The Sunday Mail
Unmasking 22: A closer look at the figures on adolescent sexuality
By Dr DavidzoyaShe Makosa
“Deliver those who are drawn away to death, and those who totter to the slaughter, hold them back [from their doom]. If you [profess ignorance and] say, Behold, we did not know this, does not He Who weighs and ponders the heart perceive and consider it? And He Who guards your life, does not He know it? And shall not He render to [you and] every man according to his works?” (Proverbs 24 v 11-12 AMPC)
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 and I know I am one among many.
Today I choose to take 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. I have been taught to give back and several years ago, Someone paid a heavy price to deliver me from slaughter and doom. Today, I would like to shed light by sharing some insights which might lead to deliverance.
I would also like to highlight that not only am I a specialist obstetrician and gynaecologist who has practised both in public and private, but I have served the nation in the Family Health Department of the Ministry of Health and Child Care where I was directly responsible for co-ordinating the nation’s Reproductive, Maternal, New-born and Adolescent Health programs, 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.” https://www.sundaynews.co.zw/dangers-of-teen-sex/ Little did I know this is where 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%. This I suppose is extracted from the Zimbabwe Demographic Health Survey of 2015 (ZDHS 2015) which states that: “In Zimbabwe, 22% 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%. 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%) were 19 year olds, 31% were 18 year olds, 21.4% were 17 year olds, 9.4% were 16 year olds and 3.2% were 15 year olds. To put this into perspective, the majority of the 22% that is being flagged in the petition to parliament were 18- and 19-year olds, accounting for nearly 80% 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% having attained only primary education while those who attained secondary level education contributed 17.3% 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 6 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 20.5years 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% 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 sensationalized the effects of illegal abortions, and fabricated polls which indicated that 85% of the public favoured unrestricted abortion, when we knew it was only 5%. We unashamedly lied, and yet our statements were quoted [by the media] as though they had been written in law.’
(quoted in John Powell, Abortion: the silent Holocaust. Tabor, Allen, Texas. 1981.)
‘How many deaths were we talking about when abortion was illegal? In NARAL (National Association for Repeal of Abortion Laws) we generally emphasized 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. I would like to extract some data from the National Adolescent Fertility Study Technical Report of 2016. The adolescent fertility study revealed that overall 9% 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%.
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% that it did not warrant further analysis.
The Multiple Indicator Cluster Survey of 2019 (MICS 2019) revealed that 17.6% of girls aged 15-19 years had had a live birth, 0.7% of these were under 15 years old. 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% 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.
Dr Myles Munroe could not have put it any better.
“The richest resource of every nation is the next generation incubating in its national womb – its children, its youth, its babies. Every nation is pregnant with a future generation, and the neglect of that generation is abuse of the future… We must, therefore, at all costs understand, protect and preserve the seed-the next generation.”(Dr Myles Munroe-foreword of The Battle of the Seed by Dr Patricia Morgan)
I would like to pose a few questions before I conclude. National reports reveal alarming figures that 70% 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? (Someone once said they had read this somewhere: “if we lived the consequences of our actions in our minds before making a decision, we would probably make the right decisions most of the time”).
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? And what about the children who are struggling with drug abuse, should we start providing them with smaller doses of drugs within the school or home so they can indulge safely?
Does the argument they are doing it anyway justify lowering the age of consent? Is that the way we have decided to start solving problems as a nation? So, if a child can now seek health services without parental consent, who pays the bills? But more importantly who will render them support, after they are diagnosed with a condition or disease? What really is driving this push? I could keep asking questions, but I shall conclude.
We know the 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? Perhaps we should be seeking how we can empower our children holistically, spirit, soul, and body to make the right decisions.
Parents, we need to ask ourselves, who is raising our children? Have we abdicated our responsibilities? We should be equipping ourselves on how best to support our children including those who have already indulged. It may be difficult to stop but it is not impossible.
A young lady who was apparently once sexually active but has since stopped wrote on her face book page: “Bear in mind even adults with access to all these have unwanted pregnancies and STIs. Do we legalise cocaine because more people are taking cocaine? The solution is hard but I believe the solution lies in instilling values and morals in our children… teach children what is right and when they mess up, love them and encourage them to desire what is right. Let us not give up on our children too easily… they can surprise you – I surprised many.”
Perhaps we should also be asking ourselves how can we make communities accountable that we do not have hot spots where children are married off under the guise of culture or religion and we pay a blind eye? We should each be asking ourselves, what role can I play to preserve the future of our nation by investing in our children. Whatever, we decide to do, under no circumstances should we allow ourselves to sell the future of our nation for a bowl of soup or otherwise. We need to stand resolute on the definition of a child according to our constitution.
I would 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. There are systems in place to handle any outlier situations to protect our children and their rights.
Let me conclude with a quote from the best seller of all time. This Scripture is one reason I chose to share what I know today. Its warning has kept me awake many a time, drove me to tears but also fanned my passion for sharing knowledge.
“My people are destroyed for lack of knowledge; because you [the priestly nation] have rejected knowledge, I will also reject you that you shall be no priest to Me; seeing you have forgotten the law of your God, I will also forget your children.”(Hosea 4 v 6)
References
- Zimbabwe National Statistics Agency and ICF International. 2016. Zimbabwe Demographic and Health Survey 2015: Final Report. Rockville, Maryland, USA: Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International.
- Ministry of Health and Child Care (2016). Zimbabwe National Adolescent Fertility Study, Harare: MoHCC Technical Report authored by Dr Naomi Wekwete, Prof Simbarashe Rusakaniko and Mr George Zimbizi (Consultants)
- Zimbabwe National Statistics Agency (ZIMSTAT) and UNICEF (2019). Zimbabwe Multiple Indicator Cluster Survey 2019, Survey Findings Report. Harare, Zimbabwe: ZIMSTAT and UNICEF.
- Houghton M. (2011) Rapid Response: How the abortion movement started with deceit and lies–Dr Nathanson BMJ 2011;342:d1358: Retrieved from: https://doi.org/10.1136/bmj.d1358
- Scripture quotations taken from the Amplified® Bible (AMPC), Copyright © 1954, 1958, 1962, 1964, 1965, 1987 by The Lockman Foundation
* Dr Bernard Nathanson was an Obstetrician and gynaecologist who ran one of the largest abortion clinics in the USA before becoming a pro-life advocate. Born in New York City, NY, USA, on July 31, 1926, he died there from cancer on Feb 21, 2011, aged 84 years. A more detailed account of Dr Nathanson’s story can be found in the book “What If We’ve Been Wrong: Keeping My Promise to America’s Abortion King.” By Terry Beatley published in 2016.
Disclaimer: 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. The contents of this article are the responsibility of the author and do not reflect the views of any organisation.
