Adolescent Girls

Alliance for Open Society International (AOSI)

Human Sciences Research Council (Moletsane); University of KwaZulu-Natal (Moletsane/Stuart/Taylor/Mitchell); McGill University, Canada (Mitchell/Walsh)

Hope Enterprises - Jamaica (Wedderburn), Rakai Health Sciences Program - Uganda (Wagman), FHI, Research - North Carolina, US (Waszak Geary, Baumgartner, Toms Tucker, Johnson)

Save the Children

SC's ARSH Malawi programming worked with young people, their families, and communities to educate youth about reproduction and health, to build the teens' skills in decision-making and life choices, and to provide the means to prevent unwanted pregnancy and sexually transmitted infections (STIs) including HIV. But, with help from USAID and its own resources, SC also worked with young women who were already mothers. In line with SC's approach to ARSH, reaching out to teen mothers was understood to involve recognising the whole person - a mother's physical, mental, and social health. SC chose to reach out to teen mothers primarily as teens, with similar needs and interests as their peers, and secondarily as mothers and wives.

Specifically, SC set up Teen Mothers Clubs (TMCs) to provide young mothers with a venue in which to discuss their common concerns - openly and without stigma - and to get support from fellow teen mothers and friends. Each TMC met once or twice a week, with members facilitating their own meetings. Typical discussion topics in a TMC meeting: independence, self-reliance, and economic opportunity; self-esteem; return to school; domestic violence prevention and outreach; negotiating FP and condom use with a partner; benefits and side effects of FP use; safe motherhood and birth spacing; preventing STIs and HIV; and care of the newborn. The TMCs were also considered a convenient space for reaching teen mothers, who SC claims have higher unmet need for FP than their non-parent peers. Each club was linked to one or more local youth CBD agents who could provide FP information, advice, and methods, including oral contraceptives and condoms. Male outreach workers connected with husbands of teen mothers as a strategy to increase FP use and increase frequency of communication about FP.

TMC members linked their group meetings to outreach to other teenagers. Club members went door to door; performed music, dance, and drama; and participated in community meetings. "The main focus of our community outreach is to educate other adolescents about unwanted pregnancy and the difficulties of being a teen mother," explained one TMC member.

A key programme strategy was involving parents, community leaders, teachers, and chiefs - so-called "gatekeepers" due to their important role in youths' lives. In one such activity, a team of 4 gatekeepers, plus 2 in-school teen mothers and one teacher, raised awareness with community members and schoolgirls about the benefits of FP and the dangers of teen pregnancies. In one event, a Traditional Authority Chief stood in the presence of 5 village chiefs and more than 200 community members and advocated that parents should delay marrying off their daughters and instead keep them in school. SC also invited initiation counsellors - the women and men who guide children's initiation into adulthood - to attend an ARSH workshop where FP messages were developed and incorporated, along with HIV prevention practices, into messages passed on to initiates.

The above-described strategies were also reflected in SC's efforts to raise awareness about the Ministry of Education (MoE) policy on teen mothers' re-enrollment in school (see Key Points, below), the importance of re-enrollment, and young women's right to re-enroll. Community members and parents were encouraged to support mothers' education and learned of the benefits to the women, their children, and communities as a whole. Teachers and school officials also learned of the readmission policy and the importance of supporting teen mothers' return to and retention in school. Youth CBD agents also promoted return to school. SC staff visited and counselled some of the teen mothers, preparing them to be assertive and prevent pregnancies before achieving their educational goals. Further, SC worked with local non-governmental organisations (NGOs), the District Education Office, and secondary schools to locate financial assistance for young mothers wishing to re-enroll. Finally, project staff encouraged teens who had returned to school to participate actively in TMCs alongside those who had not, so that members could learn from each others' experience.

Girls and Women, Reproductive Health, Education.

Figures cited by SC indicate that Malawi's total fertility rate is high (5.6 children per woman) and contraceptive prevalence is low (28%). The adult HIV/AIDS prevalence rate is 15%, and young Malawian women are 3-5 times more likely than young men to be infected with HIV. Upwards of 20% of people aged 15 to 23 are HIV-positive. Even so, only 6% of sexually active 15- to 19-year-old women report using condoms.

Nearly 30% of Malawian girls aged 15 to 19 report being married, and one-third of adolescent women will have been pregnant or given birth by the time they reach 20. Most of these births occur within marriage or in union, yet pregnancy among unmarried teens has increased in recent years. Teen pregnancy is associated with poor health outcomes for woman and baby, but can also entail stigmatisation of young mothers, school dropout, and decreased likelihood that an adolescent will resume schooling after her baby is born. Traditionally, young women who are already mothers are expected to devote themselves wholly to their children and husbands, and this includes dropping out of school and ceasing to socialise with their peers.

In Malawi, 31% of girls complete primary school and 11% graduate from secondary school. Girls' dropout rate is higher than boys'; it is attributed to family responsibilities, early marriage, and pregnancy. In 1993, the Malawian MoE passed a law allowing teen mothers to return to school after the birth of a child. The policy dictates that a pregnant teen must write a letter withdrawing herself from school while she is pregnant. She must wait at least 6 months after the baby is born before reapplying for admission, at which time she must send two requests: one to the MoE and one to the school. She can be readmitted only once; if she drops out of school a second time she will be permanently expelled. SC found that most teachers, parents, and students were not aware of this policy. Young mothers in Mangochi rarely re-enrolled, and the few who tried reported discrimination and ridicule.