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This work was originally produced for UNICEF

Adolescence Introduction Pregnancy HIV and AIDS Nutrition Sara Cameron McBean Tanzania Bangladesh   Brazil   Colombia   India   Iraq   Kenya   Nepal   Papua New Guinea   Senegal   Sudan   Tanzania

Originally produced for UNICEF



Adolescence in Tanzania - Pregnancy

Evidence from the 2010 Tanzania Demographic and Health Survey suggests that fewer Tanzanian girls are getting pregnant and giving birth as adolescents. The decline seems to be so widespread that it suggests significant social change in attitudes and behaviour among young people. The TDHS shows a 12 per cent decline in the age-specific fertility rate among girls aged 15 to 19 years  −  from 132 per 1 000 females in 2004 to 116 per 1000 in 2010. Reduction in adolescent fertility is evident in almost every region and across all socio-economic groups. Key factors behind the decline include a major decline in the proportion of adolescent girls who are married and a significant increase in contraceptive use among sexually active adolescents. (There was also a fivefold increase over five years in the proportion of sexually active girls who knew their HIV status – see HIV and AIDS.)

The decline in adolescent pregnancy and childbirth rates is most marked among older adolescents, especially those aged 19 years, where the rate dropped from 52 per cent in 2004 to 44 per cent in 2010. (Fig.1) Of concern, however, is the increase in adolescent childbearing among 15 year old girls, which rose from 3.7 per cent in 2004 to 5.2 per cent in 2010 - even though the overall proportion of sexually active girls under the age of 15 years has not changed. The trend shows the importance of ensuring that adolescent empowerment and reproductive health programmes are successful in reaching younger adolescent girls.

The decline in the proportion of adolescents who have begun childbearing is evident in every zone (Fig.2).  The reduction is most marked in Zanzibar with a drop of more than 33 per cent and the Southern Zone, which recorded a drop of 28 per cent between 2004 and 2010. In the Southern Highlands the decline reached almost 20 per cent. Significant reductions are also evident in the Lake and Central Zones. Lack of progress in the Western Zone raises questions, in view of successes recorded in other regions.

Although early pregnancy has also decreased in every  quintile, adolescent girls in poorer households remain most likely to become pregnant by the time they reach 19 years.(Fig.3) Girls in the poorest and second-to-poorest quintiles are more than twice as likely to begin childbearing by age 19 as girls in the wealthiest quintile.  Girls in rural areas are also almost twice as likely to start childbearing by 19 as girls living in urban areas.

It is important to note, however, that perceptions of the mean ideal number of children has hardly changed since 2004/5. Most 15 to 19 year old females still believe that it is ideal to have four children, which will keep Tanzania at a continuing high rate of population growth - and undermine development achievements. Nevertheless, more young women want to delay pregnancy. In 2004/5, almost 15 per cent of females who had given birth when they were less than 20 years said they would have preferred to have waited until later – by 2010 that proportion had risen to almost 27 per cent.

The overall decline in adolescent pregnancy points to considerable success in some adolescent empowerment and reproductive health programmes. In particular there has been a significant increase in the use of contraceptives by sexually active adolescents. (Table 1)  Condom use among sexually active, never-married adolescent girls increased by more than 30 per cent, while among adolescent boys it rose by more than 17 per cent. Overall the met need for family planning among 15 to 19 years olds rose from 36 per cent in 2004/5 to 48 per cent in 2010.

Table 1 Never married, sexually active adolescents aged 15 to 19 years who used a condom at last sex (TDHS)





    The proportion of adolescent girls aged 15 to 19 years who are married also dropped dramatically, by more than 23 per cent; the proportion living with their partners also dropped (Table 2).


Table 2 Current marital status of girls aged 15 to 19 years (TDHS)







 More than 11 per cent of girls aged 15 to 19 years became sexually active before they were 15 years old with no change evident over the last five years.  Yet sexual activity among adolescents has declined overall. In 2004 just over 50 per cent of girls aged 15 to 19 years and about 52 per cent of boys of the same age reported that they had never had sexual intercourse. By 2010 these proportions had risen to over 54 per cent of girls and nearly 63 per cent among boys. (Table 3)

Table 3 Sexual status of adolescents aged 15 to 19 years (TDHS 2004/5 and 2010)







Adolescent pregnancy, maternal and infant mortality: Although the 12 per cent drop in adolescent fertility is impressive, the rate is still too high. By the age of 16, one in ten girls have begun child-bearing; this rises to one in five by 17 years and to more than one in three by 18 years (Fig.7). The risk of death among infants in the first month of life is particularly high when the mother is under 20 years old. Among adolescent mothers, the rate of death among infants during the first month of life – the neo-natal mortality rate - is 41 per 1000 live births, compared with 22 per 1000 when the mother is older (20 to 29 years).  While the difference is significant, it represents a slight drop from a neonatal mortality rate of 45 per 1000 live births for mother under-20 years in 2004 and 29 per 1000 for mothers aged 20 to 29 years. Skilled attendance during delivery is important for averting deaths among infants and mothers. Although adolescents are more likely to be attended by a skilled provider during birth than older women, more than 43 per cent of girls under-20 years give birth without professional care. Women who start having children in adolescence tend to have more children and shorter spacing between pregnancies – all of which are risk factors for maternal and neonatal mortality.

Worldwide, pregnancy is a leading cause of death for young women aged 15 to 19, accounting for at least 70,000 deaths each year. The incidence of adolescent maternal mortality in Tanzania is not known, however the country’s high rate of neo-natal mortality could be taken as an indicator of higher mortality risks for adolescent mothers. The Ministry of Health reports that one-third of incomplete abortion cases that turn up in health facilities involve adolescents, and one in five of the girls involved are students. It is likely that illegal abortion is a significant cause of maternal death among adolescent girls.

Causes of and response to adolescent pregnancy:  More needs to be understood about the causes of the significant decline in adolescent pregnancy, especially in Zanzibar and in the Southern and Southern Highland Zones, as well as the lack of decline in the Western Zone. It is possible that the expansion of education and of youth-focused media, and the greater availability of contraceptives as well as a growing sense of youth culture, identity and empowerment may be key factors influencing these significant social changes.

Nevertheless, economic deprivation can cause young girls to engage in transactional and/or unprotected sex to meet basic needs, or to improve their living conditions.  Lack of appropriate and comprehensive sexual and reproductive health education, including information and services for reproductive tract infections, sexually transmitted infections, and pregnancy-related issues means that many adolescents still do not know how or do not possess the means to prevent pregnancy. According the Ministry of Health’s National Standards for Adolescent Friendly Health Services: “Available reproductive services are adult centred thus making them less accessible to adolescents.” Adolescents often do not seek services due to a lack of knowledge, as well as rejection by the service providers and the community.

Currently, about one-third of Tanzania’s health facilities are reported to provide “youth-friendly” sexual and reproductive health services, including access to contraceptives.  While the quality of services provided probably varies greatly, these facilities should offer a non-judgemental, supportive environment where young people feel comfortable and confident about expressing their concerns and are able to receive treatment guidance in language and concepts that fit their experience and stage of development.




Girls

Boys

2004

38.2%

39.3%

2010

50.2%

46.1%


Married

Never Married

Living Together

2004

72.1%

21.9%

4.3%

2010

80.3%

16.8%

1.9%


Girls before 15 years

Girls 15-19

Year

Boys 15-19 Years

2004

11.4%

50.6%

52.3%

2010

11.3%

54.6%

62.7%

Reducing Teenage Pregnancy is one of the Top Ten Investments  of The Children’s Agenda for Tanzania. Key recommendations are being finalized for action on teenage pregnancy by parliamentarians, councillors, civil society organizations, mass media and other stakeholders.