Factors associated with teenage pregnancy in Rwanda

Abstract

Teenage pregnancy is more common in developing countries than developed countries and is associated with numerous social and economic factors: poverty, low education level, and the lack of awareness about sex and pregnancy prevention and we can’t ignore socio-cultural effect. Teenage pregnancy pregnancy has well known negative health consequences for both mothers and children because teenage mothers are at greater risk of maternal mortality than older women(1). Worldwide about 16 million girls aged 15 to 19 and some 1 million girls under 15 give birth every year and most of those teen are in low- and middle-income countries. Therefore, teenage pregnancy is noted as a major public health and demographic problem with medical, psychological, social and demographic implications. It has informed also that every year 3 million girls aged 15 to 19 undergo unsafe abortions(1). According to the study conducted by UNFPA in 2013, sub-Saharan Africa had the highest prevalence of adolescent pregnancy in the world where half of all births that occurred in the region were attributed to teenage mothers, with an estimated 101 births per 1000 women aged 15–19, almost double the global average(2). In most sub-Saharan countries differents studies revealed that at least 10% of single teenagers of 18 years get pregnant unwillingly due to lack of information about reproductive health. Those studies show also that unmarried mothers sometimes encounter many more difficulties than married mothers where they receive less support from their families and communities, and sometimes have fewer resources to bring up and educate their children which caracterised by growing problems of their babies (3)(4). In Africa, teenage childbearing usually brings a sudden halt to young women’s formal education and few girls find ways to continue education after giving birth but the majority do not. Furthermore, in sub-Saharan Africa, the most central problems facing young people relate to sexuality and reproduction. The combination of poverty and conflict further compound the situation(5). According the RDHS 2005&2015 the results revealed that in Rwanda most of teenagers when have sex they rarely use contraceptives and this attitudes may result in unwanted pregnancies. Moreover, the results show also that adolescent pregnancy has increased from 4.1% in 2005 to 7.3% in 2015(6). While in 1996 the percentage of teenage pregnancy raise by one percent higher than 2000. This rise can probably be accredited to the introduction of the Re-entry Policy and the effect of Genocide. However, teenage fertility reduced further in 2000 upto 2005, showing that the effect of the policy was temporary and was outweighed by reproductive health interventions. Nevertheless, a rate of 7.3% percent recorded in 2015 was still high (7)(8). There are various reproductive health challenges that young people in Rwanda are facing which among them include low use of contraception. Ministry of Education policy does not allow distribution of condoms in lower institutions of learning. Sexual activity which is often unprotected begins early and is associated with risks such as HIV/AIDS, pregnancy and unsafe abortion, economic hardship and school drop-outs. Girls aged 15-19 face higher reproductive risks than older women. Pregnancy is the leading cause of death for young women aged 15-19 worldwide with complications of childbirth and unsafe abortion being the major risk factors (9). Teenage mothers may be physically less mature and less able to handle the demands of pregnancy, childbirth, and subsequent child care. Furthermore, teenage mothers may lack experience and tend to be less psychologically mature and emotionally stable, leading to poorer maternal and child health care and infant feeding behaviours. They also face greater risks of obstetric fistula (the creation of a hole between the birth canal and anal area during prolonged labour), hemorrhage, and pelvic bone immaturity increases the likelihood of cephalopelvic disproportion, which is associated with a higher incidence of premature birth, prolonged labour, and otherwise difficult childbirth. The problem is compounded by lack of clear government policies on teenage reproductive health in many countries in the region. This creates uncertainty and hinders provision of information and services(10). In order to develop measures that prevent teenage pregnancy, it is important to understand factors that contribute to it and its consequences. Therefore, this study examined how factors in terms of socio- demographic (age, use of any method of contraception and marital status) and socioeconomic (residence, region, education and wealth index) can influence teenage pregnancy in Rwanda. Problem statement