In Nigeria, adolescent pregnancies are an often-undesirable situation that occurs disproportionately in educationally and economically under-privileged females (Undiyaundeye, Agba, & Mandeun, 2015). The continued high prevalence of adolescent pregnancies, coupled with the increased risk of negative social and health consequences on both the mother and child, makes this issue one of increased importance in Nigeria. However, effective policy regarding this issue is limited. As indicated in both the 3rd and 4th Sustainable Development Goals (SDG), “reducing adolescent childbearing through universal access to sexual and reproductive health-care services are critical” (United Nations, 2017) with quality education, especially sex-education, being major predictors of adolescent pregnancy prevalence (UNPF, n.d.). As a result, it is suggested that a comprehensive program is provided for adolescent females between the ages of 12 and 19 in Nigeria that focuses on the following:
- Early, comprehensive sex education that is mandatory across the country
- Access to adolescent-friendly sexual and reproductive health services
- Education and employment opportunities in low-income communities for adolescent females
Teenage pregnancy is a concern in Nigeria due to high prevalence and the health and social implications that adolescent pregnancy has on both the mother and the child. Nevertheless, little is done about the issue due to ineffective policy and social stigma surrounding “sex talk” (NPC, 2014). Over 23% of 15-19-year-old Nigerian women have had a child or are pregnant with their first child with large increases occurring between the ages of 17 and 18 as indicated in figure 1 (NPC, 2014). However, this prevalence is not homogenous throughout the country. 32% of adolescents in rural areas reported to have started childbearing compared to 10% in urban areas (NPC, 2014). In addition, of the adolescents who report having a child or being pregnant, twice as many are in the lowest wealth quintile and half have no education. Although, a lack of education and profitable employment seem to influence adolescent pregnancy rates, getting pregnant while in school also impacts continuing education with many teenage mothers eventually dropping out of school due to school policy, embarrassment, and/or parent’s refusal to pay school fees (Lagos State Government, 2017). Thus, representing the social implications that education and poverty can have on adolescent pregnancy prevalence and how adolescent pregnancy propagates the continuation of the poverty and low-education cycles in future generations.
When reviewing health implications, adolescent mothers are at an increased risk of eclampsia, endometritis, anemia, and infections throughout pregnancy and labor (WHO, 2018). This is due to physiological immaturity and a delay in seeking care due to embarrassment and the possible social implications if seen entering a clinic (Oyedele, 2017). In addition, children born to adolescents face a greater risk of low birthweight, preterm delivery, and severe neonatal complications (WHO, 2018). For those who decide that they want an abortion, a procedure that is illegal in the country, outcomes are grim. 72% of deaths of females under the age of 19 years a result of abortion complications (Lagos State Government, 2017). Despite these consequences, only a few organizations and policies work to prevent adolescent pregnancies and address the risks that adolescents face when pregnant. This policy brief aims to discuss these current measures and examine their shortfalls so as to recommend strategies that can be implemented in the country to prevent and mitigate adolescent pregnancies.
Nigeria experiences an overwhelmingly high burden of adolescent pregnancies. Many of these pregnancies are associated with adverse maternal and child health and socioeconomic status for both the mom and child. However, there are few, effective national policies that work to address this issue in the country. As a result, it is suggested that a comprehensive policy program be provided for adolescent females between the ages of 12 and 19 in Nigeria that focuses on the provision of sex-education, sex and reproductive health resources, and employment opportunities to address the health and socioeconomic factors associated with adolescent pregnancy.
Current polices and organizations
Comprehensive, adolescent-friendly health services are critically low within the country and many policies regarding adolescent sexuality and reproductive health remain unclear. In 1995, Nigeria created a National Adolescent Health Policy that stated, “sexually active adolescents who seek contraceptive services shall be counselled and served where appropriate” (UNFPA, 2017). This was interpreted to mean that parental consent was not required, and it was up to the provider to allow for reproductive health services (UNFPA, 2017). However, this still left the reproductive health of adolescents up to adult bias and has continued to reinforce a lack of care for sexually-active adolescents (UNFPA, 2017). Although the age to receive sexual/reproductive health services is unclear, the national age of sexual consent is lawfully considered to be 18. Despite this national law being created to protect against rape or sexual assault and therefore impact the prevalence of unintended pregnancies, it has created a reluctant atmosphere amongst adolescents who are underage and may need to seek out reproductive health services (UNFPA, 2017). Furthermore, in 2000, Nigeria adopted the National Sexuality Education Curriculum which mandates that sexuality education for 4th to 6th graders and 7th to 9th graders be provided in school (UNFPA, 2017). However, implementation and material are state specific making country-wide implementation inconsistent, with information that focuses on disease prevention and abstinence and prohibits condom and contraception use (UNFPA, 2017). Overall, policy has had minimal effectiveness in the country, indicating that this is an area of primary concern when implementing nation-wide interventions.
Despite a lack of policy, there have been a few successful organizations addressing this issue throughout the country (Oyedele, 2017). A youth sexual health unit called “Hello Lagos” has several centers across the state that promote sex education, provide condoms, and train health workers to be less condemnatory towards adolescent sexual behavior (Oyedele, 2017). In areas where early marriages are more common, organizations are encouraging teenage mothers to-be to access health care services (Oyedele, 2017). Lastly, the RAiSE Foundation is increasing awareness among “faith-based and cultural organizations”, to encourage young mothers to get both antenatal and postnatal care (Oyedele, 2017). Nigeria must adopt the beliefs of these organizations and translate their work into national policies that assist adolescents. Ultimately, more needs to be done on the national and local government forefront to effectively and clearly address the sexual and reproductive health of adolescents so that adolescent pregnancies can be prevented and actively managed when they do occur.
There are three recommendations that can be made to the Federal Ministry of Health that will help prevent early pregnancies and mitigate the health risks when adolescent pregnancies occur:
1. Early, comprehensive sex education that is mandatory across the country
Given that current policy is not implemented cohesively amongst all states and information is not being taught the same way or about the same material, a sex education program should be developed that encourages adults to break the stigma of discussing safe-sex and teach adolescents about abstinence and contraception so that they are well-informed. In addition, a study by Ochiogu et al. (2011) suggest that current timing of such sex education should be earlier due to the high occurrence of pregnancies in the age classes when sex education was occurring.
2. Access to adolescent-friendly sexual and reproductive health services for sexually active adolescents and pregnant adolescent mothers
Health centers like Hello Lagos should be mandated throughout the country, specifically in high-risk communities, that focus on education and the provision of sexual and reproductive health services to adolescents. Contraceptives should be available if needed, with counseling given about safe-sex. In addition, for women who are pregnant, services should be provided in a non-judgmental, adolescent-friendly setting so that young females are encouraged to come and ask questions rather than avoid them from fear of being seen entering such an establishment and being judged by the providers there.
3. Education and employment opportunities in low-income communities for adolescent females
An analysis of teenage pregnancy and prevention in rural Nigeria found that “white-collar” employment was a significant predictor of teenage pregnancy (Amoran, 2012). Given that poor education and low income are both risk-factors of pregnancy, the government should provide an educational program that does not require any cost on the family and an employment program that targets adolescents who may not be able to finish their education.
Increasing education, resources and collaboration whilst decreasing stigma will begin to provide the tools needed to influence adolescent populations and decrease adolescent pregnancies. In addition, we also suggest that these recommendations be carried out through policy that includes all sectors of government in order to address the multidimensional relationship between adolescent pregnancy, health and socioeconomic status. Regardless of the recommendations made above, adolescent pregnancies need to be addressed in some form on both a federal and local scale. By addressing the inequities between regions in health, education and income and understanding why these inequities persist we can begin to address the needs of adolescent females so that this problem is no longer an issue of misfortune.