KAMPALA – The wellbeing of thousands of girls in Uganda, particularly Eastern Uganda, is at risk with reports of high repeat adolescent births in nearly three decades. A repeat adolescent birth is a second or more live birth before age 20 following a first birth before age 18 years!
According to a study conducted by Dr. Dinah Amongin, a THRiVE Ph.D. scholar, over 1 in two girls who have had first birth below the age of consent (18 years), proceed to have another live birth before they make 20 years of age.
Speaking to the press on Thursday at Mulago, Dr. Amongin said, “We found out that over the 30 years, more than 50% of those girls had another baby before they could turn 20 years and this had remained high. So, repeat adolescent birth remained unacceptably high over the 30 years.”
The study, ‘Understanding trends and trajectories of repeat adolescent birth in Uganda’ sought to quantify the challenge, explore factors associated with repeat adolescent births; socio-economic and reproductive outcomes among women in Uganda toward the end of their reproductive life-course (40-49 years) and the motivators and circumstances for repeat adolescent birth in Soroti and Katakwi districts of Uganda.
However, the researcher says that following an analysis of the Uganda Demographic and Health Surveys (UDHS) of 1988/89, 1995, 2000/01, 2006, 2011 and 2016, women aged 20–24 years for whom the first birth occurred before age 18 years, the percentage reporting a repeat birth before 20 years has registered slight decline over the 30 years (58.9% in 1988/1989, 55.6% in 2016).
“When we analyzed this data for the last 30 years, we found that having first birth in adolescents has declined in Uganda; from about 70% in 1988 to about 50% in 2016. The decline started after the 2000 survey,” Dr. Amongin told the press.
When examined at age 40-49 years, women who had first birth before 18 years were poorer, less educated, had spouses of older age and low socio-economic status compared to those who did not give birth before 18 years. This was worse among those who had repeat adolescent births. Furthermore, women who had repeat adolescent births had a total of seven live births compared to five among those with no birth before 18 years of age.
“Girls who have had a repeat adolescent birth have on average seven children in life compared to 5 children among those who did not have a live birth before age 18 years,” says Dr. Amongin.
Motivators for repeat births
The data shows that extreme household poverty characterized by peasantry, alcohol abuse and large families was an overarching reason for the decisions that resulted in the first (under age birth) and subsequently, repeat adolescent birth. Poverty led to inadequate provision of basic needs resulting into girls engaging in unprotected sexual activity in a bid to secure financial support. Largely, girls were in school at first pregnancy and immediately dropped out once the pregnancy was confirmed. Teen mothers are more likely to have a repeat birth if they drop out of school.
“Repeat adolescent birth in Uganda is premised around attempts to address the economic distress precipitated by first birth. Many women want to delay that repeat birth but financial challenges rob them of their reproductive autonomy,” the research partly reads.
“The girls complained of limited provision of basic needs such as sanitary pads, scholastic material and school fees. This was made worse by the peasantry background because of high alcohol consumption by the fathers at homes that depleted even the little resources. Because of lack of these basic needs, they said they had to get male sexual partners to bridge this gap,” Amongin said.
Other contributing factors cited in the research are: vulnerability characterized by marital entrapment, partner coercion, and domestic violence.
Compared to a teen mother with one child, results show that girls who have a second birth before 20 years are at a greater risk of school discontinuation, greater likelihood of poverty and impaired health for the baby.
“Many adolescents with repeat adolescent birth are taken out of school entirely and this underscores the need to prevent early marriage in a country where marriage/union before 18 years remains common,” says Dr. Amongin.
Moreover, premature births and low birth weight are a major problem affecting children of adolescent mothers. These factors put the newborns at greater risk of poor survival and other opportunities in life. Additionally, the second or more children are more likely to put more strain onto the mother and the consequences get multiplied.
Preventing Repeat Teen births
Repeat adolescent births can be prevented. In her study, Dr. Amongin gives a number of recommendations that government, healthcare providers and communities can adopt in order to nip repeat adolescent births in the bud. These are: helping mothers gain information about and use of effective types of birth control; alleviating household poverty and domestic violence; implementation of a school continuation policy or providing alternative forms of education for adolescent mothers and strengthening legislation against early marriage.
“Beyond focusing on preventing index adolescent pregnancy, programs need to specifically place emphasis on preventing repeat adolescent pregnancy,” she advises.
The government, according to Dr. Richard Mugahi, the Assistant Commissioner for Reproductive and Infant Health at the Ministry of Health, dedicated a division for adolescent health whose package of interventions is delivered through a three-form framework.
“We deliver interventions at the health facility level; community level because we know that adolescents are economically not well advantaged and this makes their access to health services also impeded in a way,” he said.
“As the Ministry of Health, we provide post-delivery / pattern family planning and post-abortion family planning. These are arms that we are going to strengthen and they will directly address repeat teenage pregnancies,” Dr. Mugahi added.
At the dissemination was also Prof Nelson Sewankambo, Director Training Health Researchers into Vocational Excellence (THRiVE) consortium who urged the government to embrace research and utilize the findings, if the country is to steadily move forward.