SAfAIDS Figure 1: Young people aged 15-24 newly infected with HIV: estimated by region (UNICEF, UNAIDS, 2010)

Causes of adolescent pregnancies

1200 000 90% The rate of increase in adolescent pregnancies is a growing concern in
79%
80% southern Africa and hence it has become imperative to examine the
1000 000 Estimated Number of
new HIV Infections
various causes of teenage pregnancy in order to comprehensively address
70%
800 000 52%
Regional estimates as %
of the global total 60% this issue. Lack of sex education and awareness of pregnancy prevention
50% measures are the most important but not the only contributory factors
600 000 40% of adolescent pregnancy. The following are some factors that lead to
24%
400 000 30% adolescent pregnancy.
20%
200 000 3% 6% 4% 5% 2% 10%
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Adolescence marks the onset of sexual
0 Sub- Eastern West Middle South East Asia Latin CEE/CIS Global
0% maturity, and most young people start exploring their sexuality at this
Saharan and and Central and Asia and the America
Africa Southern Africa East  and the stage. In most southern African countries, most young women often
Africa Africa Caribbean
experience sexual intercourse for the first time between 15-19 years
Source: UNAIDS unpublished estimates, 2010 which is earlier than their male counterparts who often experience
it at age 20. This makes the girls vulnerable to pregnancy if they do
Adolescent pregnancies are associated with many factors, some of which not have enough sex education and are not aware of the pregnancy
include lower educational levels, higher rates of poverty, use of drugs and prevention measures.
alcohol, lack of education and availability of contraceptive measures, sexual
abuse, inter-generational relationships and peer pressure to have sexual t
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Use of drugs and alcohol may possibly
intercourse. In other countries and cultures, particularly in the developing encourage unintended sexual activity. Often when adolescents are
world, teenage pregnancy is usually within marriage and does not invite intoxicated, they forget to use protection. Young people are twice as
social stigma. likely to have unprotected sex whilst under the influence of alcohol
or drugs compared to when they are sober. This often results in the
Figure 2: Births by 15-19 year olds by region, 2005 – 2010 period (WHO, 2010) girls becoming pregnant and also exposing them to the risks of HIV
20%
infection.

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16%
Adolescent girls often face peer pressure from their boyfriends and
social networks to engage in sexual intercourse. Early sexual debut

Position Paper
14% has become a trend in most societies and this often pressurises
12%
adolescent girls to indulge in sexual intercourse because of fear of
Births to adolescents as % of all births

being stigmatised by their peers. Most of the girls become pregnant

10% as they are not fully aware of the consequences of sexual intercourse
Addressing adolescent 8% and use of contraception.

pregnancy challenges in 6%

4%
SAfAIDS conducted a web-based poll in June 2011 on “Factors
causing the increase in number of teenage pregnancies”. The results
southern Africa in the era 2%
indicated that most of the participants felt that peer pressure to have
sexual intercourse at a young age was a major cause of adolescent
of HIV 0% Latin America
and the
Sub- Saharan
Africa
South-Central
Asia
West Asia South-Eastern
Asia
Europe Eastern Asia
pregnancies. The table below shows the results from the poll.
Caribbean
Figure 3: Results from the SAfAIDS Poll: Factors contributing to the increase in the number of
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secritariat, 2009 adolescent pregnancies in southern Africa. (SAfAIDS, 2011)
Evidence supporting issues
Approximately 16 million women aged between 15–19 years give birth SAfAIDS recognises adolescent pregnancies as a challenge especially in Factors contributing to adolescent pregnancies Percentage
each year, which accounts for 11% of all births worldwide. In low and middle- southern Africa. Countries with high HIV prevalence among young women indication by
income countries, almost 10% of girls become mothers by age 16, with are equally challenged by high adolescent pregnancy rates. Addressing the participants
the vast majority being in sub-Saharan Africa (WHO, 2011). The proportion issue of adolescent pregnancies will not only help reduce HIV infection but
of women who become pregnant before age 15 varies enormously even also the rate of maternal and child mortality in Africa. It is therefore important Peer pressure to have sexual intercourse at an early age 23.13%
within regions and countries. For example, the rate in Rwanda is 0.3% to advocate for ways to address teenage pregnancy whilst understanding Insufficient sex education and knowledge about pregnancy 19.40%
compared to 12.2% in Mozambique. Globally it was estimated in 2010 that its inter-linkage with HIV. To achieve better results it is crucial to understand prevention options
young people between the ages of 15-24 years accounted for 41% of the the different cultural norms and societal beliefs that often influence the Lack of access to condoms and other birth control methods 12.69%
new HIV infections with most infections occurring in sub-Sahara Africa. behaviour of young women and girls. In some societies, early marriage
Young women aged 15-24 years are at least eight times more likely to be Inter-generational relationships (where young girls are in 17.91%
and traditional gender roles are important factors in the rate of teenage relationships with older men)
HIV positive than men their age. Protecting women and girls from HIV pregnancy. For example, in some sub-Saharan African countries and Indian
means protecting them from adolescent pregnancies and other factors Use of alcohol and other inhibition-reducing drugs 14.18%
sub-continent, early pregnancy is often seen as a blessing because it is
such as gender- based violence (UNAIDS, 2010).
proof of the young woman’s fertility (UNAIDS, 2010).

1 2 3
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Adolescents may lack
knowledge of, or access to, conventional methods of preventing
pregnancy, as they may be too embarrassed or frightened to seek such
information. Adequate knowledge of contraception is often lacking
among young women in Africa, due to negative attitudes regarding
sexual activity before marriage. Young girls are not educated about
contraceptive use because most African cultures believe there is no
need to educate them; they must wait until they are married to have
sexual intercourse.
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Adolescent girls in relationships
with older boys, and in particular with adult men, are more likely to
become pregnant than teenage girls in relationships with boys their
own age. With age discrepancy, there is also a high chance of an
adolescent female being molested and raped by men far older
than them.

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sexual abuse of teenage girls perpetrated by their male partners,
family members and criminals. The rate of physical and sexual

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abuse is high all over the world. A study conducted by WHO in 2010
revealed that between 3.6 and 50.0% of young women aged 15-19
reported being subjected to an act of physical or sexual violence by
their male partners. Studies have indicated a strong link between
early childhood sexual abuse and subsequent teenage pregnancy,
especially in developing countries.
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Pregnancies among adolescents is often


related to social problems and this is predominant within developing
countries, especially in poverty stricken communities. Risky sexual
behaviours among teenagers are more likely to occur in poor families
and those with single parents. The lack of resources, might force girls
to become involved in sexual activities in an effort to get materials
and food.
A qualitative study was conducted by the University of Stellenbosch in Taung,
South Africa in 2009 involving interviews with pregnant teenagers and three
focus groups with 10 women aged 19-25 who had babies as teenagers, 14
teenage girls aged 16-19 who had never been pregnant and 11 males aged 18-
23 years. The study was aimed at understanding the attitudes and perceptions
of teenagers regarding teenage pregnancy and to explore their understanding
of sexuality and contraception. The study revealed that socio-economic factors
are a major contributor to adolescent pregnancies. Poverty, the controversial
influence of the child support grant, and financial support from older partners
to secure income for the teenage girl or her family, can influence adolescent girls
to become pregnant. (Joseph Kanku, Department of Family Medicine,
Stellenbosch University December, 2009)
Behaviour Change Communication (BCC) approaches as a strategy to
reduce adolescent pregnancies and HIV infections
A better understanding of culture and behaviour is essential in
promoting positive change among adolescents. The BCC approaches
adopted should recognise that presenting facts alone does not ensure
behaviour change. Information and education promoting behaviour
change is essential to reducing adolescent pregnancies and stemming
the HIV pandemic. At the International Conference on Population and
Development (ICPD) in 1994 it was agreed by the countries that:
“Information and services should be made available to adolescents to
help them understand their sexuality and protect them from unwanted
pregnancies, sexually-transmitted diseases and subsequent risk of infertility.
This should be combined with the education of young men to respect
women’s self-determination and to share responsibility with women in
matters of sexuality and reproduction” (ICPD, 1994 paragraph 7.41).
4 5
The increase in the number of adolescent pregnancies in southern Africa has
a huge impact on the rate of HIV infections in the region. BCC approaches
focusing on promoting adolescent behaviours to reduce pregnancies are
also essential in reducing HIV infection rates in southern Africa especially
among young women. In addressing the issue of adolescent pregnancies
while using BCC approaches it is important to note that adolescents are
often affected by social pressures exerted on them not only by their peers
but also their communities.
Therefore the BCC approaches adopted should address the larger
context that affects individual behaviour including the impact of culture,
societal norms, laws and policies. The approaches used should empower
adolescents with skills to voluntarily adopt positive practices and change
their behaviours for their future benefit. To effectively address adolescent
pregnancy, it is important to use approaches that:
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counselling and testing services.
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knowledge and attitudes.
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communities to influence the social norms and policy environment
within which adolescents function.
Applying the BCC approaches in southern Africa will result in the decline in
adolescent pregnancies and reduction in HIV infection rates. This is achieved
through abstinence and increased contraceptive use, especially condom
use, among adolescents. Fear of being infected with HIV also changes
attitudes of young people about sexuality and engaging in unprotected
sexual intercourse.
BCC intervention to address adolescent pregnancy and HIV infections
SAfAIDS views the BBC approaches as appropriate interventions that will
help reduce adolescent pregnancies and reduce HIV infections in southern
Africa. Interventions that have proven to be more effective in this regard
include:
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be effective in encouraging abstinence and preventing transmission
of HIV.
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use for safe sex among young people.
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in persuading both female and male adolescents to change risky
behaviours that may lead to pregnancy and HIV infection. An example
of effective social and media campaign is the Love Life campaign which
was launched in South Africa in 1999. The campaign has reached youth
in South Africa and enabled them to openly discuss sex, sexuality and
the link to HIV.
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health information can increase protective behaviours.
recommendations
In order to reduce adolescent pregnancies in southern Africa whilst at the
same time reducing the rate of HIV infections, SAfAIDS recommends that
special attention be given to the following issues:
Policy makers and governments :
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local context. This should be done by supporting adolescents in building
up their social and economic resources so that they have the power to
make their own choices about sex and reproduction.
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other issues such as alcohol and drug abuse because of the inter-
linkage that exists with adolescent pregnancies. It should be routine
for professionals to address sexual health and substance abuse issues
Address Details: SAfAIDS Regional Office: 479 Sappers Contour, Lynnwood, Pretoria 0081, South Africa. Tel: +27-12-361-0889, Fax: +27-12-361-0899, E-mail: reg@safaids.net, I Country Office: Zimbabwe (PVO 14/96): 17 Beveridge Road, Avondale, Harare, Zimbabwe. Tel: +263-4-336193/4 Fax: +263-4-336195, E-mail: info@safaids.net
simultaneously.
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adolescents between the ages of 10-14 so that young girls are
informed at a young age.
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Country Offie Mozambique: Av. Paulo Samuel Kankombe N.2051 R/C, Maputo, Mozambique, Tel/Fax +025-921302623 I Country Office: Zambia (Reg. No. ORS/102/35/3338) : Plot No. 4, Rhodes Park, Lusaka, Zambia, Tel: +260-125-7609 Fax: +260-125-7652, E-mail: safaids@safaids.co.zm,
priority in their countries. Limited education is usually associated with
adolescent pregnancies and sexually-transmitted infections which
often results in HIV infection.
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programming decisions. This can help them understand the risks and
prevention strategies.
and employment skills.
Civil society
environment that promotes healthy behaviours and safer attitudes
among young adults.
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which reduces the risk of early pregnancies and HIV infection.
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vulnerable to pregnancy and HIV infection because they cannot
negotiate safe sex in relationships.
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especially the most vulnerable including, street children, migrants
and victims of violence.
Country Office Swaziland: Office No.2 Ellacourt Building, Esser Street, Manzini, Tel:+268 -7670-9662: Website: www.safaids.net
Conclusion
If the rates of adolescent pregnancies continue to rise every year, it
will continue to impact on the HIV infection rates in southern Africa
in a major way. This paper examines the different contributory factors
of adolescent pregnancy and provides recommendations that can be
adopted by governments and civil society to address the issue. It is
therefore imperative to examine the situation in southern Africa and
align with the different strategies that can be adopted to ensure the
reduction in adolescent pregnancies and HIV infections.
References
1. UNAIDS (2010), Report on the Global AIDS Epidemic
2. UNICEF, UNAIDS (2011), Opportunity in Crisis : Preventing HIV from early adolescence
to young adulthood
3. WHO (2010), Position paper on mainstreaming adolescent pregnancy in efforts to
make pregnancy safer
4. UN Women (2011), Latest Data and Statistics : Gender Equality, Women and HIV
5. UNFPA (2009), Factsheet : Young People and Times of Change
6. African Youth Alliance (2007), Behaviour Change Communication
7. Love Life (2011), www.lovelife.org.za