Adolescent girls, illegal abortions and “sugar-daddies” in Dar es Salaam: vulnerable victims and active social agents

https://doi.org/10.1016/S0277-9536(00)00299-9Get rights and content

Abstract

Adolescent girls’ early sexual activity, early pregnancy, induced abortions and the increase in HIV infections have become major concerns in Sub-Saharan Africa. Efforts, though, to understand their sexual behaviour and to prevent reproductive health problems are almost non-existent. Adolescent girls are normally seen as victims and easy preys of (often older and married) men's sexual exploitation. This article, which is based on a qualitative study of 51 adolescent girls who had just had an illegal abortion in Dar es Salaam, Tanzania, reveals that these girls are not only victims but also willing preys and active social agents engaging in high-risk sexual behaviour. In order to get material benefits they expose themselves to serious health risks, including induced abortion — without realising their own vulnerability. In our study, one out of four girls had more than one partner at the time they became pregnant, and many counted on an illegally induced abortion if they got pregnant. Even if adolescents are now allowed free access to family planning information, education and services, our study shows that this remains in the realm of theory rather than practice. Moreover, most adolescent girls are not aware about their right to such services. The paper concludes that the vulnerability of adolescent girls increases without the recognition that sexuality education and contraceptive services do not constitute a licence to practice illicit sex — but rather a means to create more mature and responsible attitudes and to increase sexual and reproductive health.

Introduction

Promoting adolescent sexual and reproductive health — in particular that of girls — in the developing world has become a major issue on the international agenda. Close to 17 million girls under the age of 20 give birth each year. Most of these pregnancies are unplanned, and it is estimated by the WHO that as many as 4.4 million abortions are sought by adolescent girls each year (WHO, 1998). In addition, more than 50% of all new HIV infections occur among the 15–24 years old, with young girls being at particular risk from contact with older men (Key actions for further implementation of the ICPD Programme of Action, 1999).

The issue of induced abortion in most sub-Saharan countries is highly controversial — as the heated discussions at the International Conference on Population and Development in Cairo in 1994 clearly reflected. The issue is even more controversial when it concerns adolescent girls, who are not expected to be sexually active, though it has been repeatedly documented that they are (Bledsoe & Cohen, 1993). Their early sexual activity is generally attributed to fundamental socio-economic change, the erosion of moral codes, familial control and abandoned rituals such as initiation ceremonies which served to prepare adolescents for their roles and responsibilities as adults. As such, early sexual activity is perceived as a moral problem.

Adolescent girls’ ‘illegitimate’ sexual activity, unintended pregnancies, induced abortions and deteriorating sexual and reproductive health are often linked to the fact that young girls are objects of (older) men's choices. The ‘sugar daddy’ phenomenon which is particularly widespread in African cities is well described in the literature (see, for example Mpangile, Leshabari, Kayaa, & Kihwele, 1996; Haram, 1995; Komba-Malekela & Liljeström, 1994; Bledsoe & Cohen, 1993). With increasing awareness of HIV/AIDS, these men are now increasingly blamed for luring younger, ‘safer’ girls who are hopefully too young to be infected by HIV into sexual relations by promising them some degree of financial security. The character, though, of these relationships, the role that these men play in the girls’ lives, the use of contraceptive measures and the degree of male involvement in the girls’ induced abortion are not well described.

In Tanzania, adolescent girls’ sexual activity is on the rise, and their unwanted pregnancies and illegal abortions constitute a major threat to their sexual and reproductive health (UMATI, 1994; Tanzania Demographic and Health Survey (1993), Tanzania Demographic and Health Survey (1996)). In order to obtain a deeper insight into sensitive and less visible aspects of such adolescent girls, a qualitative study was undertaken in a hospital setting in Dar es Salaam. The aim was to understand illegal abortions in a broader socio-economic and cultural context — to acquire an in-depth knowledge of adolescent girls’ sexual activity, their relation with their partners, to find out whether the girls were ‘lured’ into unprotected sexual activity, or if they were active social actors themselves. Emphasis was also made to explore their access to contraceptives, and the factors that influenced them to have an illegal and expensive abortion. Although Tanzania's Strategy for Reproductive Health and Child Survival 1997–2001 (1997) does give priority to adolescents’ reproductive health, there are no well co-ordinated programmes that address adolescents’ sexual and reproductive health needs and issues. Consequently, our aim was also to contribute knowledge for future reproductive health initiatives aimed at adolescent girls.

Section snippets

Background

Only very few African countries (e. g. Zambia, Burundi and recently South Africa) permit induced abortion for reasons other than those threatening life. Elsewhere, induced abortions being illegal, the number of safely induced abortions in sub-Saharan Africa is unknown. According to the WHO, 5,000,000 unsafe abortions are performed annually in Africa; these abortions constitute 13% of all maternal deaths (WHO, 1998). In Tanzania, illegal abortions are punishable by imprisonment of up to 14 years

Methods

The present study was carried out in Dar es Salaam, the capital of Tanzania, which has about two million inhabitants and is divided into three districts. Each district has one district hospital, and the city has one referral hospital. The data collection took place at district hospital level in one of the districts.

From July to September 1997, a group of adolescents registered in the admission book with the diagnosis ‘incomplete abortion’ were approached consecutively. Fifty-one adolescents who

Identification of respondents

All 51 girls interviewed were unmarried. Their age varied from 15 to 19 (on average 17.5). They had different ethnic backgrounds. Eighteen of them were Christians and 33 were Muslims. Twenty-five of them (close to 50%) were still in school and resided with their parents or relatives. The other 26 girls (51%) who were employed as house girls, barmaids or engaged in petty trade, stayed in a room at their workplace or rented a room. Nineteen girls (27%) had finished primary school. Age at time of

Discussion

According to Bledsoe and Cohen (1993), becoming pregnant deliberately is often a strategy for obtaining a husband and gaining in social status. Linked to this, most adolescent girls seem to believe that the need to find a suitable husband and begin a family far outweighs the costs to their education and career opportunities (ibid). However, none of the girls in our sample — but for five — had any intention of ‘trapping’ a husband. Also, even if their relationships seemed fairly stable, the fact

Concluding observations

Although this study was carried out in Tanzania, the issue of illegal induced abortions has wider implications. As do the issues of adolescent sexuality, family planning, abortion, communication with one's partner, STD/HIV as well as male responsibility. In Sub-Saharan Africa — as elsewhere in the world — these issues are pertinent, and at the forefront of public health discussions. At the Cairo+5 conference meeting in the Hague (1999), adolescents’ sexual and reproductive health was regarded

References (51)

  • M. Fuglesang

    Lessons for life — past and present modes of sexuality education in Tanzanian society

    Social Science & Medicine

    (1997)
  • G.S. Mpangile et al.

    Factors associated with induced abortion in public hospitals in Dar es Salaam, Tanzania

    Reproductive Health Matters

    (1993,[object Object])
  • Bamurange, V., 1998. Relationships for survival — young mothers and street youths. In H.K. Rwebangira & R. Liljeström...
  • G.K. Barker et al.

    Influences on adolescent sexuality in Nigeria and KenyaFindings from recent focus-group discussions

    Studies in Family Planning

    (1992)
  • T. Barnett et al.

    Aids in AfricaIts present and future impact

    (1992)
  • Bledsoe, C. H., & Cohen, B. (Eds.), (1993). Social dynamics of adolescent fertility in sub-Saharan Africa. Washington:...
  • Brundtland, G. H. (1999). Statement: ICPD+5 forum, The Hague, 8–12 February...
  • Centre for Reproductive Law and Policy, 1999. Implementing adolescent reproductive rights through the convention on the...
  • A. Justesen et al.

    Abortions in a hospital settingHidden realities in Dar es Salaam, Tanzania

    Studies in Family Planning

    (1992)
  • The Hague International Forum (1999). Draft report. Netherlands Congress Centre (NCC), The Hague, Netherlands, 8–12...
  • Haram, L., 1995. Negotiating sexuality in times of economic want: The young and modern Meru women. In: Klepp,...
  • S.H. Kapiga et al.

    Predictors of AIDS knowledge, condom use and high-risk sexual behaviour among women in Dar es Salaam, Tanzania

    International Journal of Sexually Transmitted Diseases and AIDS

    (1995)
  • S.H. Kapiga et al.

    Reproductive knowledge and contraceptive awareness and practice among secondary school pupils in Bagamoyo and Dar es Salaam, Tanzania

    Central Africa Journal of Medicine

    (1992)
  • Key actions for further implementation of the ICPD Programme of Action (1999). Report of the Secretary-General for the...
  • Kissling, F., (1993). Abortion. The link between legality and safety. Reproductive Health Matters, 1 (2),...
  • Kinoti, S. N., Gaffikin, L, Benson, J., & Nicholson, L. A. (1997). Monograph on complications of unsafe abortion in...
  • Klepp, K.-I., Biswalo, P. M., & Talle, A. (Eds.) (1995). Young people at risk. Fighting AIDS in Northern Tanzania....
  • Komba-Malekela, B., & Liljeström, R., 1994. Looking for men. In Z. Tumbo-Masabo, & R. Liljeström (Eds.), Chelewa,...
  • Kulczycki, A., Potts, M., & Rosenfield, A. (1996). Abortion, & fertility regulation. The Lancet, 347 (9016), 1663–1668....
  • Leshabari, M. T., & Kaaya, S. F., (1996). From blame to potential solutions: Reproductive health problems among youth...
  • M.T. Leshabari et al.

    From teenage unwanted pregnancy to induced abortionwho facilitates the links?

    International Journal of Adolescence and Youth

    (1994)
  • Leshabari, M. T., & Rwebangira H. K. (1992). Vulnerability of school teenagers to the AIDS virus in Tanzania: What...
  • Leshabari, M. T. (1988). Factors influencing school adolescents’ fertility behavior in Dar es Salaam, Tanzania. Ph.D....
  • Liljeström, R., Masanja, P., Rwebangira, H. K., & Urassa, E. J. N. (1998). Cultural conflicts and ambiguities. In K. R....
  • K.S. Mnyika et al.

    Determinants of high-risk sexual behaviour and condom use among adults in the Arusha region, Tanzania

    International Journal of Sexually Transmitted Diseases and AIDS

    (1997)
  • Cited by (222)

    • Beyond the law: Misoprostol and medical abortion in Dar es Salaam, Tanzania

      2020, Social Science and Medicine
      Citation Excerpt :

      As an example, Silberschmidt and Rasch have problematized the vulnerability that accompanies female sexual agency in Dar es Salaam. Within a system of poor access to sexual and reproductive health services, adolescent's agency puts girls often unknowingly at risk of exploitation and need for abortion (Silberschmidt and Rasch, 2001). In line with the thinking of critical medical anthropologists like Farmer (2004) and Scheper-Hughes (2004), it is important to consider the lack of influence marginalized and stigmatized individuals have on the systems that surround them, despite elements of agency and empowerment.

    View all citing articles on Scopus
    View full text