II. Teenage pregnancy, Womens Health problems and Status, Ethiopian culture, customs and practices related to RH 2.

1 Teenage pregnancy Teenage pregnancy is formally defined as a pregnancy in a young woman who has not reached her 20th birthday when the pregnancy ends, regardless of whether the woman is married or is legally an adult (age 14 to 21, depending on the country). Is teenage pregnancy a health problem? Teenage pregnancy is associated with a number of adverse medical and psychosocial outcomes for mother and child, including maternal depression, preterm delivery, perinatal/infant mortality and, in the long-term, adverse general and mental health and offspring neurocognitive development. However, association between teenage pregnancy and adverse outcomes does not equal causation (i.e. adverse outcomes caused by young age). Indeed, the body of evidence suggests that having a baby or becoming pregnant below the age of 20 years per se is unlikely to be causal in these associations. Currently, most activity focuses on reducing teenage pregnancy rates rather than reducing the risk to teenage parents of social exclusion. However, the fact that maternal age is unlikely to be causally related to many of the adverse health outcomes with which it has been associated should not be used to remove interventions that have been developed in many obstetric units and strategic health authorities to improve outcomes for pregnant teenagers. Interventions aimed at reducing social exclusion need to be formally evaluated and those shown to be effective implemented across the country. Causes and consequences of teenage pregnancy Long term relationships lead to pregnancy. Precautions may not be taken in such a situation. Carefree sex or rather casual sex without thinking too much about it. Lack of sufficient knowledge of the preventive measures. Immaturity, Lack of guidance from elders, Hushed up affairs, Rape, Lack of self control, Experimenting, Not using birth control devices or they failing at times, Passion There is unequivocal evidence that young women from disadvantaged backgrounds are more likely to be mothers early in life, and that women who become mothers early in life are more likely to be disadvantaged in adult life than those who do not. Interventions that are effective in preventing early motherhood and in mitigating the psychosocial consequences of having a child early in life have the potential to break the cycle of deprivation. However, a more thorough knowledge is required of the factors that can alleviate the effects of socioeconomic adversity, social isolation and lack of support, and the processes and pathways in the transfer of disadvantages from one generation to the next.

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Teenage Pregnancy is to be avoided as it is not conducive to health. Young people cannot take on the responsibility of having a child, and from the health point of view it is also not advisable. Enjoy sex, but take precautions as well. Preventing teenage pregnancy: Early childhood interventions for pre- and primary school children and their parents, and youth development programmes promoting social and academic skills Personal and academic support, parental involvement and conflict resolution skills Education and career development programmes providing tailored support for childcare and bonuses to encourage young parents back into education, training and employment Implementation of wider measures to tackle social disadvantage and poverty among young people to lower teenage pregnancy rates and promote long-term social inclusion Services to ensure that young people are well informed about sexual matters, including contraceptive availability. Many interventions have been evaluated and evidence-based strategies implemented but gaps in the evidence base remain. 2.2 Womens health problems and status Women have the right to the enjoyment of the highest attainable standard of physical and mental health. The enjoyment of this right is vital to their life and well-being in their ability to participate in all areas of public and private life. Womens health problems Womens health problems, which were formerly conceived as bio logical and reproductive issues, are nowadays re-conceptualized to encompass gender issues. This is because reproductive health issues do not give the full picture of the problem as womens health is also embedded in the social and cultural settings. Accordingly, the womens health problems can be classified into two: The first is maternal health problems which are directly related to child bearing complications of pregnancy. In this regard, Ethiopia is one of the developing countries with high maternal mortality ratio (871 deaths per 100,000 live births in 2000) Although the MMR has reportedly decreased since then to 673 deaths per 100,000 live births for the period 2000 to 2005, according to the recent DHS 2005 result, it is still on the higher side. Similarly, among women aged 15 49 and with children under three years, 25% have Body Mass Index of below 18.5, a cut-off point used to identify chronic energy deficiency. This percentage shows a serious nutritional situation in the country. The other health problem related to the low socio-economic and cultural status of women, are among others, Female Genital Mutilation (FGM), rape, abduction, etc. In Ethiopia, 80% of women (and in some parts of the country up to 100%) are mutilated, as a means of womens loyalty to culture and faith. It is also estimated that, in each

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of the 28 woredas in Addis Ababa, three women are raped each day making it a total of 30,660 rape cases every year. Women Status in Ethiopia Womens status, including family and community roles, profoundly influences their ability to make decisions about their own health care and childbearing, which, in turn, affects their vulnerability to illness and HIV/AIDS. In developing countries, the other health problems of women the higher maternal and infant mortality, maternal morbidity, lower expectation of life at birth, Mal-nutrition, mental disorders, suicide rate and certain sex selective diseases are linked to their status and role in the society. Child bearing and rearing is still the dominant role assigned to most women in developing nations. Like many African countries, the majority of women in Ethiopia hold low status in the society. They have been denied equal access to education, training and gainful employment opportunities and their involvement in policy formulation and a decision making process has been minimal. Women play a vital role in the community by taking care of all social activities. However, they do not enjoy the fruits of their labor and suffer from political, economical, social and cultural marginalization. Although women constitute 49.8% of the population and contribute their share in agricultural production and other household activities, they have not benefited from their labor equally with their male counterparts. Different studies indicated the low status of women in developing countries in general and in Ethiopia in particular. Lack of access to productive resources such as land; lack of access to education, employment opportunities, basic health services, and protection of basic human rights; low decision making; violence and harmful traditional practices are some of the indicators of the socioeconomic marginalization of women in the country. From her birth, an Ethiopian female in most families is of lower status and commands little respect relative to her brothers and male counterparts. As soon as she is able, she starts caring for younger siblings, helps in food preparation, and spends long hours hauling water and fetching firewood. As she grows older, she is valued for the role she will play in establishing kinship bonds through marriage to another family, thereby strengthening the community status of her family. She is taught to be subservient, as a disobedient daughter is an embarrassment to her family. Low status characterizes virtually every aspect of girls and womens lives. Given the heavy workload imposed on girls at an early age, early marriage without choice, and a subservient role to both husband and mother-in-law, girls and women are left with few opportunities to make and act on their own decisions. In Ethiopia, women traditionally enjoy little independent decision making on most individual and family issues, including the option to choose whether to give birth in a health facility or seek the assistance of a trained provider. Harmful traditional practices, including female genital cutting, early
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marriage and childbearing, gender-based violence, forced marriage, wife inheritance, and a high value for large families, all impose huge negative impacts on womens Reproductive Health (RH). Today, Ethiopia has the second largest population in sub-Sahara Africa, and the average woman bears 4.8 children, placing an insupportable burden on families, communities, and a country facing chronic food shortages and environmental degradation. High maternal and infant mortality rates are inevitable results.

2.3 Ethiopian culture, customs and practices related to RH

The majority of Ethiopian people remain with their traditional health attitudes, values and practices due to the limited access to essential health and other relevant messages. Women and girl-child are more vulnerable due to their biological reproductive role, strong cultural influence and the low socioeconomic status. Traditional practices and widely accepted norms of early marriage, expectations of bearing limitless number of children, subordination to the husband and others highly influence reproductive health behaviors of women in Ethiopia. The cultural diversity in Ethiopia shows the existence of different influences on the reproductive health behavior. In Ethiopia, FP and RH services are limited in scope and geographic coverage. Most of the already available services are concentrated in the major towns. Many ordinary residents in Ethiopia do not know the concept of RH, although the components were well known. The majority of the people had positive attitudes towards the provision of RH services; although, the services were perceived as inadequate, inappropriate, inaccessible, and not widely available (esp. to the rural population). According to a study done, the major RH problems identified in all the regions in Ethiopia were HIV/AIDS/STIs, teenage pregnancy, abortion, large family size and complicated delivery. Barriers to using available RH services included lack of accessibility, awareness or acceptability, negative attitude, poor quality of services, and poor health seeking behavior due to the influence of culture and religious practices. Low motivation and negative attitude towards RH services among the service providers were also the barriers.

Physical well being Safe pregnancy and delivery , Safe and effective contraception, Safe sexual life, Preventing complication leading to; Maternal morbidity and mortality, Addressing problems of infertility, Menopausal problems , Other gynecological and obstetric problems Mental well being:

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 depressions and mood swings, related to pregnancy, post delivery, Postpartum depression, Pre-menopause mood disorders and depressions are parts to be considered as RH issues Etc. Social well being includes: social pressures/ stigma/ alienation in connection to say infertility, HIV/AIDS, fistula, female genital cutting, early marriage, attitudes and expectations harming the reproductive health of women and men, gender roles, decision making power to get medical help.

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