Black teenage pregnancy in South Africa: some considerations.

Cunningham, Peter W. ; Boult, Brenda E.

INTRODUCTION

The swinging sixties left an echo that would lead to extensive research into adolescent sexuality. What adults were accepting as their rights, all too soon became during the process of socialization and imitation, what the young felt was "okay" to emulate - an exploration of the delights of unrestricted and unrestrained sexual activity. A recent newspaper report noted that most adolescents, irrespective of their culture, are sexually active before the age of twenty - even if their parents are reluctant to admit it (Eastern Province Herald, 1994).

The consequences have been an upsurge in the incidence of sexually transmitted diseases (Masters, Johnson, & Kolodny, 1988; Hacker, 1989; Duncan et al., 1990) and in the number of unplanned and unwanted pregnancies among adolescents too young to assume the psychological and physical burden of parenthood (Jones et al., 1987). The medical literature of the late sixties and early seventies (Utian, 1967) shows that concern and, that the medical profession was relatively unprepared for the challenge. Subsequent studies show that with appropriate medical surveillance, teenage pregnancy need be no more physiologically hazardous than it is for the older primipara (the first time pregnant) (Blumental, Merrel, & Langer, 1982; Goldberg & Craig, 1983; Frisancho, Matos, & Flegel, 1983; Ncayiyana & Ter Haar, 1989). While the medical profession has coped with problems attendant upon childbearing by the very young, neither the family nor society has solved the problem of how to cope with "children having children."

How do we define "the very young" or "teenagers" or "adolescents"? In physiological terms, the definition would depend on the age of menarche. This would further depend on a definition of the time lapse between age of menarche and gestational age (Felice, James, Shragg, & Hollingsworth, 1984; Scholl et al., 1989). Medically, the optimum time lapse between the two should be two years so as to obviate the physiological problems that could arise as a consequence of lack of physical readiness. The "punch line" is that should a girl begin to menstruate at age nine, after the age of eleven, statistically she should encounter no medical problems during her pregnancy at age eleven-and-a-half. She is thus not likely to fall prey to those problems commonly associated with "teenage pregnancy" such as gestational proteinuric hypertension, anemia, spontaneous premature labor or, run the risk of having a low birth-mass baby.

Research, however, does not fully support this contention. The pregnant teenager is "at risk," as is her unborn infant. There are serious physical and neurological problems of development associated with low birth-mass infants, and several reports show an association between early maturation and foetal growth (Scholl et al., 1989).

Infant Mortality and Low Birth-mass Infants

Infant mortality is significantly linked to birth-mass. The lower the birth-mass, the less likely the infant is to survive, and there is an undisputed tendency for teenagers (and younger teenagers in particular) to give birth to low birth-mass infants (Boult & Cunningham, 1993).

Infants weighing less than 2,500 grams are more at risk for neurological and other developmental deficiencies (including cerebral palsy. Their nursing care also presents more problems for medical personnel, their young and inexperienced mothers, her family, and the state. The latter has to provide the services for their survival (Van de Elst, 1990).

Maternal Mortality

It is in the developing countries that teenage pregnancy has become a primary cause for concern as a result of its contribution to higher maternal mortality rates. It is in these countries where industrialization and Westernization have led to the adoption by adolescents of the practices of their Western counterparts, that the price has been highest (Oronsaye, Ogbeide, & Unuigbe, 1982; Oppong, 1987; Kulin, 1988). School drop-out, illegal abortion, medical problems such as vaginal or rectal fistula resulting in social ostracism, child neglect and child abandonment, are but some of the problems referred to (World Bank Policy Study, 1986; Kulin, 1988).

SOCIAL CONSEQUENCES OF TEENAGE PREGNANCY

The most salient social consequences of teenage pregnancy are: school drop-out or interrupted education; vulnerability to or participation in criminal activity; abortion; social ostracism; child neglect and abandonment; school adjustment difficulties for their children; rape, abuse, and incest; adoption; lack of social security; poverty; repeat pregnancies before age 20; and negative effects on "domestic life."

School drop-out or interrupted education. We found, in our 1991 study of 145 pregnant black teenagers under the age of 18, that in about 50% of cases the teenager is unlikely to return to school. This finding corroborates other research findings in Africa (Oppong, 1987) and the United States (Clarke, 1986; Height, 1986). There is lack of provision at schools to facilitate resumption of her education, and if she does so, she is forced to leave her baby at home and discontinue breast feeding which may affect mother-child bonding.

Vulnerability to or participation in criminal activity. The young mother's immaturity, social inexperience, and lack of child-rearing skills have deleterious effects on her children. She and her children are more likely to become victims of crime (incest, rape, and family violence). The young black mother and her out-of-wedlock offspring are also vulnerable to participation in criminal activity, such as prostitution, drug trafficking, and the illegal sale of alcohol. As a consequence, in the United States, this group is disproportionately represented in the crime statistics. The problem is aggravated by their lack of adequate access to legal representation. This increases the possibility of her being jailed, thus leaving the baby in the care of society or the family, or for her children to become young offenders and imprisoned.

Abortion. In countries (or states) where abortion on demand is not available, teenage pregnancy encourages illegal abortion with the attendant medical problems of pelvic infection and infertility. Some medical opinion recommends that legal abortion should be available to all pregnant teenagers age 16 years and younger.

Social ostracism. Social ostracism for the mother may result in rejection by her family and peer group. Her children also suffer psychological consequences, e.g., not knowing who their father is, a lack of a father figure as a role model, and the trauma of guilt for the mother's ill-fortune and subsequent poverty. Absence of the father role-model has been shown to affect boys in particular. They tend to develop a negative image of females which can lead to violence against women (including rape) in young adulthood.

Child neglect and abandonment. Children born to teenage mothers are often left to the care of ageing family members. They may be exposed to the violence of family life in the townships and socialized into accepting violence as the only means to resolve conflict. The "abandoned children in African cities" referred to by Kulin (1988) and the growing numbers of "street children" in urban areas in developing countries may be connected with teenage pregnancy. Research is needed to confirm or refute any association.

School adjustment difficulties for their children. Several studies have reported problem behavior, lower IQs, and maladjustment in school for children born to teenage mothers in both childhood and adolescence (Furstenberg, Brooks-Gunn, & Morgan, 1987; Franklin, 1988; Dash, 1989; East & Felice, 1990).

Rape, abuse and incest. In South Africa, abortion is allowed in cases of pregnancy resulting from rape. However, in many cases poor black families are unable to follow the required processes for the sanctioning of the abortion. The teenager is victimized not only because of the pregnancy but the rape, which results in an intensification of her psychological trauma. Further, the current rate of high unemployment in South Africa, principally among males - with its attendant problems of depression and alcohol abuse - places the young child at increased risk of sexual encounter with a member of his or her family. "Childhood abuse increases the odds of future delinquency and adult criminality overall by 40%," according to a study by the American National Institute of Justice (CSD Bulletin February, 1994).

Children born of incestuous relationships need special counselling by an informed social worker when they reach young adulthood. McWhinnie & Batty (1993) found that the persons concerned were more distressed about the secrecy surrounding their origins, and their "feeling of betrayal at being lied to" than the fact of incest.

In the pilot study preceding our 1991 study of black teenage pregnancy, an interesting case was found. A twelve-year-old who had been living with her aunt had been raped by her older cousin. The children in the house slept in one room and the aunt and uncle in another. She became pregnant and was delivered of a small but otherwise healthy infant. Because the baby was conceived as a result of incest or "intra-cultural impregnation," it was not acceptable to her family and was given up for adoption.

Adoption. There is a growing trend for young unmarried girls not to relinquish their babies for adoption to childless couples or single persons wishing to adopt a child. Where socioeconomic or personal circumstances make adoption options advisable, a shortage of adoptive or foster parents is experienced among certain ethnic groups. The South African Child and Family Welfare Association does not condone inter-racial adoption as being in the "best interests of the child." It has also been reported that among black families in South Africa, adoption of a child who is not a clan member leads to severe family and social disapprobation (Pakati, 1982).

Lack of social security. The younger the teenager, the more likely she is to have no conception of the needs of her infant or child. With little or no education and skills she may be forced to turn to prostitution as a means of support for herself and the child. Having multiple partners places her and her future unborn child at greater risk for sexually transmitted diseases, including HIV and AIDS.

Poverty. Pregnant teenagers almost invariably become trapped in a cycle of poverty. Even if they are employed at the time of becoming pregnant, they are vulnerable to dismissal and receive insufficient maternity benefits to cover their needs. Employers may also be reluctant to allow pregnant young employees time off to attend an antenatal clinic.

The majority of teenagers who become pregnant are still in school. If after giving birth there is no female member of their family to assume child care while they are either in school or at work, they will be unable to take the child for immunization. Periodic epidemics of measles may well be directly linked to the high neonatal and child mortality rates on the African continent. In the absence of a national health service, and an inadequate primary health care program, this is not unexpected in African countries where teenage pregnancy is estimated at 12 to 25%.

Repeat pregnancies before age 20. Research shows that girls are vulnerable to repeat pregnancies (Clarke, 1986; Height, 1986) if their first pregnancy occurred before the age of eighteen. In a result, they will join the millions of women worldwide, handicapped by poor education and skills, who are overrepresented at the bottom of society's socioeconomic strata.

Negative effects on domestic life. Spencer (1970) in discussing the "multi-problem" family states that they "... appear to transmit the same patterns of behavior from one generation to another, and whose disorganized and often destructive way of life seems to threaten society's basic values and standards" (p. 3). This pattern appears to be a feature of teenage pregnancy (Craig, 1980; Clarke, 1986; Height, 1986). (Curtis, Lawrance, & Tripp, 1988) note: "The parents of the study group were significantly more likely to be divorced, the mothers to have married when they were under age 21 years, and the first child in the family to have been conceived before marriage" (p. 375).

How does this disturbing account fit into the concept of "domestic life"? In any democratic society, where the emphasis is on individual freedom, should sexual activity be controlled? Does the individual, as a result of hereditary and environmental factors (Golub, 1983; Winterer, Cutler, & Loriaux, 1984; Hoff et al., 1985; Burger & Gochfield, 1985) who experiences early menarche and becomes vulnerable to the onset of sexual activity (Van Coeverden de Groot & Greathead, 1987; Nash, 1990; Boult & Cunningham, 1991) pose a threat to herself, her "boyfriend," her family, and society?

This question is asked in all seriousness, for the concept of "children having children" has a profound effect on the family and domestic life in general. Children are not commonly orphaned. Their socialization takes place within a domestic structure whether it be a nuclear family, a single-parent family, or a kin group. It is within this framework that youth learn their life skills, part of which is how to cope with sexuality and its reproductive consequences.

Our research (Boult & Cunningham, 1991/1993) into black teenage pregnancy corroborated findings worldwide. She is vulnerable because she has early menarche, early onset of coitus, perhaps too low on the educational ladder to comprehend the association among onset of menarche, coitus, reproduction, and contraception. When she falls victim to an unwanted pregnancy, her family reacts negatively, and her boyfriend (in most cases, only an adolescent himself) is generally equally dismayed.

The problem is also a pressing one among blacks in America. Height (1986) cautions, "The as yet unknown outcome of this disruption of the basic sociological concept of the family is a crucial question, and is worthy of important time, effort and study. . . . Blacks must address themselves to the reality that the fastest growing new family formation in the black community is that in which the mothers are unmarried and under eighteen years of age" (p. 42).

It is not known to what extent South African black families resemble their American counterparts, but there is evidence of family disorganization in studies of pregnant teenagers (Craig, 1980; O'Mahoney, 1987; Boult & Cunningham, 1991). In our study of pregnant black teenagers in Port Elizabeth, we found that only one third of the sample lived in nuclear families (see Table 1).

The single-parent mother families and kin groups consisted mostly of adults and children who were their maternal rather than fraternal kin. The number of persons per dwelling unit ranged from 2 to 22, with a mean of 6.8 and a mean of 3.15 rooms per family. However, further research needs to be done to establish the relationship between single-parent mother/kin group families and teenage pregnancy.

Table 1: Family Composition

Type of family Percentage

Nuclear 33.8
Nuclear step parent 1.4
Single parent - mother 35.9
Single parent - father 3.4
Kin group 18.6
Siblings 4.1
Husband and children 1.4
Boyfriend's family 1.4

CONCLUSION

The debate about teenage pregnancy remains inconclusive. Is it really a social problem? Although there is general consensus that it is, the definition of "problem" is relative and subjective; however, it does draw attention to the importance of considering the issue. As Spencer (1970) posits, it has "limited diagnostic value" (p. 4).

Various reasons for teenage pregnancy have been advanced. For example, Burger and Gochfeld (1985) offer a provocative hypothesis - that the pheromonal climate to which prepubertal females are exposed has changed and affects the onset of menarche, causing it to occur earlier. Animal studies show that exposure to females delays puberty while exposure to males accelerates it. They posit that the pheromonal climate in today's homes has changed as a consequence of women going out to work and greater father presence owing to a shorter work week. In single-parent and kin-group families there is likely to be an even greater male presence as a result of high unemployment among blacks, with many females either in domestic labor or the informal sector as traders. Such change in the pheromonal climate would result in early onset of menarche, leaving these teenagers vulnerable to early onset of coitus and risk of pregnancy.

If this hypothesis has any validity, improvement in the economic climate of the country might provide a twofold benefit - a rise in the age of onset of menarche and a reduction in the incidence of teenage pregnancy. Another advantage would be a general rise in the socioeconomic status of vulnerable adolescents which would offer alternative leisure-time activities.

Could Teenage Pregnancy Be Beneficial?

Current theories of evolution are based on evidence that in both the biological and zoological worlds, under adverse conditions, seed-, and young-producing efforts proliferate to ensure survival of the species. We then might hypothesize that the steadily lowering of the age of menarche since the turn of the century and the growing number of teenage pregnancies and births are "nature's" way of ensuring survival of the species in the face of the growing threat of epidemics, environmental degradation, and violence. It is an accepted fact that the number of HIV infections and AIDS cases is increasing exponentially in Africa and other developing countries. Further, the dangers posed by the recent development of drug resistance to malaria and tuberculosis infections in Africa (and elsewhere) is well documented.

At the present stage of knowledge concerning the validity of this hypothesis, what we do know is that the high incidence of teenage pregnancy places great strain on the individual, her child, her family, and on society as a whole.

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Brenda E. Boult, SRN.SCM.MA (UCT), Department of Sociology, University of Port Elizabeth.

Reprint requests to Prof. Peter W. Cunningham, Department of Sociology, University of Port Elizabeth, P.O. Box 1600, Port Elizabeth, 6000, South Africa.