The scourge of early pregnancies

MASERU – JERMINAH Khosi was just 19 years and in her first year at the National University of Lesotho (NUL) when she fell pregnant.
Young and unmarried, Khosi felt overwhelmed by fear.

“Even the idea of being sexually active was still very abstract to me at the time but I fell pregnant from my one time sexual encounter,” Khosi says.

“I was frustrated as I didn’t plan on having a baby at that age and had disappointed my parents.”

“That time I had intended to get my education and a job. A child was not in the script.”

Abortion was out of the question because it is illegal in Lesotho.

“It changed my script and I had to adjust.”

In second year, seven months after her first child, Khosi fell pregnant again.

“It got more frustrating than the first time because I was already carrying some baggage. Ho thoe ke senyehile (It was said I was spoiled).”

It was a struggle commuting to school, studying and raising two children. One of them was always sick, she says.
Khosi lost her second child to pneumonia.

She says she knew about contraceptives but because of her age she was too embarrassed to pick them at the local clinic. There was a stigma associated with young women who request contraceptives.

“The first question asked at the clinic is how old are you? I was just a 19-year-old and unmarried.”

Being in a relationship with an older man did not help matters.

“It was difficult to ask him if we could use contraceptives.”

Khosi said she was the talk of the village and parents would discipline their children using her as an example.

“They would say U tl’u sek’ab’a tšoana le Jerminah (Do not ever be like Jerminah).”

Her story, however, had a happy ending.
She finished her degree and is now employed.

She is now using her experience to teach young women about the importance of contraceptives and the dangers of early pregnancies.

She wants them to understand that it’s fine to ask for contraceptives and an early unplanned pregnancy should not kill their dream.

“However, I feel like the unintended pregnancies robbed me of something – an opportunity to transition properly from my teens to a mature woman – because I became a mother prematurely,” she says.

“I wasn’t prepared for that and it wasn’t anywhere near my plans. It changed a lot of things for me except my ultimate goal in life.”

“As a student, I had to stretch my M800 stipend to buy formula milk. It hits at both personal and societal level.”

Khosi’s experience is just one of many in a country, according to the United Nations Population Fund’s 2021 report, six out of 10 girls (60 percent) aged 15 to 19 are mothers or pregnant with their first child.

Only Namibia (seven out of ten girls) have worse figures than Lesotho among East and Southern African countries

During the launch of the World Population 2022 Report last week, HIV Activist Tšepang Maboee said the key factors contributing to early and unplanned pregnancies in adolescents include lack of friendly health facilities.

Maboee also blamed inaccessibility of health services, misinformation and misconceptions about contraceptives, lack of skills for teenagers to negotiate condom usage in relationships and Gender-Based Violence (GBV).

“Our country is not doing much to address these issues as they are always raised in adolescent forums and nothing has been done to date,” Maboee said.

“I wish conversations like this were not just heard for the sake of it but rather be coupled with action,” she said.

“It’s so discouraging to keep talking about the same thing without change.”

Maboee said it took her a long time before she could use contraceptives because of society’s attitude towards them.

Advocate Thakane Shale says apart from ignorance, early pregnancies can result from rape and early marriages.

She says early pregnancies condemn women to a life of poverty.

“When one is married early, the balance of power in that relationship is such that the man has the power to decide whether they can use condoms or contraceptives. Often, there is no negotiation,” Advocate Shale says.

“Women in Lesotho, as in many other developing countries, still do not have bodily autonomy, a right over their bodies, and they are not able to negotiate certain things.”

“There are cases of women hiding their contraceptives and they got beaten to a pulp when their partners found out about them.”

She says societal perception of young women on contraceptives is another barrier.
Most early or unplanned pregnancies lead to illegal abortions.

“Just because it is illegal in Lesotho, it doesn’t mean it’s not happening. The situation on the ground shows that it’s happening except it’s illegal and unsafe.”

“We lose lives due to unintended pregnancies. While other women do get hospitalised and survive, they can’t have children in future or face lifelong medical complications.”

The Lesotho Planned Parenthood Association (LPPA) spokesman, Tlali Matela, says unintended pregnancy affects men as well.

“Men don’t bear the unplanned pregnancy physically but they suffer the consequences too,” Matela says.

He says men must understand that women have a right to decide what to do with their bodies as much as they do with theirs.

“Men need to be taught to respect women’s reproductive rights and decisions.”
Seipati Motšei, the programme manager of the Ministry of Health’s Prevention of Mother-To-Child Transmission (PMTCT), says the challenge is to get the message about early pregnancies and contraceptives to young women.

“Although programmes are introduced, some adolescents still face the trap of early unintended pregnancies. Some community-based distributors are dysfunctional and need to be revived,” Motšei says.

She says teenagers are not actively involved in awareness campaigns but “we plan to extend the service to them if budget permits”.

“Adolescents are at risk of unintended pregnancies. If only we can put our hands together to find ways to avail family planning tools beyond facilities.”

“If we can strengthen distribution, I guess we will be able to overcome the problem,” she says.
The UNFPA Representative, Dr Marc Derveeuw, says unintended pregnancy is a crisis in Lesotho as one in three women start childbearing in adolescence.

Dr Derveeuw says nearly half of them are children and unintended pregnancies destroy their lives.
He says more than 60 percent of unintended pregnancies end in abortion.

Dr Derveeuw says unplanned pregnancies can lead to school dropouts, high risk of post-partum depression and unsafe abortion leading to maternal death and morbidity amongst others.
He says Lesotho has to prioritise prevention as unintended pregnancies are preventable.

“We need to empower women to make affirmative decisions about sexuality and motherhood,” he says.

For this to happen, he says, Lesotho needs to educate young people about sexuality and reproduction, not only about HIV.
He says access to contraceptives and gender inequality must be guaranteed.

He says the 2019-2021 statistics show that 35.7 percent of girls aged 10-14 were admitted to hospitals due to abortions and 8.17 percent were aged between 15 and 19 years.
He says Mohale’s Hoek is the highest district with backyard termination of pregnancies and it is also the highest in pills distribution through illegal providers.

The Development Planning Minister, Selibe Mochoboroane, says one of the noticeable effects of unintended pregnancy in Lesotho is abortion.
He says school dropout, destitution and orphanhood are critical effects due to maternal mortality brought by unintended pregnancy.

“Development becomes improbable due to the high number of orphans and deaths of women and girls. The national development agenda can’t be achieved until females are actively involved in economic activities,” he says.

The adolescent birth rate in Lesotho is reported to be high at 94 per 1 000 girls aged between 15 and 19 years, according to the 2003-2018 statistics.
The Lesotho Demographic Health Survey (LDHS) 2014, reports that teenage pregnancies were highest among girls from rural areas and families in the lowest wealth quintile.

Data from School Report Cards (SRc) collected from schools participating in the School Improvement Project (SIP) indicates that pregnancy and early marriage are the number one reason for girls dropping out of secondary school at 46.7 percent and 45.7 percent in 2018 and 2019.

Mapule Motsopa