There are three things about the seminar that I found completely astonishing
and I am not sure which part of me I need to pinch for a reality check.
The first is that the seminar was a real dialogue that integrated sectors
including pupils, the department of health and the national population unit.
Minister of Basic Education Angie Motshekga stayed, wrote notes and engaged
in the debate. We did not creep around contentious subjects, but talked
about race, culture, abortion, comprehensive sexuality education and
condoms. It felt like fresh air.
The second thing that surprised me was the results. Teenage fertility has
declined. In 1996, in the 15-19 age group, 78 babies were born per 1000
teenaged girls. In 2001, this had dropped to 65 per 1000 and in 2007 it had
dropped to 54 per 1000.
Though we have the lowest measure in the region, it remains unacceptably
high.
Rates of teenage fertility are higher in schools in poor neighbourhoods
(no-fee schools, farm schools), those involving age-mixing (combined
schools) and those that are poorly resourced.
Pregnancy results from, rather than causes, dropping-out. Pregnancy and
dropping-out share two causes - poor school performance and poverty.
Dropping-out is viewed as a significant risk for early pregnancy and HIV.
Despite liberal policies, only about a third of teenage mothers return to
school.
There is no empirical evidence linking teenage fertility and the child
support grant. There is a low uptake of the grant by teenaged mothers, and
evidence suggests that there is higher school enrolment and better nutrition
when children receive the grant.
There is a shift in attitudes towards pregnancy, with two- thirds of teenage
pregnancies being unwanted because of the mothers' educational aspirations.
Teenagers displayed high levels of contraceptive knowledge, but incorrect
and inconsistent use persists.
This leads me to my third point: future strategies.
The national population unit's Jacques van Zuy Dam aptly noted the
disconnect of the sexual and reproductive health and rights movement,
largely due to the influence of American foreign policy during the Bush era.
This stopped flows of funds to women's health, and sexual and reproductive
health groups, for the past 10 years in developing countries, including
South Africa, though United Nations agencies and bilateral funding. The
Aids-treatment movement had its own battles to fight and steered clear of
sexual and reproductive health issues.
It's no wonder that we have evidence of the incorrect and inconsistent use
of contraception. In the last month of Bush's term, he tried to pass
legislation to stop foreign funding for contraception. We've barely been
able to say the word condom, our mainstay in promoting safer sex
practices the flush groups addressing adolescents of late have been
faith-based groups that have focused on abstinence.
The department of education has committed itself to using evidence to inform
its work.
Evidence suggests that abstinence is a threat to adolescent sexual health,
and those exposed to this teaching - as opposed to comprehensive sexuality
education - are at risk of practising risky sex and of being vulnerable to
HIV and pregnancy. Teenagers equipped with knowledge have less risky sex and
tend to delay their first sexual experiences.
The department appeared open to considering spaces to scale up condom
distribution.
In 2007, only 11.8 male condoms were distributed to each male over 15. There
are inequities and system challenges - in Western Cape, the figure was 50
and in Johannesburg it was eight. This is clearly inadequate.
Female condoms should be made accessible and the role of prophylaxis
following sexual assault also needs to be addressed in the education
environment. Pupils and teachers need to know how to access this and what
they need to do within the limited time frame following exposure.
Finally, the issue of access to abortion needs to be reviewed in
collaboration with the national department of health. Designated surgical
services have decreased from 60% to 43% due to health-system constraints,
and demand outstrips supply.
The recent confidential maternal mortality survey notes an increase in
deaths from unsafe abortions and HIV-Aids, with a number of teenage deaths.
Medical abortion is now available only in the private sector until the 56th
day of pregnancy.
The provision within the national strategic Aids plan, under the prevention
of mother to child transmission, noting that medical guidelines should be
finalised and implemented, should be fast-tracked. This is a serious equity
issue.
Stevens manages the Women and HIV Gauge at the Health Systems Trust. This
was written in her personal capacity
Source: Marion Stevens, The Times, 01 Sep 2009. http://www.thetimes.co.za/News/Article.aspx?id=1058379
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