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