by Lakshi Upananda
Published on The Morning on 11th April 2024.
Reproductive health is a crucial aspect of overall well-being, particularly for women living in urban slums where access to healthcare services may be limited. Colombo is home to a significant population living in slum areas, and the reproductive health of women in these communities is a matter of concern. In recent years, there has been an increasing focus on addressing the reproductive health needs of women in Colombo slums, with particular emphasis on tackling issues such as teenage pregnancies.
One of the key reproductive health challenges faced by women in Colombo slums is the high prevalence of teenage pregnancies. According to the World Health Organization (WHO), teenage pregnancy is defined as pregnancy occurring in girls aged 19 or younger. In slum communities, where poverty, lack of education, and limited access to healthcare services are prevalent, teenage pregnancies pose a significant risk to the health and well-being of young girls and their children. These pregnancies often result in adverse outcomes, including higher rates of maternal and infant mortality, as well as increased risk of complications during childbirth.
Current Situation
The current situation of teenage pregnancy in Sri Lanka is a pressing issue that has far-reaching implications for the well-being of young girls and the community as a whole. According to recent statistics, the rate of teenage pregnancy in Sri Lanka has been steadily increasing over the past decade, with young girls from low-income households being particularly vulnerable (Sevanatha, n.d.). This alarming trend has raised serious concerns about the socio-economic and public health implications of teenage pregnancy, prompting a closer examination of its underlying causes.
Multiple interrelated factors contribute to the prevalence of teenage pregnancy in Sri Lanka. Firstly, inadequate access to comprehensive sexual and reproductive health education plays a significant role in putting young girls at risk. Many adolescents lack access to accurate information about reproductive health, which can lead to unintended pregnancies. In Sri Lanka, most teenage pregnancies are unintended since pregnancies before adulthood are a socially, culturally, and most importantly health-wise taboo. The reason is, that they face higher risks of eclampsia, puerperal endometritis, and systemic infections. Additionally, unwanted pregnancies are more likely to have resulted from the unprotected sexual conduct of many unmarried teens in Asian countries including Sri Lanka.
Social and cultural norms that stigmatize discussions about sex and contraception further perpetuate the problem. Childbearing and pregnancy during early adolescence is unwelcome in many Asian societies including Sri Lanka because it will usually reduce the mother’s social position and contribution to society. Unfortunately, however, large numbers of adolescents in many South Asian countries continue to have children, even though many governments and institutions have attempted to minimize the incidence of adolescent childbearing.
Economic disparities and poverty along with limited access to resources such as sanitary facilities are also major contributors to the high rates of teenage pregnancy in Sri Lanka. Most women and girls in slums use pipe-borne water and common lavatories which is a serious issue when it comes to their reproductive health. Young girls from low-income households further face limited access to educational and economic opportunities, which can lead to early marriage and childbearing as a means of financial stability. Additionally, the lack of comprehensive support systems for pregnant teenagers, including access to healthcare services and social support, further exacerbates the challenges faced by these vulnerable adolescents.
Teenage pregnancy is a significant issue that has many consequences, spanning biological, sociological, economic, and cultural aspects.
Biologically, teenage pregnancy can have adverse effects on both the mother and the child. Teenage mothers are at a higher risk for complications during pregnancy and childbirth, such as preterm labour, low birth weight, and pre-eclampsia (Chatterjee et al 2007). These complications are the main threats and causes of morbidity and mortality among adolescent girls. Further, these can have long-term consequences for both the mother and the child, impacting their physical and mental well-being. Not only do a large number of adolescent abortion seekers die every year in the Asian region another large proportion suffer due to abortion complications, including haemorrhage, septicaemia, cervical and vaginal lacerations, pelvic abscess, and secondary sterility (CPO, 1990).
Further, increased sexual behaviour and lower use of contraception result in more adolescents being exposed to sexually transmitted diseases (STDs). Where data on STD levels is available, the highest rates occur in 15-19 and 20-24 years old. According to reports, five to six per cent of people attending STD clinics in Sri Lanka are also adolescents. In Sri Lanka, 27 per cent of the neonates of illiterate mothers had low birth weight compared with 11 per cent of those born to mothers with A-level education or more. These illiterate mothers no doubt are the early dropouts from school.
Additionally, teenage mothers may face challenges in completing their education and pursuing career opportunities, which can perpetuate a cycle of poverty and limited opportunities for themselves and their children. Early school dropouts in slums are a major cause of the youth's inability to foresee respectable occupations in the future. Under such circumstances, teenage mothers might be forced to engage even in heavy physical labour. Whether the labour is done outside or within her home, it could harm her overall health including reproductive health. An adolescent mother is put in a riskier environment in this scenario. Even worse, unmarried teenage girls, after giving birth may engage in one or more dangerous activities, such as prostitution, drug trafficking, alcohol sales, or domestic help for more vulnerable households, due to financial instability.
On a sociological level, teenage pregnancy can have far-reaching implications for the individuals involved, their families, and their communities. Teenage mothers often face discrimination, which can lead to social isolation and limited support networks. This can exacerbate the challenges they face in raising their children and navigating their transition to adulthood. Children born to teenage mothers are more likely to experience adverse health and developmental outcomes. Furthermore, they may experience social and emotional difficulties, as they may be more likely to grow up in single-parent households and face economic hardship.
From an economic perspective, teenage pregnancy can place significant financial burdens on families and societies. The costs of prenatal care, childbirth, and child-rearing can strain the resources of teenage mothers and their families, potentially leading to intergenerational poverty. Additionally, teenage mothers as mentioned above as well, are more likely to experience lower education levels and reduced earning potential, impacting their ability to contribute to the economy and support their families. This can also place a burden on social welfare systems and public services, as they may need to provide support for teenage mothers and their children.
Culturally, teenage pregnancy can be influenced by societal attitudes and norms surrounding sexuality and reproductive health. In some communities, there may be limited access to comprehensive sex education and reproductive health care, leading to higher rates of teenage pregnancy. The attitude and behaviour of the service providers may also discourage adolescent girls from seeking antenatal and postnatal care which is vital to their reproductive health and the health of newborns. Further, even though contraceptives have been made available to young women, legal restrictions and limited access still make use difficult. Additionally, cultural attitudes towards motherhood and premarital sex can shape how teenage mothers are perceived and treated by their communities, potentially exacerbating the challenges they face.
On a micro level, teenage pregnancy can have individualized impacts on the mental and emotional well-being of the individuals involved. Teenage mothers may experience heightened stress, anxiety, and depression as they navigate the responsibilities of parenthood while still developing their sense of identity and purpose. Similarly, the children of teenage mothers may face challenges in forming secure attachments and developing a sense of stability and security, which can impact their long-term well-being.
Way forward
To address the issue of teenage pregnancy in Sri Lanka, it is crucial to implement comprehensive and evidence-based interventions such as providing comprehensive sex education, addressing the underlying social and economic factors that contribute to teenage pregnancy and bringing about community-based interventions that engage parents, caregivers, and other influential figures in the lives of young people. Adolescents' generally good health has relegated adolescent health, particularly reproductive health, to a low priority for health professionals and policymakers. While young girls and boys face many other health problems which relate to their overall well-being, reproductive health issues are the major health concern of female adolescents. For a large number of girls, adolescence can be best defined as the period which starts with the premature end of education and ends with the premature start of pregnancy and childbearing or even death.
Firstly, there is a need for widespread implementation of age-appropriate sex education in schools and communities, but it is still an issue how this should be implemented, due to the cultural differences present in Sri Lanka. At the adolescent age, young people are just starting to navigate the changes in their bodies and the onset of sexual maturity. It is crucial to provide comprehensive sexuality education that is age-appropriate, accurate, and inclusive. This education should cover topics such as anatomy, puberty, menstrual health, as well as sexual and reproductive rights. Furthermore, it should address issues surrounding boundaries, and healthy relationships, as well as information about sexually transmitted infections (STIs) and HIV/AIDS. By equipping young people with accurate information, they can make informed decisions about their sexual and reproductive health. Even though this is a prominent necessity that should be addressed as quickly as possible we witnessed how religious leaders resisted when it was once proposed that sex education should be included in the school curriculum (Fernando, 2022). The policymakers and relevant authorities should work towards a comprehensive approach to achieve this.
Additionally, there is a need to improve access to reproductive healthcare services, including contraception and prenatal care, particularly for vulnerable populations. International agencies and NGOs are needed to play a key role in encouraging countries to adopt needed policies and programs that support adolescent reproductive health services. The country may need to consider different strategies, starting from age-appropriate sex education to inclusive reproductive health services for improving adolescent reproductive health at different stages of their development. Supportive, non-judgmental, and youth-friendly health services that are tailored to adolescents’ specific needs should be put in place. It should be ensured that everyone receives these healthcare services equitably.
Legislation and policies that protect the rights of adolescents and promote gender equality are also crucial in addressing the underlying societal factors that contribute to teenage pregnancy. Laws and public policy can be used to formulate programs that are intended to improve adolescents’ reproductive health status. Furthermore, it is essential to provide support and resources for teenage mothers to ensure that they can continue their education and pursue economic opportunities. This includes targeted interventions such as childcare support, vocational training, and access to affordable and quality healthcare services. Empowering teenage mothers to take control of their futures is essential for breaking the cycle of poverty and improving the overall well-being of their children is a major measure that everyone needs to focus their attention on.
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* Ms. Lakshi Upananda is an Intern (Research)at the Institute of National Security Studies (INSS), the premier think tank on National Security established and functioning under the Ministry of Defence. The opinion expressed are her own and not necessarily reflective of the institute or the Ministry of Defence.