Between March 2022 and March 2023, 553 girls in the Eastern Cape between the ages of 10 and 14 gave birth, according to the latest statistics from the provincial department of health.

However, only 60 cases of statutory rape arising from these pregnancies were opened.

Early-age pregnancies take a devastating toll on mothers and children. 

Out of the 493 maternal deaths reported in the province over the past three years, four were mothers aged 10-14, while there were 17 neonatal deaths due to premature birth in that maternal age group.

Between 2020 and 2023, 1,841 girls aged 10 to 14 gave birth at public health facilities in the province.

Between 2020 and 2022, 17,740 teenagers aged 15 to 19 gave birth at state hospitals in the province.

‘An enormous toll’

Dr Mfundo Mabenge, a veteran of several decades in the public health sector and the head of Dora Nginza Hospital’s Department of Obstetrics and Gynaecology, still gets emotional when he talks about teenage pregnancy.

“It takes an enormous toll on us to handle these traumatic pregnancies,” he said.

Mabenge said very young expectant mothers often hide their pregnancies and do not receive any antenatal care.

“They are not screened for potentially fatal conditions like pre-eclampsia, anaemia and HIV, they don’t eat well and they don’t supplement. We are seeing huge problems with anaemia. It causes preterm deliveries, severe bleeding after the baby is born and can result in the death of the child,” Mabenge said.

Pre-eclampsia, a high blood pressure disorder that occurs during pregnancy, can be fatal.

“We often see early-onset pre-eclampsia in teenagers who are pregnant. This also impacts on the babies as it results in them being growth-restricted,” Mabenge said.

“Something that we don’t speak about a lot is that the babies of teenage moms are often born with congenital abnormalities. As we often do not screen them as they do not seek antenatal care, we miss this and then we find it after the baby is born.

“The majority of teenagers only arrive at the hospital when they are already in labour. They are uncooperative. They haven’t had any antenatal classes, they do not know how to manage their pain and they often persistently refuse care from health workers.

“It is really difficult to help them and to monitor them and this would often result in unfavourable outcomes.”

He said that very young mothers often develop cephalo-pelvic disproportion because of the strain that pregnancy and labour put on the bones.

Postpartum depression

Apart from the physical dangers, Mabenge has observed many teenage mothers suffering from “postpartum blues” that turn into postpartum depression.

“The babies are not what they want. They refuse to bond with the child and we have many who refuse to breastfeed because they are keen to keep their young figures intact.

“Many don’t want the responsibility of breastfeeding. They want to go back to their lives,” he said.

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He said there was a strong link between an increase in teenage pregnancy and an increase in child abandonment.

“The sharp increase in teenage pregnancy during the Covid-19 pandemic has and still is putting a huge burden on us in the public sector,” he said. “This is a very emotional situation for us to deal with.”

It was important that teenagers be made more aware of contraception choices.

“Many of the teenagers we see have never used contraception. It is too late to get contraception if they are already sexually active, as many get pregnant the first time they have sex. Education on contraception must start early and before teenagers are sexually active,” he said. “We have to accept that most teenagers will experiment with sex.”

He said a huge change in the attitude of public healthcare staff at clinics was needed. “Nobody should threaten a teenager to tell their parents if they come to a clinic and ask for contraception.”

Clinics, he said, should make provision for teenagers to come after school and access counselling and contraception services. “I have seen many instances where clinic nurses are refusing to accommodate the teenagers after school.”

He called for the establishment of discreet pregnancy confirmation centres at places frequented by young people, such as shopping malls.

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“We offer counselling and safe abortion services but if the teenagers only come to us when they are in labour it is too late. 

“I also want to stress that it doesn’t help for parents to refuse permission for their children to receive counselling options on the contraceptive options available to them. 

“In 2007 and 2008, a group of nurses and I went to schools in Nelson Mandela Bay to talk to young teenagers about contraception. It became a big issue and parents fought with us. At the time, the teacher told us that half the school was already sexually active — and this was a primary school,” he said.

“Parents must understand that for some of the girls, a pregnancy will mean the end of their academic careers.”

Mabenge said they were seeing a disturbing trend among young, pregnant teenagers.

“Their partners are much older men and many are working. Technically, it is statutory rape and we report these cases to social workers and the SAPS. But the parents more often than not know about this relationship and benefit in some way from it, so we get no cooperation in pursuing a criminal case.

“Teenage pregnancy is a very traumatic event for everyone involved. You end up not knowing what to do. I think of every one of these girls as my own children. It really gets you.”

Reducing teen pregnancies

The Eastern Cape Department of Health’s director of re-engineering primary health, Nokuthula Sopiseka, leads a team that has reduced the incidence of teenage pregnancy in parts of the province.

“For now, we are concentrating on the places with the highest rates of teenage pregnancy,” she said.

“We are looking at incremental reductions and we have managed a 7% overall reduction, which is a huge improvement already. For now, we are focusing on rural schools,” she said.

Sopiseka said it was important to discuss contraception with children. But, she said, parents were not signing consent forms for their children to receive counselling on contraception.  

“We are working with the school governing bodies to also have dialogues with parents,” she said.

“I wouldn’t want my girl to fall pregnant. Teenage pregnancy affects lives in a very real way and it is a major risk factor for future issues.”

She said communities had an important part to play in reducing teenage pregnancies. “Teenagers need something to do and a safe place for their activities. Otherwise, there is a big risk that they can fall prey to men. 

“We are intervening at the clinics to create a system for teenagers where they can make an appointment so they don’t have to stand in line and feel embarrassed. We also have a system where they can come after school.” 

She is happy with what they have achieved. “I don’t think we will ever have zero teenage pregnancies, but we do what we can.”

Cases underreported

“If last year’s pregnancy rate is anything to go by, then statutory rape cases are being significantly underreported. We can accurately assume that less than a quarter of all the births by girl children have been reported as statutory rape,” the Democratic Alliance’s Jane Cowley said.

Doctors have often reported how families refuse to open rape cases as the rapist is the only breadwinner in the house or is in another position of power.

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“These pregnancies and subsequent births by underage girls have a devastating impact on the psychosocial welfare of young moms and massive socioeconomic implications for their families. It also increases the burden on the provincial government, which has to ringfence resources from several departments to support them,” Cowley said.

The acting head of the Eastern Cape Department of Health, Sindi Gede, said in a written reply to the legislature that pregnant children are referred to social workers for management and counselling. 

“There is no policy that guides the healthcare workers on actions to take when these incidents occur. The Eastern Cape Department of Health is discussing with the National Department of Health to lead the development of this guiding policy in collaboration with associated departments including the departments of Justice, Police, Social Development, Education, Cooperative Governance and Traditional Affairs and any other affected stakeholders.” DM