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Davidzoyashe Makosa
Correspondent
There is a time to keep silent. This is certainly not one of them for me. I have been reading and watching the discussion around removal of restrictions for children to access reproductive health services and I am deeply concerned by one petition made to Parliament. I know I am one among many.
Today I am taking up my midwifery role in contributing to the safe delivery of our children and future generations into the future God has ordained for them.
If you were just about to dismiss me as a self-righteous moral preacher, I urge you to indulge me just a little while longer. For what it is worth I am by no means perfect and have made many mistakes, including wrong moral choices and so my disposition is not meant to judge anyone, but shed light.
Not only am I a specialist obstetrician and gynaecologist who has practiced both in public and private, I have served the nation in the Family Health Department of the Ministry of Health and Child Care where I was directly responsible for coordinating the nation’s reproductive, maternal, new-born and adolescent health programmes, interventions as well as give technical advice on reproductive health policy.
I am also a mother and one of my sons has just transitioned into adolescence.
A few years ago, I wrote an article in one of the local papers in my personal capacity on “The Dangers of teen sex.”
Little did I know this is where I would be five years later. Having had the privilege to serve in this domain in various capacities, I would like to humbly submit a few insights.
Firstly, I would like to address the issue of numbers, figures, or statistics. The petition submitted to Parliament quotes a teenage pregnancy rate of 22 percent. This I suppose is extracted from the Zimbabwe Demographic Health Survey of 2015 (ZDHS 2015) which states that: “In Zimbabwe, 22 percent of women age 15-19 years have begun childbearing.”
It is critical that whenever a statistic is flagged, we analyse and interpret the data presented and apply the knowledge appropriately.
Let us look at the breakdown of this 22 percent. Table 5.11 of the ZDHS 2015 on teenage pregnancy and child motherhood reveals that, of the teenagers who had begun child bearing at the time of the survey: Nearly half (48,3 percent) were 19-year-olds, 31 percent were 18-year-olds, 21,4 percent were 17-year-olds, 9,4 percent were 16-year-olds and 3,2 percent were 15-year-olds.
To put this into perspective, the majority of the 22 percent that is being flagged in the petition to parliament were 18 and 19-year-olds, accounting for nearly 80 percent of teenage mothers.
The same table also shows that the risk of pregnancy was higher in those with lower levels of education with 37,8 percent having attained only primary education while those who attained secondary level education contributed 17,3 percent and the contribution of those who had gone beyond secondary education was minimal.
Risk of pregnancy was also associated with wealth quintile with the lowest quintile contributing the greatest margin. Rural girls were also shown to be at higher risk. A similar association is shown when analysing median age at first sexual intercourse.
More educated women were shown to wait longer before having sex, with almost a six-year difference in the median age at first sexual intercourse among women with no education and those with more than a secondary education (16,4 years compared with 22,1 years). This really is about social determinant factors and inequities.
In addition, the ZDHS 2015 also states that the median age at first sexual intercourse is 18,7 years, while the median age of marriage among women is 19,8 years.
Regarding trends, the ZDHS also states that since 1999, the median age at first sexual intercourse among women aged 25-49 years has remained constant at 18,7 years. Among the men, the median age at first sexual intercourse increased from 19,7 years in 1999 to 20,5 years in 2015.
Over the same 16-year period women age 25-49 years engaging in sex by age 18 has remained steady at about 4 in 10 women. Just from this basic analysis, we can tell just how possibly deceptive and potentially dangerous it is to simply state the 22 percent without providing context.
I could almost choke in tears as I read a response to the obituary of a colleague in one of the medical journals. His story alerted me to the danger of quoting statistics casually.
The author of this rapid response to the obituary, Dr Mark Houghton quoted the late Dr Bernard Nathanson in the following texts:
“We fed the public a line of deceit, dishonesty, a fabrication of statistics and figures. We succeeded (in breaking down the laws limiting abortions) because the time was right, and the news media cooperated. We sensationalised the effects of illegal abortions, and fabricated polls which indicated that 85 percent of the public favoured unrestricted abortion, when we knew it was only 5 percent. We unashamedly lied, and yet our statements were quoted (by the media) as though they had been written in law.”
In NARAL (National Association for Repeal of Abortion Laws) we generally emphasised the drama of the individual case, not the mass statistics, but when we spoke of the latter it was always 5 000 to 10 000 a year. I confess that I knew the figures were totally false, But in the “morality” of our revolution, it was a useful figure, widely accepted, so why go out of our way to correct it with honest statistics? (Bernard Nathanson, Richard Ostling. Aborting America. Pinnacle Books. New York 1979)
For the record, I am by no means implying that the writers of the petition have inflated figures as Dr Bernard Nathanson would later confess to have done. I am simply alerting that there is a danger of misrepresenting facts when figures are not given in context and that at worst statistics can be used to push an agenda, hence we must do our due diligence.
I would still want to look at two more national documents before I move from the contentious issue of numbers. The National Adolescent Fertility Study Technical Report of 2016 revealed that overall nine percent of the adolescent girls aged 10-19 years had ever been pregnant and that the proportion of adolescent girls who had ever been pregnant increased with age with the 18 and 19-year-olds accounting for the majority, contributing 33 percent.
This latter trend is similar to what is revealed by the ZDHS 2015. The authors of the adolescent fertility study technical report state that the percentage of adolescents aged 10-14 years who had ever been pregnant was quite negligible at 0,2 percent that it did not warrant further analysis.
The Multiple Indicator Cluster Survey of 2019 (MICS 2019) revealed that 17,6 percent of girls aged 15-19 years had a live birth, 0,7 percent of these were under 15. These trends seem to tally with the ZDHS 2015 and the National Adolescent Fertility Study which show also show an increase in risk of pregnancy with age. Of note the MICS 2019 also revealed that 44 percent of the girls who fell pregnant belonged to two religious sects.
There are many facets to this issue, but I thought to just shed light on the story behind the statistics. Numbers if not interpreted well can be misleading. Our perception on what the issue is about will determine our solutions. Children and youth are the future of any nation. Therefore, anything that affects them requires scrutiny and the full attention of any nation as a matter of national security.
National reports reveal alarming figures that 70 percent of sexual abuse survivors are children (Family Health Report 2019). What would happen to this figure if restrictions should be removed? Is this really a just health issue or a moral issue with effects in health, education, economics, and many other domains? Has health inadvertently become an excuse for destroying our longstanding moral values?
Have we imagined what the nation would look like in 20-40 years’ time should we pass this as law and destroy family values? What is next? Should we lower the age of alcohol purchase or consumption because we have children who drink anyway? Should we start selling alcohol at school tuckshops?
We know social factors that contribute to early sexual debut, early pregnancy, and marriage. Perhaps we must focus on addressing these in our respective capacities as individuals, families, professionals, communities, churches, and various organisations. Perhaps we should be talking more about the other “R— Responsibility.
As families we need to take responsibility for the orphans in our extended families. Fostering has always been part of us. This is part of the “ubuntu” that we so love to talk about. Perhaps we should be asking how can we keep our children longer in school and do something about it?
I strongly recommend harmonisation of the age of sexual consent, consent to marriage, consent to accessing health services including reproductive health services at the legal age of majority.
Dr Davidzoyashe Makosa is an obstetrician and gynaecologist and former deputy director of Reproductive Health Services in the Ministry of Health and Child Care. She writes in her personal capacity.
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