Adolescent pregnancy, gender-based violence and HIV World AIDS Day Networking Learning Discussion #WAD #ExpectRespect

Introduction 1. Unplanned adolescent pregnancy is a worldwide phenomenon. It has detrimental effects for the health and wellbeing of mother and child. 2. It is one of the key SRHR issues concerning adolescents today. 3. Pregnant teenagers are more likely to be infected with HIV prior, during, and after pregnancy due to high rates of risky sexual behaviour and existing STIs.

Definitions Adolescence: World Health Organization - adolescents are individuals between 10 years and 19 years of age. It is a period of transition, growth, exploration and opportunities for teens. It is also a period of certain risks such as unplanned pregnancy, and health risks associated with early childbearing and HIV.

Definitions Gender Based Violence: GBV describes violence that occurs as a result of the normative role expectations associated with each gender, along with the unequal power relationships between the two genders, within the context of a specific society. (Bloom, 2008)

Definitions The human immunodeficiency virus: World Health Organization defines HIV as a virus that infects cells of the immune system, destroying or impairing their function. Infection with the virus results in progressive deterioration of the immune system, leading to "immune deficiency”. The immune system is considered deficient when it can no longer fulfil its role of fighting infection and disease.

Photo by UNFPA / Public domain A global view About 16 million girls aged 15 to 19 and some 1 million girls under 15 give birth every year— most in low- and middle-income countries. Complications during pregnancy and childbirth are the second cause of death for 15-19 year- old girls globally. Every year, some 3 million girls aged 15 to 19 undergo unsafe abortions. Babies born to adolescent mothers face a substantially higher risk of dying than those born to women aged 20 to 24. (WHO, 2014) Photo by UNFPA / Public domain

What about South Africa? In South Africa, incidences of HIV and pregnancy among adolescents are high. 01 HIV prevalence among young women aged 15–19 is around 7% and about 1 in 5 for the age range between 20–24 (Christofides et al, 2014; Shisana et al 2009). 02 In 2003, the Demographic Health Survey reported that 27.3% of women had a pregnancy while they were teenagers (Department of Health, 2008). 03 What about South Africa?

Link to Gender Based Violence Pregnant adolescents with a history of interpersonal violence may be at even higher risk for HIV (Kuo et al, 2014). Limited studies have been done on this linkage but there is a clear link between interpersonal violence and contracting HIV due to biological factors (e.g., comprised immune system) and behavioral factors such as substance abuse and not being able to negotiate safe sex Photo: Girls Not Brides

Drivers of adolescent pregnancy Drivers of teen pregnancy Gender inequality and harmful attitudes Poverty Sexual violence and coercion Child marriage Social pressures (eg to have sex at an early age) Exclusion from education and job opportunities Drivers of adolescent pregnancy

Risk factors Girls pressured to leave school Girls denied access to contraceptives or RH health information Girls who are vulnerable or grow up poor, poorly educated, live in rural areas Girls who lack choices and opportunities Girls forced into child marriage Gender-based violence Risk factors

Girls may be forced to marry Adolescents from poor background may be malnourished, causing health complications during pregnancy and birth (and develop fistula) Unsafe abortion Babies are at risk of being stillborn or dying in the first few weeks of life, have low birth weight and experience other long term effects Girls may have to drop out of school and become vulnerable to falling pregnant again Pregnant adolescents are excluded from other opportunities in life such Girls may be forced to marry Consider talking about: Education Abstinence only education Public policy Other Consequences

“Education raises a girls’ status in their households and communities, and gives them more say in decisions that affect their lives. An educated girl is less likely to enter into a child marriage. She is also better able to delay childbearing, and is more likely to have a healthy pregnancy, with better outcomes for her future children” ~ UNFPA, 2017

How can we end unplanned adolescent pregnancy? Efforts should be holistic to: empower young women and girls, address harmful attitudes and take into account the role of men and boys. How can we end unplanned adolescent pregnancy?

Disempowerment and entering into child marriage

Approaches to end unplanned adolescent pregnancy 1 Age-appropriate comprehensive sexuality education for all young people 2 Investment in girls’ education 3 Prevention of child, early and forced marriage, sexual violence, and coercion 4 Building of gender-equitable societies by empowering girls and engaging men and boys 5 Measures to ensure adolescents’ access to sexual and reproductive health information as well as services that welcome them and facilitate their choices; 6 Improved quality research on adolescent girls to inform future interventions. Approaches to end unplanned adolescent pregnancy

Thank you!