reported that in a rural district in Uganda, 50 percent of women aged 13-19 living in main-road trading centers were seropositive for HIV (Wawer et al., 1991~.
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From page 159... ...
Although the DHS data indicate mortality differences for children of adolescent mothers, the age of the mother may be a smaller causal factor than are primiparity, inadequate prenatal care, low socioeconomic status, and the perceived legitimacy of the birth (Haaga, 1989; National Research Council, 1989; Zabin and Kiruga, 1992~. Multivariate techniques can provide some insight into the importance of maternal age.
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From page 160... ...
Botswana 1978-1988 <20 35 22 20-29 42 16 Burundi 1977- 1987 <20 138 129 20-29 87 108 Ghana 1978- 1988 <20 97 95 20-29 73 80 Kenya 1979- 1989 <20 68 44 20-29 55 36 Liberia 1976- 1986 <20 177 110 20-29 155 97 Mali 1977- 1986 <20 177 195 20-29 116 166 Nigeria 1981 - 1990 <20 121 123 20-29 79 107 Senegal 1976-1986 <20 119 134 20-29 83 130 Togo 1978- 1988 <20 90 93 20-29 79 85 Uganda 1978- 1988 <20 120 117 20-29 104 92 Zimbabwe 1978- 1988 <20 78 36 20-29 47 31 aExcept in the cases of Mali and Nigeria, the rates are based on the calender year of the survey up to the month preceding the date of the interview. SOURCE: Demographic and Health Surveys Standard Recode Files, weighted data.
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From page 161... ...
Using the Cole d'Ivoire Fertility Survey of 1980-1981, Meekers finds that children born before cohabitation have higher mortality levels than children born to women who are living with men, whether or not they are the fathers. SOCIOECONOMIC CONSEQUENCES OF ADOLESCENT FERTILITY In the tightly woven fabric of African societies, adolescent fertility has consequences beyond the repercussions for the young women and their families.
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From page 162... ...
Enrolling in schools with fewer qualified teachers and poorer teaching resources, they may perform poorly on national achievement tests, though we have no direct evidence for this comparison. It should not be surprising that such girls decide that ties
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From page 163... ...
The mothers were aged 15-19 at the time of the survey. SOURCE: Demographic Health Surveys Standard Recode Files, weighted data.
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From page 164... ...
On the other hand, in Ghana and Kenya, there are no appreciable differences in fostering by mother's marital status, while in Botswana and Uganda. married women aged 15-19 foster out children more than unmarried women do.
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From page 165... ...
suggest that urban fathers made clear distinctions between their children by legitimate versus nonlegitimate unions. In The Gambia, however, administrators of an adolescent fertility survey limited their study to Greater Banjul because they considered premarital pregnancies to adolescents a more significant problem in the major urban area than in rural areas (Gambia Family Planning Association, 1988~.
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From page 166... ...
For such women, the social and economic consequences of not bearing children are immense. But just as some urban schoolgirls may be better off becoming pregnant and dropping out of school, many young mothers at the other end of the spectrum-rural, uneducated, married ones may have problems that re
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From page 167... ...
In both the rural and the urban configurations we have examined, health outcomes are products of social forces: The problems associated with one model stem from pressures to begin marriage and childbearing early, whereas the deleterious outcomes of pregnancy to unmarried schoolgirls frequently stem from the risks they take to avoid detection and the sanctions that would follow. The unfortunate irony is that regardless of whether young mothers bear their children in rural areas or urban ones, they may receive inadequate health care: In rural areas few health care options exist; and in urban areas, though the availability of medical care is greater, the social condemnation they face often prevents them from seeking help.
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