Credit: Michael Duff/UNFPA

By External Source
Apr 13 2022 (IPS)

The United Nations Population Fund recently released the 2022 State of World Population report. It highlights that almost half of all pregnancies between 2015 and 2019 were unintended. That amounts to roughly 121 million unintended pregnancies each year.

Unintended pregnancy is defined as pregnancy among women who were not planning to have any (more) children. This includes pregnancies that occurred earlier than desired. The report also says over 60% of unintended pregnancies end in abortion. And 45% of all abortions performed globally are unsafe. About 7 million women a year are hospitalised as a result.

While the global rate of unintended pregnancies in Europe and North America was 35 per 1,000 women aged 15 to 49, in sub-Saharan Africa it was 91 per 1,000 women. Within the region it ranged from 49 in Niger to 145 in Uganda

Up to 257 million women who want to avoid pregnancy are not using safe, modern contraception methods. And about a quarter of all women are not able to say no to sex.

A closer look at regional estimates shows how far behind African countries are in preventing these unplanned pregnancies and protecting the reproductive rights of women and girls. While the global rate of unintended pregnancies in Europe and North America was 35 per 1,000 women aged 15 to 49, in sub-Saharan Africa it was 91 per 1,000 women. Within the region it ranged from 49 in Niger to 145 in Uganda.

The drivers of unintended pregnancies in sub-Saharan Africa are complex and operate at individual, household, community and policy levels. Understanding them is important to develop policies and effective interventions to reduce unintended pregnancies and unsafe abortion in the region.

In my view, based on research done in a number of African countries, the high rate of adolescent childbearing in Africa could be the main factor contributing to the stark regional differences reported.

Drivers of unintended pregnancy

At the individual level, poverty, lack of autonomy and low education attainment limit women’s and girls’ access to accurate contraceptive information and services. Some women and girls simply cannot afford to pay for contraceptives. In places where contraceptives are freely available, some women lack accurate knowledge of them and how they work.

In some settings, people interpret religion as prohibiting contraceptive use. They use religion to deny young people accurate contraceptive information. When women and girls lack access to accurate contraceptive information and services, their risk of unintended pregnancy increases.

In a study conducted by the African Population and Health Research Center, adolescent girls in Kenya told us they got pregnant because they were young and naive about relationships and contraceptives. Some of them had to exchange sex for their basic needs. Others were sexually violated. Because they did not seek care in clinics or know about emergency contraception, they were vulnerable to unintended pregnancy. Some had dropped out of school.

At household level, parents seldom communicate well about methods of preventing pregnancy. Where they do talk about it, they focus on abstinence rather than contraceptives, and they sometimes use fear tactics. Another household driver is insufficient financial support from the family, pushing girls into transactional relationships.

Quality contraceptive services consist of accurate and sensitive counselling, a wide range of options, and well trained providers. Research has shown that in communities where such services are available and accessible, more women and girls are able to plan their pregnancies.

However, access to quality services is lacking in many African communities. Stock-outs remain a problem for family planning programmes. The COVID-19 pandemic also disrupted the supply of contraceptives and services.

Unintended pregnancies are far higher in gender unequal communities and countries compared to more gender equal countries. Sociocultural norms sometimes discourage women and girls from exercising their choice to use contraceptives, including condoms.

Policy and legal constraints continue to limit access to comprehensive sexuality education and safe abortion in most African countries. Most African countries offer students some sexuality education in response to the HIV epidemic. But what they offer is far from comprehensive and is mostly abstinence-based.

The global gag rule reinstated by the Trump administration also limited access to family planning. This is a US federal policy that prohibited foreign nongovernmental organisations that received US international family planning assistance from using their own, non-US funds to support abortion services in any way.

Many countries in Africa depend on donor funds for their family planning programmes. The global gag rule meant a significant reduction in funding for programmes and clinics providing access to contraceptives for millions of women in Africa. Some programmes and clinics had to close or downsize.

Ways forward

The relationship between social and economic development and unintended pregnancy goes both ways. When women and girls are not empowered or lack autonomy, they are less likely to use contraceptives. They are prone to unintended pregnancy.

Unintended pregnancy, especially among young people, can be disempowering. It can prevent girls and young women from getting the education and skills they need to improve their economic prospects and productivity. Breaking this cycle of early unintended pregnancy is critical to realising socio-economic development in Africa.

Given the deep and lifelong effects of unintended pregnancy on women, their families and society, decision-makers and health systems should prioritise the prevention of unintended pregnancy. This would entail increasing access to quality contraceptive services, particularly in resource-poor settings, and expanding access to sexual and reproductive health information, especially for boys and girls.

Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research Center

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A pregnant woman waits in line for a medical check-up. Health indicators for women on Sri Lanka’s tea estates are lower than the national average. Credit: Amantha Perera/IPS

By Kanya D'Almeida
COLOMBO, Sep 23 2014 (IPS)

A mud path winds its up way uphill, offering views on either side of row after row of dense bushes and eventually giving way to a cluster of humble homes, surrounded by ragged, playful children.

Their mothers either look far too young, barely adults themselves, or old beyond their years, weathered by decades of backbreaking labour on the enormous tea estates of Sri Lanka.

Rani* is a 65-year-old mother of six, working eight-hour shifts on an estate in Sri Lanka’s Central Province. Her white hair, a hunched back and fallen teeth make her appear about 15 years older than she is, a result of many decades spent toiling under the hot sun.

She tells IPS that after her fifth child, overwhelmed with the number of mouths she had to feed, she visited the local hospital to have her tubes tied, but gave birth to a son five years later.

“If women are the primary breadwinners among the estate population, generating the bulk of household revenue in a sector that is feeding the national economy, then maternal health should be a priority." -- Mythri Jegathesan, assistant professor in the department of anthropology at Santa Clara University in California
Though she is exhausted at the end of the day, and plagued by the aches and pains that signal the coming of old age, she is determined to keep her job, so her children can go to school.

“I work in the estates so that they won’t have to,” she says with a hopeful smile.

Her story is poignant, but not unique among workers in Sri Lanka’s vast tea sector, comprised of some 450 plantations spread across the country.

Women account for over 60 percent of the workforce of abut 250,000 people, all of them descendants of indentured servants brought from India by the British over a century ago to pluck the lucrative leaves.

But while Sri Lankan tea itself is of the highest quality, raking in some 1.4 billion dollars in export earnings in 2012 according to the Ministry of Plantation Industries, the health of the labourers, especially the women, leaves a lot to be desired.

Priyanka Jayawardena, research officer for the Colombo-based Institute of Policy Studies of Sri Lanka, tells IPS that “deep-rooted socio-economic factors” have led to health indicators among women and children on plantations that are consistently lower than the national average.

The national malnutrition rate for reproductive-age mothers, for instance, is 16 percent, rising to 33 percent for female estate workers. And while 16 percent of newborn babies nationwide have low birth weight, on estates that number rises significantly, to one in every three newborns.

A higher prevalence of poverty on estates partly accounts for these discrepancies in health, with 61 percent of households on estates falling into the lowest socio-economic group (20 percent of wealth quintile), compared to eight percent and 20 percent respectively for urban and rural households.

Other experts say that cultural differences also play a role, since estate populations, and especially tea workers, have been relatively isolated from broader society.

“Many women are uneducated, and tend to be careless about their own health, and the health of their children,” a field worker with the Centre for Social Concern (CSC), an NGO based in the Nuwara Eliya district in central Sri Lanka, tells IPS.

“They have a very taxing job and so spend less time thinking about food and nutrition,” she states.

In fact, as Jayawardena points out, only 15 percent of under-five children on estates have a daily intake of animal protein, compared to 40-50 percent among rural and urban populations.

The same is true for daily consumption of yellow vegetables and fruits, as well as infant cereals – in both cases the average intake among children on estates is 40 percent, compared to 60 percent in rural and urban areas.

Breastfeeding patterns are also inadequate, with just 63 percent of estate workers engaging in exclusive breastfeeding for the first four months of a child’s life, compared to 77 percent in urban areas and 86 percent in rural areas, according to research conducted by the Institute of Policy Studies.

The situation is made worse by the demands of the industry. Since many women are daily wage labourers, earning approximately 687 rupees (just over five dollars) each day, few can afford to take the required maternity leave.

But even when alternatives are provided by the estate management, experts say, a lack of awareness and education leaves children without proper attention and care.

Jayawardena tells IPS that almost half of all women on estates drop out of school after the primary level, compared to a national dropout rate of 15 percent. Literacy levels are low, and so even awareness campaigns often fail to reach the targeted audience.

Many female estate workers are daily wage labourers, earning approximately 687 rupees (just over five dollars) each day. Credit: Anja Leidel/CC-BY-SA-2.0

“Women on the estates do not believe they have many options in life beyond working on the plantations,” the CSC field officer says.

“Most are extremely poor, and from childhood they are exposed to very little – there are hardly any playgrounds, libraries, gathering places or social activities on the estates. So they tend to get married early and become mothers at a very young age.”

Though the national average for teenage pregnancies stands at roughly 6.4 percent, it shoots up to ten percent among estate workers, resulting in a cycle in which malnourished mothers give birth to unhealthy babies, who will also likely become mothers at a young age.

“If women are the primary breadwinners among the estate population, generating the bulk of household revenue in a sector that is feeding the national economy, then maternal health should be a priority,” Mythri Jegathesan, assistant professor in the department of anthropology at Santa Clara University in California, tells IPS.

“Any form of agricultural labour is hard on the body, and many of the estate workers in Sri Lanka work until they are seven or eight months pregnant. They need to be acknowledged, and more attention given to their wellbeing and health,” she adds.

Several NGOs and civil society organisations have been working diligently alongside the government and the private sector to boost women’s health outcomes.

According to Chaaminda Jayasinghe, senior project manager of the plantation programme for CARE International-Sri Lanka, the situation is changing positively.

The emergence of the Community Development Forum (CDF) introduced by CARE in selected tea estates is providing space and a successful model for inclusive development for estate communities, he tells IPS.

This has already resulted in better living conditions and health outcomes among estate communities while mainstreaming plantation communities into the larger society.

*Not her real name.

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.