Counting the costs of childbirth in young girls

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South Africa has made little progress in addressing global nutrition targets. When babies are born to mothers who are still children themselves, some as young as just nine years old, the problem is compounded and likely to persist.

Earlier this month, the department of health reported that more than 65 teenage mothers between the age of 13 and 19 years of age gave birth on New Year’s Day. This was on top of more than 23 000 girls from Gauteng who gave birth between April 2020 and March 2021. Of these, 934 girls were under the age of 14 years old and 14 577 were aged 19 years and below.

This was a 60% increase since the start of the Covid-19 pandemic, which led to interruptions in the schooling system, where some learners did not attend school for many months, or attended on a rotational basis.

The staggering increase in the number of babies born to pre-teens and teenagers is happening against the backdrop of South Africa’s failure to reach global targets towards maternal, infant and young child nutrition.   

According to the 2021 Global Nutrition report, the country has made no progress towards improving on its birth weight targets, with 14.2% of infants having a low weight at birth. The World Health Organisation (WHO) defines low birth weight as under 2.5 kilogrammes.

There has also been no progress towards achieving the target for eradicating stunting – an indication of chronic malnutrition in early childhood – with 21.4% of children under five years of age affected. The prevalence of overweight children under aged below five years is 11.6%, although the country seems on course to keep it from rising.

The report further stated that 30.5% of women of reproductive age between 15 and 49 were affected by anaemia, which puts pregnant people at an increased risk of having preterm births. South Africa had intended to reduce the figure by up to 50% by 2025, but this now looks unlikely.

Pre-teen and teenage pregnancies carry a very high risk of mortality for both mother and baby, according to child nutrition specialist Dr Chantell Witten from the University of Free State. The health risks are increased as both compete for scarce nutrients during the pregnancy. 

“Pre-teen and teenagers are still growing and they need the nutrition to grow and develop fully, but while pregnant these nutrients are needed by the developing baby, and so both mother and baby fall short, with high rates of micronutrient deficiencies like iron and zinc which can lead to conditions like anaemia,” Witten said.

In the 2020 Child Gauge by the Children’s Institute at the University of Cape Town, low birth weight was said to be an important predictor of malnutrition in childhood. Poor birth outcomes such as prematurity and neonatal mortality were related to maternal health and nutrition status.

The nutritional status of South African children has remained poor for years. 

In a statement welcoming the 1 700 New Year’s babies, the department of health encouraged the mothers to consider exclusive breastfeeding for the first six months, noting that a child’s health was most vulnerable during the first 1 000 days of its life and the right nutrition during this period could have a “profound” impact on its ability to develop and learn.

Witten, however, argues that the absence of a breastfeeding policy within the schooling environment means pre-teen and teenage mothers would not be supported to breastfeed at school.

Research from 2018 showed that although teenage mothers initiated breastfeeding, about 30% of those under 17 years stopped early, while others experienced breastfeeding problems, according to senior researcher and demographer at the University of South Africa’s (Unisa) Institute of Gender Studies, Dr Sibusiso Mkwananzi.

The recommendation for exclusive breastfeeding has been shown to be hampered by the need for underage mothers to return to school,” she added.

A social movement that supports mothers, Embrace, believes that the stigma experienced by pre-teens and teenagers when pregnant and the absence of comprehensive breastfeeding information and support contributes to their inability to breastfeed once their babies are born.

“Teenage mothers hold a dual identity as adolescents and mothers, and this intersectionality has its own complexities,” said Embrac’s advocacy and communications strategist Nonkululeko Mbuli.

“Firstly, the stigma of teenage pregnancy has been shown to have implications for their experiences of the healthcare system. As mothers, teenagers who struggle to breastfeed exclusively for six months are made to feel like they are giving their babies their second-best if they do not breastfeed.”

In her 2017 research, Mkwananzi found that most partners of underage mothers were  older than their female partners and the majority of these were adult men. For adolescent girls aged between 12 and 14 years old, up to 88% of their partners were between 15 and  24 years old. 

In South Africa, at least on paper, the age of consent is 16. Children aged between twelve and sixteen can consent to sex with each other, as long as the age gap is not more than two years and the older partner is not over 18. Any sex with someone younger than 12 is illegal. 

“To prevent further similar cases it is important to firstly start asking the right questions: Who is impregnating these young girls? And what happens to cases of known statutory rape as well as cases of pregnancy below the age of 12 years?” Mkwanazi said.

“Investigation and incarceration of such men, as the law stipulates, would be a step in the right direction,” Mkwananzi said, adding that she supported the department of basic education’s policy compelling teachers to report pregnancies at schools to the police.