Stand up for adolescent reproductive health

The youth day that was commemorated under the theme, “unity and innovation for a smart Zambia,” drew young people from all walks of life to share experiences, ideas, innovations, and future aspirations.

Various pronouncements were made by a number of stakeholders regarding the well-being of youths in the run up to this day, but it’s a call to approach the reproductive health challenges for young people with renewed vigor that caught my attention.

Zambia’s population is predominantly young with half of the 13 million people under the age of 14 years. Yet, the young people face significant challenges that include HIV and Sexually Transmitted Infections (STIs), unwanted pregnancy, unsafe abortion, and Gender-Based Violence (GBV).

The national HIV prevalence as at the last Demographic and Health Survey (DHS) of 2013/2014 stands at 13 per cent with 1.2 million people living with HIV. A total of 720, 000 people are eligible for Antiretroviral Therapy (ART) and out of this number, 46, 000 are children.

About 12 per cent of young women and 16 per cent of their male counterparts between 15 and 24 years old have had sexual intercourse before the age of 15 while the HIV prevalence in adolescents, currently stands at 4.8 per cent.

Furthermore, 29 per cent of adolescent girls aged 15-19 years have already had a birth or are pregnant with their first child and the percentage of women who have started childbearing increases rapidly with age, from five per cent among women aged 15 years to 59 per cent among the 19 year-olds.

Teenage Pregnancy is higher in rural areas at 36 per cent than 19 per cent in urban areas.

Southern Province accounts for 36 per cent of young women aged 15-19 years that have started giving birth while the national proportion of teenage pregnancy has hardly changed in the past few years.

The statistics outlined above clearly show that adolescents signify a very important age group in the provision of contraceptives owing to a disproportionate share of Zambia’s health burden of STIs, HIV, and unplanned pregnancies.

Therefore, there is need for serious introspection into the sexual and reproductive health rights of Adolescents.

Some of the potential threats that derail the provision of reproductive health services to adolescents include:

Age of consent

The age of consent in Zambia is not harmonised in different policies and guidelines, thus posing a serious challenge in dispensing reproductive health services, especially contraceptives to adolescents.

Decisions on whether a young person has adequate capacity to access reproductive health services is determined by age, rather than the capacity to assess understanding.

Article 50 of the penal code provides for teenagers who are 16 years and above to have adult rights of medical consent while those below 16 are considered as minors with limited legal capacity and require a legally authorised decision maker such as parent or guardian to make health choices for them.

Service providers are usually in a tight spot when dealing with young people below the age of 16 who frequent health facilities to access contraceptives.

Elizabeth Ng’ambi is a senior nursing officer in charge of adolescents and reproductive health in Ndola District in the Copperbelt.

She explains that, “we have situations where young girls, who are below 16 years old come to seek contraceptives. These girls are sexually active and they want protect from STIs and early pregnancy because they have boyfriends.”

“At the same time, service providers know that if this service is not offered, the girls would succumb to teenage pregnancy but again they need the parents’ consent as required by law. In the end, we just counsel and let them go without providing the service they desperately need for fear of legal implications.”

Low contraceptive use

The DHS shows that only 40 per cent of girls and 49 per cent of boys aged 15-24 years used a condom at last high risk sex.

Young people engage in unprotected sex for various reasons such as pressure to prove their fertility, misinformation on side effects of certain methods of contraception, and limited access to contraceptives especially in rural areas.

In addition to that, some religious and cultural beliefs forbid the use of contraceptives, further exposing teenage girls to the risks of unintended pregnancy, and abortion.

Weak parent-child bond

The relationship between parents and children is one of the most important avenues for improving sexual and reproductive health outcomes for young people.

Nonetheless, it is considered a taboo in the Zambian setup for parents to discuss issues of sexuality with their children and many parents feel uncomfortable to do so, which leaves young people vulnerable to misinformation.

The discomfort many parents feel in talking to their children about sexuality further impedes their ability to provide guidance on the best practices.

Early marriages and sexual activity

The thorny issue of early marriage is one of the reproductive health risks for young women as it leads to early pregnancies that put young expectant mothers at risk for obstetric fistulae, as well as HIV infection.

In Zambia, early marriages are fueled by inconsistencies in the legal system that has seen the statutory law legalising marriage at the age of 21 for both boys and girls, but on the contrary, the customary law allows girls to get married once they reach puberty.

Sexual activity by adolescents, within or outside of marriage leads to negative reproductive health outcomes, hence there is need to address the gaps in the provision contraceptives.

Adolescents have the right to lead healthy lives, and once provided with necessary requisites such as information, favourable legal environment, and quality health care services, they have the potential to protect themselves from negative sexual health outcomes.

We need concrete action plans that translate into improved reproductive health lives of young people.

#familyplanning