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Teen mums in South Africa: largest ever study explores what it takes to go back to school

Pregnancy itself is a potential mental health stressor, even for older women. Generally, women are twice as likely to experience mental health challenges as their male counterparts. According to a research article published in 2022, although research on maternal mental health in Africa is sparse, some studies estimate the prevalence of postpartum depression in Africa to range between 15 to 25%.30,31. The prevalence of postpartum depression among adolescent mothers ranges from 14% to 53%. This is more than double that observed in older mothers (7–17%). The article also states that teenage mothers with untreated depression have a far greater likelihood of having a second pregnancy within two years. According to the South African Medical Journal, the number of births to young teenagers aged 10 - 14 years increased by 48.7% (from a baseline of 2 726, which is very high by developed-country standards) and the birth rate per 1 000 girls in this age category increased from 1.1 to 1.5. SAMJ analysed the data available in the public sector database, the District Health Information System, from 2017 to 2021. In adolescent girls aged 15 - 19, the number of births increased by 17.9% (from a baseline of 114 329) and the birth rate per 1 000 girls in this age category increased from 49.6 to 55.6. These increases also occurred year on year in a continuous upward trend as well as in all provinces, but at different rates. Generally, rates were higher in the more rural provinces such as Limpopo, Mpumalanga and Eastern Cape than in more urban provinces such as Gauteng and Western Cape. Londeka and Patience are both mothers who fell pregnant whilst teens. They shared their mental health struggles as well as what being pregnant whilst still a teenager is like. Londeka Ngcongo, is a 17 year old mother of a 1 year 4 months old girl. She fell pregnant in August 2020 and I gave birth in May 2021. “I was nervous; I thought that I will be kicked out at home but I didn't think of having an abortion. I first told my boyfriend that I was pregnant. He was shocked but he gave me a lot of support and took care of me. I was 3 months pregnant at the time when he told his family. They gave me much support, love as well and they love the baby too. Our relationship is good”, she says. The teen mum who is from Inanda, Durban, lives with her mother’s family. “At home everything is bad, I’m being insulted, they are talking behind my back, gossiping. I feel like a prisoner. Everything that I do is not appreciated, I feel like I am useless and I am not a member of the family, I feel like an outcast, life is difficult”, she says. Ngcongo says that her father’s side of the family is a bit more supportive. “My father’s family is okay, they are supporting me they understand that I am a child and I also do mistake as other teenagers, I even wished if I could live with them but I can’t because they live in rural area northern KZN plus I am still studying I can’t just go and live in rural area”, she says. Ngcongo had to skip school last year because her baby was very sick. “We stayed at the hospital for 2 months, and even this year my baby is still in and out of the hospital, which is a difficult thing for me as a young mother”. She says that she is grateful that her boyfriend's family is still supporting them, which she is not experiencing from her family. “In my family, it seems as if they don’t even care about my suffering; they don’t ask me anything regarding myself and or the child’s wellbeing. Ngcongo says being in school, as a young mother is not easy. “Not because I have a child but because of the depression and trauma I have. My high school life has been difficult since Grade 9 because I had no support from home, even the school uniform that I had was not in a good condition. It became worse when they found out that I was pregnant, even my mother she didn’t support me not to mention my friends as well who also turned their backs on me which is the thing I didn’t expect honestly, but I told myself that life goes on I have to be strong for myself and for my child”, she says. During the week, Ngcongo’s child stays with her grandmother (her boyfriend's mother) because she is still at school but during the weekends, holidays and school holidays, she makes sure that she fetches her child. Though Ngcongo does receive a social grant, she says it is not enough for a child who is always sick because most of the time she needs to see a doctor or be sent to hospital. “Life is tough but I try by all means to take it one step at a time”, she says. Ngcongo gets her income from hair braiding, hair styling and manicures. “My dream one day is to have my own salon in town, because to tell you the truth I don’t see myself as a career woman but I see myself as a business woman one day”, she says. 21 year-old mother to twins, Patience Mentoor, also gets income through manicures. Mentoor, who lives in Delft, Cape Town fell pregnant in Grade 11 and felt like her life was over. “It wasn’t easy at all, but I love my children. Finding out that you are pregnant at 17 isn’t easy but now finding out that it was twins was even worse. The first thing that crossed my mind was my parents, I knew that they were going to be disappointed. I gave birth in June (matric year) and dropped out of school, so I don’t even have matric”, she says. Mentoor says that the pregnancy was not easy and she was depressed throughout it. “Getting through the day was hard. Both of our parents agreed that I should stay at home until the babies were born but the environment at home wasn’t nice, especially with my father. There was also a time when suicide crossed my mind because I felt like a burden and unworthy.”, she says. I was lucky that I fell pregnant towards the end of Grade 11 so I didn’t really have to face people’s comments and stares at school but I knew that when matric started I’d have to face it eventually because my bump was growing”, she says. Mentoor says that a social worker in the community encouraged her to join a support group for teen mothers, because she could see how it was affecting her mental health. “Aunty Lydia (social worker) was actually more supportive than my family, in terms of emotional support, so that did help in a way. She really guided me and told me that I need to speak about how I am feeling and not keep it inside. I am grateful to her because it really helped with the mental health struggles I was having and still have sometimes”, she says. Mentoor started doing people’s nails as a way to make income. “My boyfriend’s and his family do help financially but I just wanted to make sure that I am making money of my own, so I started with something simple. It’s not a lot but it’s a start. I really hope to study someday. I didn’t finish matric but I still hope that I can do something to secure my future.” she says. A 2020 study explores the intersection between mental health and sexual and reproductive health amongst adolescent girls and young women in South Africa. In South Africa, adolescent girls and young women (AGYW) are at risk of poor mental health, HIV infection and early pregnancy. Poor mental health in AGYW is associated with increased sexual risk behaviours, and impeded HIV testing and care. Using in-depth interviews and focus group discussions, the study explored subjective experiences of mental health and sexual and reproductive health (SRH) amongst 237 AGYW aged 15–24 years in five South African districts. Respondents shared narratives of stress, emotional isolation, feelings of depression, and suicidal ideation, interconnected with HIV, pregnancy and violence in relationships. In the South African context, pregnancy may exacerbate existing social and contextual stressors, adding additional stressors such as interpersonal relationship challenges, regret around ‘unintended’ pregnancies, and depression. Respondents suggested that due to social stigma attached to teenage pregnancy, pregnant AGYW fear being judged and gossiped about: “Pregnant girls feel sad, some even contemplate suicide (azive efuna ukuzibulala) because of hearing unpleasant things about their life being spoken by other people”. (15–18 years, WC, isiXhosa) “Pregnant girls are teased, and then they drop out of school, they don't finish; here at school, we gossip about each other in the toilets.” (15–18 years, WC). The emotional ‘burden’ of teenage pregnancy was described as a key contributing factor to poor mental health: “They say having a child is a good thing, but as a teenager it is a burden, it’s difficult to cope” (15–18 years, EC). The study also revealed that a lack of emotional support from partners/fathers of children also contributed to stress and depression amongst young mothers. Lacking a supportive social environment negatively impacted on mental health and self-esteem. Suggestions from this study include addressing the burden of unplanned teenage pregnancy. Sex education needs to be incorporated into discussions at school, home, and health facilities. Further, safe, stigma-free access to contraceptives needs to be provided for adolescents. Authors from the study also suggest that the sociocultural stigma and taboo associated with discussions about sex at school and within the community needs to be mitigated to provide a safe environment for teens to engage. Community health workers, who are typically lay members of the community who work either for pay or as volunteers with the local health care system, can be trained to provide sex education community members (including teenagers and their families). “Teens are more comfortable learning from teens. Trained peer counsellors and support groups have been used to provide safe environment for adolescents to have healthy conversations on sexual and reproductive health”. There are several organisations throughout South Africa that provide support for teenage mothers and their families. A few include: Mamkhulu.org in Mpumalanga, Teen Moms Youth Development run by Options Care Centre in George, The Parent Centre in Wynberg, Cape Town, Lifeline Pregnancy Support and Girl Pride Africa . - Health-e News
Being a teenager is hard enough these days, nevermind being pregnant. Teen moms share their journeys, often difficult and lacking in support. (Photo: Freepik)
Pregnancy itself is a potential mental health stressor, even for older women. Generally, women are twice as likely to experience mental health challenges as their male counterparts. According to a research article published in 2022, although research on maternal mental health in Africa is sparse, some studies estimate the prevalence of postpartum depression in Africa to range between 15 to 25%.30,31. The prevalence of postpartum depression among adolescent mothers ranges from 14% to 53%. This is more than double that observed in older mothers (7–17%). The article also states that teenage mothers with untreated depression have a far greater likelihood of having a second pregnancy within two years. According to the South African Medical Journal, the number of births to young teenagers aged 10 - 14 years increased by 48.7% (from a baseline of 2 726, which is very high by developed-country standards) and the birth rate per 1 000 girls in this age category increased from 1.1 to 1.5. SAMJ analysed the data available in the public sector database, the District Health Information System, from 2017 to 2021. In adolescent girls aged 15 - 19, the number of births increased by 17.9% (from a baseline of 114 329) and the birth rate per 1 000 girls in this age category increased from 49.6 to 55.6. These increases also occurred year on year in a continuous upward trend as well as in all provinces, but at different rates. Generally, rates were higher in the more rural provinces such as Limpopo, Mpumalanga and Eastern Cape than in more urban provinces such as Gauteng and Western Cape. Londeka and Patience are both mothers who fell pregnant whilst teens. They shared their mental health struggles as well as what being pregnant whilst still a teenager is like. Londeka Ngcongo, is a 17 year old mother of a 1 year 4 months old girl. She fell pregnant in August 2020 and I gave birth in May 2021. “I was nervous; I thought that I will be kicked out at home but I didn't think of having an abortion. I first told my boyfriend that I was pregnant. He was shocked but he gave me a lot of support and took care of me. I was 3 months pregnant at the time when he told his family. They gave me much support, love as well and they love the baby too. Our relationship is good”, she says. The teen mum who is from Inanda, Durban, lives with her mother’s family. “At home everything is bad, I’m being insulted, they are talking behind my back, gossiping. I feel like a prisoner. Everything that I do is not appreciated, I feel like I am useless and I am not a member of the family, I feel like an outcast, life is difficult”, she says. Ngcongo says that her father’s side of the family is a bit more supportive. “My father’s family is okay, they are supporting me they understand that I am a child and I also do mistake as other teenagers, I even wished if I could live with them but I can’t because they live in rural area northern KZN plus I am still studying I can’t just go and live in rural area”, she says. Ngcongo had to skip school last year because her baby was very sick. “We stayed at the hospital for 2 months, and even this year my baby is still in and out of the hospital, which is a difficult thing for me as a young mother”. She says that she is grateful that her boyfriend's family is still supporting them, which she is not experiencing from her family. “In my family, it seems as if they don’t even care about my suffering; they don’t ask me anything regarding myself and or the child’s wellbeing. Ngcongo says being in school, as a young mother is not easy. “Not because I have a child but because of the depression and trauma I have. My high school life has been difficult since Grade 9 because I had no support from home, even the school uniform that I had was not in a good condition. It became worse when they found out that I was pregnant, even my mother she didn’t support me not to mention my friends as well who also turned their backs on me which is the thing I didn’t expect honestly, but I told myself that life goes on I have to be strong for myself and for my child”, she says. During the week, Ngcongo’s child stays with her grandmother (her boyfriend's mother) because she is still at school but during the weekends, holidays and school holidays, she makes sure that she fetches her child. Though Ngcongo does receive a social grant, she says it is not enough for a child who is always sick because most of the time she needs to see a doctor or be sent to hospital. “Life is tough but I try by all means to take it one step at a time”, she says. Ngcongo gets her income from hair braiding, hair styling and manicures. “My dream one day is to have my own salon in town, because to tell you the truth I don’t see myself as a career woman but I see myself as a business woman one day”, she says. 21 year-old mother to twins, Patience Mentoor, also gets income through manicures. Mentoor, who lives in Delft, Cape Town fell pregnant in Grade 11 and felt like her life was over. “It wasn’t easy at all, but I love my children. Finding out that you are pregnant at 17 isn’t easy but now finding out that it was twins was even worse. The first thing that crossed my mind was my parents, I knew that they were going to be disappointed. I gave birth in June (matric year) and dropped out of school, so I don’t even have matric”, she says. Mentoor says that the pregnancy was not easy and she was depressed throughout it. “Getting through the day was hard. Both of our parents agreed that I should stay at home until the babies were born but the environment at home wasn’t nice, especially with my father. There was also a time when suicide crossed my mind because I felt like a burden and unworthy.”, she says. I was lucky that I fell pregnant towards the end of Grade 11 so I didn’t really have to face people’s comments and stares at school but I knew that when matric started I’d have to face it eventually because my bump was growing”, she says. Mentoor says that a social worker in the community encouraged her to join a support group for teen mothers, because she could see how it was affecting her mental health. “Aunty Lydia (social worker) was actually more supportive than my family, in terms of emotional support, so that did help in a way. She really guided me and told me that I need to speak about how I am feeling and not keep it inside. I am grateful to her because it really helped with the mental health struggles I was having and still have sometimes”, she says. Mentoor started doing people’s nails as a way to make income. “My boyfriend’s and his family do help financially but I just wanted to make sure that I am making money of my own, so I started with something simple. It’s not a lot but it’s a start. I really hope to study someday. I didn’t finish matric but I still hope that I can do something to secure my future.” she says. A 2020 study explores the intersection between mental health and sexual and reproductive health amongst adolescent girls and young women in South Africa. In South Africa, adolescent girls and young women (AGYW) are at risk of poor mental health, HIV infection and early pregnancy. Poor mental health in AGYW is associated with increased sexual risk behaviours, and impeded HIV testing and care. Using in-depth interviews and focus group discussions, the study explored subjective experiences of mental health and sexual and reproductive health (SRH) amongst 237 AGYW aged 15–24 years in five South African districts. Respondents shared narratives of stress, emotional isolation, feelings of depression, and suicidal ideation, interconnected with HIV, pregnancy and violence in relationships. In the South African context, pregnancy may exacerbate existing social and contextual stressors, adding additional stressors such as interpersonal relationship challenges, regret around ‘unintended’ pregnancies, and depression. Respondents suggested that due to social stigma attached to teenage pregnancy, pregnant AGYW fear being judged and gossiped about: “Pregnant girls feel sad, some even contemplate suicide (azive efuna ukuzibulala) because of hearing unpleasant things about their life being spoken by other people”. (15–18 years, WC, isiXhosa) “Pregnant girls are teased, and then they drop out of school, they don't finish; here at school, we gossip about each other in the toilets.” (15–18 years, WC). The emotional ‘burden’ of teenage pregnancy was described as a key contributing factor to poor mental health: “They say having a child is a good thing, but as a teenager it is a burden, it’s difficult to cope” (15–18 years, EC). The study also revealed that a lack of emotional support from partners/fathers of children also contributed to stress and depression amongst young mothers. Lacking a supportive social environment negatively impacted on mental health and self-esteem. Suggestions from this study include addressing the burden of unplanned teenage pregnancy. Sex education needs to be incorporated into discussions at school, home, and health facilities. Further, safe, stigma-free access to contraceptives needs to be provided for adolescents. Authors from the study also suggest that the sociocultural stigma and taboo associated with discussions about sex at school and within the community needs to be mitigated to provide a safe environment for teens to engage. Community health workers, who are typically lay members of the community who work either for pay or as volunteers with the local health care system, can be trained to provide sex education community members (including teenagers and their families). “Teens are more comfortable learning from teens. Trained peer counsellors and support groups have been used to provide safe environment for adolescents to have healthy conversations on sexual and reproductive health”. There are several organisations throughout South Africa that provide support for teenage mothers and their families. A few include: Mamkhulu.org in Mpumalanga, Teen Moms Youth Development run by Options Care Centre in George, The Parent Centre in Wynberg, Cape Town, Lifeline Pregnancy Support and Girl Pride Africa . - Health-e News
Being a teenager is hard enough these days, nevermind being pregnant. Teen moms share their journeys, often difficult and lacking in support. (Photo: Freepik)

Kathryn Steventon Roberts, University of Oxford and Janina Jochim, University of Oxford

Imagine the weight of responsibility for caring for a child when you are not yet fully grown yourself, and the fear of being shamed by parents, fellow learners, and even strangers within the community?

Vast numbers of adolescent mothers, many of them very vulnerable, exist across Africa, but there remains little research on their challenges and what can be done to support them and their children.

Policies and programmes are often small scale, poorly implemented, or not inclusive of adolescent parents.

Detailing findings from the largest adolescent mother cohort study in sub-Saharan Africa, this article sheds light on some of the challenges they face, potential entry points for interventions and programmes, and opportunities to support adolescent mothers and their children.

Some adolescent mothers from sub-Saharan Africa say they did not realise they could get pregnant or how to prevent pregnancies, pointing to the challenges to provide youth with comprehensive sex education and the possible cultural obstacles to communication about sexunderlying early pregnancy.

Even before the COVID-19 pandemic sparked an education crisis, nearly one in five girls aged between 15 and 19 globally were not in school, employment or training.

Many adolescent mothers have a history of poor school performance, and a pregnancy can act as a catalyst for early dropout.

The HEY BABY (Helping Empower Youth Brought up in Adversity with their Babies and Young children) research study was conceptualised to better understand adolescent mothers’ needs.

The study aimed to identify the hurdles young mothers face and how to overcome them. Between 2017 and 2019, HEY BABY collected data from over 1,000 adolescent mothers and their children living in rural and urban areas of South Africa’s Eastern Cape.

Addressing mothers’ obstacles and identified points of intervention

Prior research, using older samples, from South Africa indicates that only between 30% and 50% of young mothers manage to continue their education, highlighting a continued need to understand better why this is the case.

Our most recent study showed that almost 70% of young mothers indicate having returned to school after birth. These mothers showed lower poverty rates, fewer repeated grades preceding the pregnancy, continued schooling during pregnancy, higher daycare/crèche use, more family childcare support, and lower engagement in exclusive breastfeeding within six months of birth.

Examining the relationship between poverty and school enrolment within this population, we identified two distinct routes towards a return to school:

Route one: Lower household poverty drives schooling throughout pregnancy which, in turn, drives higher school return rates post-birth;

Route two: Lower household poverty drives the use of daycare/crèche services which, in turn, drives higher school return rates post-birth.

The large proportion of mothers – 30% in our sample – who do not return to school might require substantial targeted support to re-engage with education.

Our results suggest that financial support alone might not be sufficient to support adolescent mothers. But when combined with other resources, such as affordable daycare and services that support school retention during pregnancy, they could prove effective.

This evidence aligns with the growing interest in cash-plus programmes which provide cash payments in addition to complementary interventions to strengthen outcomes. This type of intervention might help adolescent mothers to continue their education.

Further research from the HEY BABY team provides valuable insights into maternal education and its potential drivers and consequences:

  1. Better maternal education is associated with increased child cognitive development.

  2. Withdrawal from school during pregnancy is associated with more poverty, higher grade repetitions and greater lack of information about the pregnancy.

  3. Some adolescent mothers face compound risks. For example adolescent motherhood and HIV-infection double the chances of dropping out of school.

  4. Food security is associated with both education and lowered HIV behaviours, including age-disparate sex and sex on substances.

  5. Access to formal childcare services has a substantial positive impact for adolescent mothers such as engagement with education and employment, optimism about the future, and improved parenting) and showed better child development over time.

Evidence to improve the implementation of school policies

Progressive laws and school policies, and their effective implementation, are essential to increase school access for pregnant girls and adolescent mothers.

In South Africa, a national policy assigns the responsibility for managing the care and support for adolescent mothers to individual schools. These schools need to know how to provide effective and targeted help, and which community networks to tap into.

Establishing and promoting education, health, and social systems that are responsive to the rights and needs of pregnant girls and adolescent mothers will require that the policy implementation is grounded in robust evidence.

Only then can we effectively improve the lives of adolescent mothers and our future generations.

Kathryn Steventon Roberts, Researcher – Global Health, University of Oxford and Janina Jochim, Postdoctoral fellow, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    Health-e News is South Africa's dedicated health news service and home to OurHealth citizen journalism. Follow us on Twitter @HealtheNews

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