For a region experiencing one of the highest population growth rates in the world, East Africa is also teetering on the brink of a crisis of underage pregnancies.
East Africa has been rated second globally after West Africa as the region with the highest number of women reporting a birth before the age of 18.
At least five per cent of young women below the age of 18 in the region are already mothers while four per cent of girls below the age of 15 have children, shows a new report by the United Nations Population Fund.
The UNFPA report, titled “Motherhood in Childhood: Facing the challenge of adolescent pregnancy,” said Uganda leads the region in the number of teenage pregnancies at 33 per cent, followed by Tanzania (28 per cent) and Kenya (26 per cent).
This is becoming a big concern for policymakers given that the five East African Community countries are grappling with fast rising populations, that threaten to strain their limited economic resources. The high population growth rates have been blamed on low usage of contraceptives and rising cases of teenage pregnancies.
According to the Human Development Report 2013 and based on projections from earlier censuses in the region, East Africa’s population in mid-2012 was estimated at 144 million people, representing an increase of five million people from 139 million two years earlier.
The population is projected to hit 237 million by 2030. Currently, Kenya’s population growth rate is at 2.9 per cent per year. Burundi’s average annual rate of population growth is estimated at 3.2 per cent, Uganda’s at 3.3 per cent, Tanzania 3 per cent while Rwanda’s population is growing by 2.7 per cent.
Population and medical experts say that although the East African region has made progress over the past five years in the use of contraceptives compared with other African countries, a greater push is needed in increasing family planning and promoting reproductive healthcare among adolescents.
At the 2013 International Conference on Family Planning (ICFP 2013) in Addis Ababa, experts highlighted the challenges of reaching young people with contraceptive information and services.
“When adults try to engage with young people, the message often falls flat due to generational differences. ‘Peer-to-peer’ programmes that enlist youth to be leaders are essential,” said Theo Sowa, the chief executive of the African Women’s Development Fund.
Worldwide, more than 220 million women want to plan their families but do not have access to modern contraceptive methods. Addressing these needs for contraception would result in fewer women and girls dying in pregnancy and childbirth, fewer unintended pregnancies and fewer infant deaths.
“Young pregnant women are more likely to seek unsafe abortion later in their pregnancies, thus increasing their risk of death and disability,” said Jonathan Monda, a doctor at Kenyatta National Hospital.
He said that although other factors like culture and religion are a contributing factor to low contraceptive use, most people are not aware of the different family planning methods and their importance.
“Girls who are 15 or younger are at markedly higher odds for conditions such as eclampsia, anaemia, postpartum haemorrhage and puerperal endometritis than older adolescents,” said Dr Monda.
Evidence also suggests that the adverse neonatal outcomes associated with adolescent pregnancies are greater for younger adolescents. Many countries with high levels of early adolescent motherhood are also those with very high maternal mortality ratios.
According to the UNFPA report, adolescent birth rates often vary within a country, depending on factors such as poverty and prevalence of child marriage.
“When policy failures or other pressures on adolescent girls result in large numbers of pregnancies, the economic costs may extend beyond the individual to the community and the nation,” says the report.
The costs may arise through increased demand on already overstretched health care systems for the management of complications from unsafe abortions.
The report shows that the lifetime cost of adolescent pregnancy in Uganda stands at 33 per cent of the annual GDP, followed by Tanzania at 18 per cent and Kenya at 17 per cent.
According to the UN, every day 20,000 girls younger than 18 give birth in developing countries, representing 95 per cent of births to adolescent girls worldwide. Nearly 300 of the 1,000 births reported among the young people are in the age bracket of 20-24 years.
Various efforts are under way in East Africa to curb the increasing number of teenage pregnancies. But will they work? Mid last year, Kenya joined a list of countries that have signed up to a new $4.2 billion drive to promote family planning services.
Kenya has recently launched a new programme to educate the youth on contraceptive use and family planning. The programme run by Jpiego, a Kenya urban reproductive health initiative, is funded by the Bill & Melinda Gates Foundation. Isaac Ochieng, a youth from Nairobi is one of the programme’s ambassadors in Kenya.
The 21-year old said he got interested while in high school after he saw many young girls drop out of school due to teenage pregnancies.
Ochieng and hundreds of other youth are being used to sensitise their peers on the use of contraceptives, especially through demystifying the belief that contraceptives can lead to infertility and cancer.
“We offer the youth short-term contraceptives like condoms but for those in need of long-term methods like Depo-Provera, intrauterine devices and contraceptive implants, we refer them to health facilities,” he said in an interview.
So far, he said, they have been able to reach over 200 young people, some as young as 13 years old.
In Rwanda, the Family Planning Project, an interactive training programme targeting 10 to 14-year-olds deals with issues such as puberty, fertility, gender norms, communications and relationships.
Developed by the Institute for Reproductive Health and implemented in conjunction with Catholic Relief Services, the project improved child-parent communications about sexuality and gender roles.
In Uganda, the government has raised the annual budgetary allocation for family planning supplies from $3.3 million to $5 million for the next five years and improved accountability in procurement and distribution.
Uganda has also developed and implemented a campaign for integration of family planning into other health services. This includes partnerships with the private sector and scaling up of innovative approaches, such as community-based distribution, social marketing, social franchising, and youth-friendly service provision.
A recent report titled “Forced out” by the Centre for Reproductive Rights indicated that over 55,000 female students in Tanzania have had to leave schools in the past decade because of pregnancy.
The report revealed that contraceptive use among adolescent girls remains minimal. Only 10.7 per cent of sexually active women aged 15-19 report using any family planning method.
At the 2012 London Summit on Family Planning, where funds were pledged to ensure 120 million women and girls in poor countries access contraceptives by 2020, President Jakaya Kikwete highlighted Tanzania’s continued efforts to improve family planning.
Tanzania’s budgetary allocations and actual spending for contraceptives remain weak, though modest government funds for family planning increased threefold from 2010 to 2011. Modern contraceptive use in the country has increased in the past two decades but is still low at 27 per cent.
According to the FP2020 progress report launched in Addis Ababa in November, in the past one year, one-quarter of the commitment-making countries — which include Burkina Faso, Kenya, Niger, Senegal, and Zambia — have launched detailed national family planning plans.
Kenya, Tanzania, Uganda, Nigeria, Sierra Leone, Ethiopia and Indonesia are among countries that have increased their national budget allocations for family planning services or supplies.
According to Kigen Bartilol, Kenya programme manager at the Division of Reproductive Health, family planning, while politically and socially controversial, offer proven low cost interventions to addressing all the eight Millennium Development Goals.
“Proper family planning methods can prevent 99 per cent of all maternal mortality and offers delayed child bearing in the youth, prolonged birth intervals that contribute to increased child survival as well as increased participation in the labour market that comes with families having fewer young dependants, a major contribution to an improved quality of life for the families and by extension the national economy,” said Dr Bartilol.
However, he said that 90 per cent of teenage pregnancies are a result of inconsistent or incorrect use of contraceptives.
According to UNFPA, while teens have steadily increased their use of condoms and contraception over the past 20 years, a significant number still do not use contraceptive methods effectively or consistently.