In her school uniform and sitting in a classroom with rows of wooden desks and blue plastic chairs, Otlotleng Moolikwe (18) looks just like any other Grade 12 pupil. It’s hard to imagine she’s the mother of a four-year-old boy.

Moolikwe says she was 13 when she and her boyfriend first had sex. They had grown up as next-door neighbours and were both in Grade 7. They hadn’t planned on having sex that day, she recounts. “It just happened.”

The two found themselves home alone, and what started simply as making out quickly turned into clothes being shed.

They had both had the abstinence talk – at home and at school – and also knew about using a condom. But in the rushed reality that theoretical knowledge came to naught, Moolikwe says: “The condom slipped off during sex.”

Three months later – and after taking three pregnancy tests – Moolikwe had to accept that she was having a baby.

She recalls: “My mother noticed because she would buy me sanitary pads and then just see them in my wardrobe – unused.”

Let’s talk about sex

Moolikwe grew up in Majankeng in rural North West, just under an hour’s drive from Potchefstroom. The road to her home (she lives with her parents, brother and cousin) runs past farms dotted with cows, goats and chickens. 

Teen pregnancies are frowned upon here. But they happen.

There was a 25% increase in the number of girls between 10 and 14 years old who gave birth in public healthcare facilities in North West from 2017 to 2021, according to an April study published in the South African Medical Journal (SAMJ).

Moolikwe shuffles on the blue plastic chair, staring at the cracks in the plaster of the classroom wall. A breeze blows through the open window, which looks out over a clump of trees and a mountain.

“I knew there was a chance I could be pregnant. But still, when I found out, I was scared,” she says.

In Moolikwe’s community, the default approach to sex education is “just don’t have sex”. But that approach isn’t working.

More than 80% of girls in rural KwaZulu-Natal had some sexual experience by the time they were 13, a 2015 survey found. About one in five were having sex before the age of 15.

Sex itself is not the problem, but rather that children are having sex without contraception. 

According to the 2016 Demographic and Health Survey, one in six girls between 15 and 19 years old have had a child. In 2020, close to 34,000 births in South Africa were from mothers younger than 18 – and more than 600 of them were between 10 and 13. 

The SAMJ study showed that nationally the number of births to teen girls between 10 and 14 years had increased by close to 50% between 2017 and 2021. For those between 15 and 19 births increased by about 18%.

Teenage pregnancy can have serious health complications, such as the risk of developing very high blood pressure that can cause seizures and young girls being more susceptible to bacterial infections that can enter the bloodstream and lead to death if not treated in time.

Also, because their bodies may not yet be fully developed, adolescent girls are more likely to have complications during labour and mothers between 15 and 19 are twice as likely to die during childbirth than those who have babies in their twenties. 

A pregnancy at a young age can also be bad for the baby. The foetus is likely to develop slower when the mom is in her teens and the baby could be born too early, which could raise the risk of the infant dying from complications such as its lungs not being fully developed.

But kids often don’t know how to broach talking about sex and pregnancy – something Moolikwe experienced. Even when she was worried about the chance that she might be pregnant, she wasn’t sure how to bring up the taboo topic with her family.

She recalls: “I couldn’t talk to my parents. I always talked with my friend or my cousin. I’m more comfortable talking with them, because they always listen to me.”

The tangled relationship of teen pregnancy and school dropouts

The worry about teen pregnancies is about more than health risks since it can also disrupt young girls’ education and cause them to drop out of school. This can jeopardise their chances of finding a job later.

There were 3,449 young people who were unemployed and didn’t finish school in the 2019 National Income Dynamics Study. Of these, 81% are women. The most common reason for not looking for a job is responsibilities at home, and one in five said having a baby or being pregnant was the reason they stopped going to school.

“Pregnancy is both a cause and a consequence of school dropout,” the authors of a 2019 paper published in Health Education & Behaviour showed.

The study found that girls who fell pregnant while still in school were twice as likely to drop out than their peers who didn’t get pregnant. Similarly, pupils who left school before completing their studies had a four-times greater risk of falling pregnant than girls who stayed to finish school.

Given South Africa’s high teenage pregnancy rate and the disruptive effect on girls’ schooling, the Basic Education Department introduced a new policy in December to help keep teenage moms in school.

This document says all pupils should have access to sex education and pregnant girls should be allowed to carry on attending classes as long as they can and then be encouraged to return after giving birth.

One plus one makes another one

However, keeping pregnant girls in school is an uphill battle.

In 2021, an update of the earlier National Income Dynamics Study showed that, compared with 2018, triple the number of students between the ages of seven and 17 were no longer in school.

And although it doesn’t specify how teen pregnancies have been affected, a report by the South African Medical Research Council noted that teenage girls struggled to access contraceptives during Covid-19 lockdowns, which, they say, could be part of the reason for the rise in teen pregnancies during the first year of the pandemic. 

That’s a pattern seen at Matsukubyane Secondary School, which Moolikwe attends. 

Tinyiko Rakobela of the HIV prevention organisation Show Me Your Number has been working with pupils at Matsukubyane since 2019. In the past year there have been 16 pregnancies at the school (the school has 1,018 pupils) – a definite spike since pupils started returning after lockdown. Typically, the school saw only one or two pregnancies a year, she says.

“During Covid, kids were at home most of the day, so they had lots of free time and little supervision,” explains Rakobela.

Rakobela says their organisation helps with clinic referrals, offers financial assistance and creates a space for young moms when they need to talk. She helps to answer questions about their relationships and sex, what type of protection to use, where to get contraceptives and how giving consent to sex works.

Moolikwe says: “Without the support of my friends at school and my family, I’m not sure I would have stayed in school.”

She speaks to Rakobela about her relationship with her boyfriend or problems at home, but she also relies on the network of teen mothers at the school.

Moolikwe says: “We can support each other. The others will always come to me and ask me about what kind of things they should be doing when their child is crying.”

Parental guidance advised

When Moolikwe gets home from school, she is greeted by her mom, who takes care of her son. He’s across the street spending the afternoon with his father and paternal grandparents.

When he returns, he heads straight for the floral couch and his grandma immediately pulls him onto her lap.

Moolikwe is preparing to apply to university and is doubling down on studying. 

Her biggest help? Her mom.

“My parents insisted that they would look after the baby so that I could finish school,” she says. “Dropping out was not an option.”

But many girls don’t have a good support system.

Even though the law protects girls’ right to remain in school while pregnant and after giving birth, schools are not obliged to go to extra lengths to make that happen.  

A 2013 report for Partners in Sexual Health, an NGO focused on sexual and reproductive rights, outlines how implementing policies meant to protect girls is “filtered through people’s own views on teenage sexuality, and beliefs about ‘appropriate girls and boys norms’ – and this has led to many violations of these policies”.

So, although girls are not being expelled outright, the culture of stigma around sex and pressure to hide the pregnancy force many to drop out.

And it’s not only school staff who have to come around. 

Says Moolikwe: “I thought that in school children will not judge each other. I thought they’ll just know that we can fall pregnant. But every time when there’s a girl who’s pregnant, they judge her – and most of the time it’s the girls. Sometimes I tell them that you may be judging her today, but tomorrow it could be you.”

That’s why creating a culture of support, at home and in schools, is an important part of helping young girls stay in class. Parents can be an important link in this system, says Réjane Woodroffe, director of the Bulungula Incubator, an NGO that works to improve living conditions in the rural Eastern Cape. 

Part of their strategy is having zero tolerance for dropping out – not just specific to teen pregnancies – and helping pupils to return to school.

Girls who have the backing of their mothers are more likely both to return to school and to complete their studies. Having a parent at home can also help relieve the pressure on the teen mother, who has to study while looking after the baby.

Moolikwe explains: “I’m not the one who raised my child. He was raised by my parents… Sometimes my parents will tell me, ‘This is not your child; this is our last born. So you don’t have to stress yourself’.”

It’s cool to stay in school

During the past few months of her pregnancy, Moolikwe’s world began to narrow down to her home. As her due date drew closer, she wasn’t able to attend class in person. 

A 2021 report from the Zero Dropout campaign explains that pregnancy can interfere with a teenage girl’s education even before the baby is born. Young women are more likely to miss school during the pregnancy, because they have to take time off both before and after giving birth and need regular clinic check-ups. 

The more a pupil misses school, the harder it becomes to continue studying and catch up. A 2012 study from Cape Town found that teen moms were likely to lag behind their non-pregnant peers by more than half a year.

To undo this pattern “you have to support the school as well as the young women”, says Woodroffe.

A study in the ‘South African Medical Journal’ showed that nationally the number of births to girls between 10 and 14 years old had increased by close to 50% between 2017 and 2021. For those between 15 and 19 years, births increased by about 18%. (Photo: Media24 / Gallo Images)

Rather than just introducing a policy that says girls must be allowed to remain in school while pregnant, training should be available to teachers and staff to help them get on board with this decision, she explains.

Woodroffe says some teachers are worried that by accommodating expecting mothers “you’re encouraging young women to fall pregnant while still in school and that this sends a negative message to other learners”. 

Schools also need support in handling potential emergencies and health problems pregnant pupils face. For example, if a student were to give birth at school, there should be a plan for getting her to a healthcare facility and keeping her safe.

But these strategies can’t be left just to the school – it should be a team effort between the school, the pupil and her family, Woofroffe says.

During the later stages of school pregnancies, the Incubator has family members accompany girls all day in case they go into labour – specifically because there are no hospitals close to the rural school the Incubator runs or an ambulance service in the area.

“But it does place a burden on the girl’s family, as they have to sacrifice their time to be with her,” says Woodroffe.

Woodroffe and her team try to keep teen moms in class for as long as possible, because studying at home isn’t always possible. In the part of the Eastern Cape where she works (the Elliotdale district), online study “isn’t really an option”.

“We don’t even have electricity. You have to find a way to charge the device and even if a learner has a cellphone, there isn’t a signal everywhere.”

Ultimately, Woodroffe realised that distance learning was possible only if it could be done with textbooks and worksheets.

Moolikwe’s school took a similar approach. “After school, my friend used to bring me books and assignments,” she says. “My mother used to take me to school so I could write my exams and then bring me back home afterwards.”

This support and hands-on help from her teachers allowed Moolikwe to stay on top of her classwork.

She was considering taking a gap year after matriculating. But her father put his foot down.

She smiles: “He said no child of his will take a gap year, ‘you’re going to varsity’.” DM/MC

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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