Early unintended pregnancy can have negative consequences for adolescent girls and young women. Not only may their health be at risk; so may their education , economic mobility and productivity.
Preventing early unintended pregnancy is an integral part of all major global and regional developmental agendas. The Sustainable Development Goals, for example, address sexual and reproductive health rights in goals 3 and 5 . It is also a focus of many governments and developmental partners. But despite over two decades of action and advocacy, very little and uneven progress has been made in the sub-Saharan Africa region.
The rate of adolescent pregnancy is generally high in the region – as high as 40% in Mozambique . In South Africa, the proportion of women aged 19 who had begun childbearing was 28% in 2016. Sexual violence is also widespread in the country. South Africa has the highest rate of rape in the world with 132.4 incidents per 100,000 people .
But little research has been done to explore any link between early unintended pregnancy and sexual violence.
Most efforts to understand and prevent early unplanned pregnancy have focused on access to information on contraceptives and related services as well as poverty . Existing studies do suggest that sexual violence plays a role in unwanted pregnancies, though.
To add to the body of knowledge about this, we conducted a study among adolescents and young women in South African universities. We found an association between sexual violence and unintended pregnancy. Girls who had experienced sexual violence were more likely to report an unintended pregnancy compared with those who had never experienced sexual violence.
Our study was conducted among university students aged 17-24, who were unmarried and sexually active between June and November 2018. We defined unintended pregnancies as those that were mistimed, unplanned, and unwanted at the time of conception. We defined sexual violence as sexual acts, or attempts to obtain a sexual act, by violence or coercion by any person, irrespective of their relationship to the victim. We asked participants if they had ever experienced any act of sexual violence, including unwanted and inappropriate touching of genitalia, coerced sex and rape.
In our analysis, we accounted for the contributions of other factors such as age, religion and the number of children participants already had. We also considered the impact of recreational drug use, alcohol use, relationship status, family's socioeconomic support, ability to communicate sexual experiences with parents, and parenting styles.
About two out of five adolescent girls and young adults had experienced an unintended pregnancy. A quarter of these pregnancies ended in abortion. In addition, two out of five of the girls in the study had experienced sexual violence at some time in their life, and one in five did so before her 16th birthday. Two-thirds of the perpetrators had some forms of relationships with the victims. Boyfriends and friends were more likely to be the violators. Over half (54.4%) of the participants who had experienced sexual violence reported an unintended pregnancy. It's important to note that the pregnancy was not necessarily from the incident of sexual violence. Among those who had never experienced sexual abuse, 34.3% had had an unintended pregnancy.
Our findings are similar to other studies conducted outside Africa.
There are several ways that sexual violence and unintended pregnancy may be associated. For example, studies have found that sexual violence leaves no room for the victim to negotiate condom use. Also, sub-optimal awareness of emergency contraception and accessibility of emergency contraception , as well as stigma and social exclusion, result in many victims of sexual violence being unable to receive care. This also leaves them vulnerable to unwanted pregnancy. Other than getting pregnant, victims of sexual violence also face an increased risk of sexually transmitted infections , injuries, stress, anxiety, and depression .
The consequences of both sexual violence and early unintended pregnancy are far-reaching and lifelong. Comprehensive and integrated efforts are needed to address the two issues.
It is critical to broaden young people's knowledge of sexual and reproductive health and rights. Boys and men should be made aware of the damaging effects of sexual violence, and taught that they don't have a right to dominate women. Responsible decision making about sex should be encouraged.
These interventions should happen more rigorously in schools, and at religious or community events – to ensure that out-of-school adolescents are not left out.
Parents, caregivers and guardians should additionally take responsibility for teaching these important lessons at home.
Read more: How parents should talk to their children about sex
Authorities should also investigate properly when cases of sexual assaults are reported. They must ensure justice is served to restore confidence and encourage reporting of sexual violence. Providing judgment-free victim support will further encourage other victims to speak up.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
By Anthony Idowu Ajayi, Postdoctoral Research Scientist, African Population and Health Research Center