Thursday 15 June 2017

Teenage pregnancy - a problem solved?




The highest teenage pregnancy rate in Europe was the shameful statistic that the Blair government  decided to address. Teenagers having babies leads to all sorts of bad outcomes, high rates of prematurity and hence damaged babies requiring very expensive medical care, and also long term underemployment of the mothers, who are almost bound to remain on welfare payments and to need housing subsidies for many years. It is a medical and social disaster.  A big effort was made in schools and in the health service to provide contraception, particularly using hormone implants which work for several years (and cannot be forgotten.)

10 years later the number of teenage births has approximately halved to around 20 per 1000 girls per year. So we can clap ourselves on the back for a policy which really has achieved a worthwhile result.

But, if that is true, how can it be that very similar sharp declines  starting around 2007 have happened in other countries, such as New Zealand and the US, which did not have any major policy change in this area.  And the decline in the UK started slightly before the change in health policy. It has been suggested that it has been the rise of facebook etc. that has led to a decline in sexual activity see Telegraph article , but survey data do not support this.

It is of course impossible to look back at history and be sure of the causes of such trends. It may simply be a case of pregnancy becoming less fashionable, as also seems to be true of heavy drinking among teenagers.

In Zambia, the situation is different. The nationally the rate is about 150 i.e. over 7 times the UK figure, and about 28% of girls will become pregnant before their 19th birthday. Pregnancy rate in Zambia

Near our clinic there is a secondary school.. Parents pay fees for their children to attend, and they need uniforms and books, and they cannot work, so we are talking about the upper socioeconomic levels of rural Zambian society.  And yet there have been a lot of pregnancies recently, and as a result the school decided that all 400 or so girls should have pregnancy tests! (Medical ethics are interpreted differently here).  7 of the girls tested positive, on top of those already found to be pregnant.

Just as in the UK, this will probably put an end to any prospect of further education for these girls. The girls will be out of school for a year or so with a huge effect on their eventual attainment.  


So why the difference?  The girls can attend the local health clinic for family planning. This is done at a specific clinic on a Monday.  At the clinic the staff say that there is free access to contraception with no questions asked: But that the pupils are put off coming by ‘stigma’.  Local charities would like to go into the schools and supply/push contraception, but this is strongly opposed by traditional Zambian society, which is dominated by Christianity.

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