Reproductive health is a crucial aspect of overall wellbeing, particularly for women living in urban slums where access to healthcare services may be limited. Colombo is home to a significant population living in slum areas, and the reproductive health of women in these communities is a matter of concern.
One of the key reproductive health-related challenges faced by women in Colombo slums is the high prevalence of teenage pregnancy. According to the World Health Organisation, teenage pregnancy is defined as pregnancy occurring in girls aged 19 years or younger. In slum communities, where poverty, the lack of education, and limited access to healthcare services are prevalent, teenage pregnancy poses a significant risk to the health and wellbeing of young girls and their children. These pregnancies often result in adverse outcomes, including higher rates of maternal and infant mortality, as well as the increased risk of complications during childbirth.
Current situation
According to recent statistics, the rate of teenage pregnancy in Sri Lanka has been steadily increasing over the past decade, with young girls from low-income households being particularly vulnerable.
Multiple interrelated factors contribute to the prevalence of teenage pregnancy in Sri Lanka. Firstly, inadequate access to comprehensive sexual and reproductive health education plays a significant role in putting young girls at risk. Many adolescents lack access to accurate information about reproductive health, which can lead to unintended pregnancies. In Sri Lanka, most teenage pregnancies are unintended since pregnancies before adulthood are socially, culturally, and most importantly health-wise, taboo. The reason is that they face higher risks of eclampsia (a person with preeclampsia develops seizures/convulsions during pregnancy), puerperal endometritis (postpartum infection of the deciduas/pregnancy endometrium that can affect all layers of the uterus), and systemic infections. Additionally, unwanted pregnancies are more likely to have resulted from the unprotected sexual conduct of many unmarried teens in Asian countries including Sri Lanka.
Social and cultural norms that stigmatise discussions about sex and contraception further perpetuate the problem. Childbearing and pregnancy during early adolescence are unwelcome in many Asian societies including Sri Lanka because it will usually reduce the mother’s social position and contribution to society.
Economic disparities and poverty along with limited access to resources such as sanitary facilities are also major contributors to the high rates of teenage pregnancy in Sri Lanka. Most women and girls in slums use pipe-borne water and common lavatories, which is a serious issue when it comes to their reproductive health. Young girls from low-income households further face limited access to educational and economic opportunities, which can lead to early marriage and childbearing as a means of financial stability. Additionally, the lack of comprehensive support systems for pregnant teenagers, including access to healthcare services and social support, further exacerbates the challenges faced by these vulnerable adolescents.
Impact
Biologically, teenage pregnancy can have adverse effects on both the mother and the child. Teenage mothers are at a higher risk for complications during pregnancy and childbirth, such as preterm labour, low birth weight, and pre-eclampsia. These complications are the main threats and causes of morbidity and mortality among adolescent girls. Further, these can have long-term consequences for both the mother and the child, impacting their physical and mental wellbeing. Not only do a large number of adolescent abortion seekers die every year in the Asian region, another large proportion suffers due to abortion related complications, including haemorrhage, septicaemia, cervical and vaginal lacerations, pelvic abscess, and secondary sterility.
Further, increased sexual behaviour and the lower use of contraception result in more adolescents being exposed to sexually transmitted diseases (STDs). Where data on STD levels is available, the highest rates occur in 15-19-year-olds and 20-24-year-olds. According to reports, 5%-6% of people attending STD clinics in Sri Lanka are also adolescents. In Sri Lanka, 27% of the neonates of illiterate mothers had low birth weight compared with 11% of those born to mothers with General Certificate of Education Advanced Level education or more. These illiterate mothers no doubt are the early dropouts from school.
Additionally, teenage mothers may face challenges in completing their education and pursuing career opportunities, which can perpetuate a cycle of poverty and limited opportunities for themselves and their children. Early school dropouts in slums are a major cause of the youth's inability to foresee respectable occupations in the future. Under such circumstances, teenage mothers might be forced to engage even in heavy physical labour. Whether the labour is done outside or within her home, it could harm her overall health including reproductive health. An adolescent mother is put in a riskier environment in this scenario. Even worse, unmarried teenage girls, after giving birth, may engage in one or more dangerous activities, such as prostitution, drug trafficking, alcohol sales, or domestic help for more vulnerable households, due to financial instability.
Teenage mothers often face discrimination, which can lead to social isolation and limited support networks. This can exacerbate the challenges that they face in raising their children and navigating their transition to adulthood. Children born to teenage mothers are more likely to experience adverse health and developmental outcomes. Furthermore, they may experience social and emotional difficulties, as they may be more likely to grow up in single parent households and face economic hardship.
From an economic perspective, teenage pregnancy can place significant financial burdens on families and societies. The costs of prenatal care, childbirth, and child rearing can strain the resources of teenage mothers and their families, potentially leading to intergenerational poverty. Additionally, teenage mothers are more likely to experience lower education levels and reduced earning potential, impacting their ability to contribute to the economy and support their families. This can also place a burden on social welfare systems and public services, as they may need to provide support for teenage mothers and their children.
In some communities, there may be limited access to comprehensive sex education and reproductive health care, leading to higher rates of teenage pregnancy. The attitude and behaviour of the service providers may also discourage adolescent girls from seeking antenatal and postnatal care which is vital to their reproductive health and the health of newborns. Further, even though contraceptives have been made available to young women, legal restrictions and limited access still make their use difficult. Additionally, cultural attitudes towards motherhood and premarital sex can shape how teenage mothers are perceived and treated by their communities, potentially exacerbating the challenges that they face.
On a micro level, teenage pregnancy can have individualised impacts on the mental and emotional well-being of the individuals involved. Teenage mothers may experience heightened stress, anxiety, and depression as they navigate the responsibilities of parenthood while still developing their sense of identity and purpose. Similarly, the children of teenage mothers may face challenges in forming secure attachments and developing a sense of stability and security, which can impact their long-term wellbeing.
Way forward
To address the issue of teenage pregnancy in Sri Lanka, it is crucial to implement comprehensive and evidence based interventions such as providing comprehensive sex education, addressing the underlying social and economic factors that contribute to teenage pregnancy and bringing about community based interventions that engage parents, caregivers, and other influential figures in the lives of young people. For a large number of girls, adolescence can be best defined as the period which starts with the premature end of education and ends with the premature start of pregnancy and childbearing or even death.
Firstly, there is a need for the widespread implementation of age appropriate sex education in schools and communities, but it is still an issue how this should be implemented, due to the cultural differences present in Sri Lanka. At the adolescent age, young people are just starting to navigate the changes in their bodies and the onset of sexual maturity. It is crucial to provide comprehensive sexuality education that is age appropriate, accurate, and inclusive. This education should cover topics such as anatomy, puberty, menstrual health, as well as sexual and reproductive rights. Furthermore, it should address issues surrounding boundaries, and healthy relationships, as well as information about sexually transmitted infections and human immunodeficiency virus and acquired immunodeficiency syndrome. We witnessed how religious leaders resisted when it was once proposed that sex education should be included in the school curriculum. The policymakers and relevant authorities should work towards a comprehensive approach to achieve this.
Additionally, there is a need to improve access to reproductive healthcare services, including contraception and prenatal care, particularly for vulnerable populations. The country may need to consider different strategies, starting from age appropriate sex education to inclusive reproductive health services for improving adolescent reproductive health at different stages of their development. Supportive, non-judgmental, and youth friendly health services that are tailored to adolescents’ specific needs should be put in place. It should be ensured that everyone receives these healthcare services equitably.
Legislation and policies that protect the rights of adolescents and promote gender equality are also crucial in addressing the underlying societal factors that contribute to teenage pregnancy. Furthermore, it is essential to provide support and resources for teenage mothers to ensure that they can continue their education and pursue economic opportunities. This includes targeted interventions such as childcare support, vocational training, and access to affordable and quality healthcare services.
(The writer is a Research Intern at the Institute of National Security Studies, under the Defence Ministry. The opinions expressed are her own and not necessarily reflective of the Institute or the Ministry)
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(The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of this publication)