by
Sakhile. O.N. Ndingindwayo
Contents
CHAPTER
1
INTRODUCTION
1.0 Background
to the Study
The study sought to explore in detail whether or not
female adolescents (those between 10- 19 years of age) in Chinhoyi town can
fully exercise and enjoy their right to reproductive health- care by having access
to birth control methods as provided for in the Zimbabwean Constitution’s bill
of rights sections 76 (1) and 81(1) (f) which clearly stipulate that, “Every
citizen and permanent resident of Zimbabwe has the right to have access to
basic health care services, including reproductive health- care services,” and
that “Every child, that is to say every boy and girl under the age of eighteen
years, has the right to education, health- care services, nutrition and
shelter.” With such a comprehensive bill of rights which is also the supreme
law of the land, Zimbabwe still records
the highest number of teenage pregnancies in the Sub Saharan region, (National Teenage Fertility Study (2015) cited
in UNFPA, 2017). These teenage pregnancies are usually unintended and result in
generational cycles of socio- economic and health ills that include but are not
limited to child marriage, dropping out of school, poverty, illegal and unsafe abortions,
maternal and neonatal mortality. I went on to inquire what then perpetuates this
high rate of teenage pregnancies when both the international and national human
rights law the Zimbabwean Government is committed to uphold provides for access
to good reproductive health. Good reproductive health implies that every
individual can have a satisfying, safe sex life and the capability to reproduce
as well as the freedom to decide if, when, and how often to do so, (Zimbabwe
National Family Planning Strategy; 2016- 2020). To maintain good sexual and
reproductive health, one needs access to accurate information and the safe,
effective, affordable and acceptable contraception method of their choice.
The
study unearthed that the law in its supremacy has its own limits, there are
other socio- cultural and religious factors that influence adolescent’s uptake
of birth control. A report by the
Office on Women’s Health (2017) asserts that access to birth control services,
products and information is grounded in basic human rights, it is central to achieving
gender equality and women’s empowerment; birth control is of paramount
importance in reducing poverty. Even so, in developing countries, more
than 200 million women who intend not to get pregnant are not using safe and
effective contraceptive methods because of lack of access to information or
services, little or no support from their partners and or communities. The
study’s findings identified some of the above mentioned factors as gaps that contribute
to the less uptake of contraceptives by female adolescents in Chinhoyi even
though the law through the constitution and human rights instruments acceded to
by the Zimbabwean Government clearly stipulate the provision of reproductive
health care to all. These findings are therefore necessary in mending the gaps
between the law and the lived realities of female adolescents.
Birth
control prevents unintended pregnancies, reduces the number of backyard
abortions, and lowers the incidence of death and disability related to
complications of teenage pregnancy and childbirth. Lack of access to birth
control threatens a woman or girl’s ability to develop herself, family and
community. There is therefore need to enlighten communities on the dangers of
teenage pregnancy and the advantages of availing family planning to them
through researches as this one. If all women in developing countries with
an unmet need for
contraceptives were able to use modern methods, an additional 36 million
abortions and 76,000 maternal deaths would be prevented every year, (Office on
Women’s Health, 2017).
1.1 Brief
Overview of Chinhoyi
Chinhoyi
is the Provincial Capital of Mashonaland West Province, one of the ten
administrative Provinces in Zimbabwe, the town lies approximately 121
kilometres by road, northwest of the capital of Zimbabwe along the A1 Highway (Pindula,
2015). Transport to and from Chinhoyi is mainly by road, by virtue of the town lying
along a major highway means that it is not completely cut off from technology,
communication, development and the rest of Zimbabwe’s major cities and towns. According
to the Zimbabwe Population Census (2012), Chinhoyi approximately has a
population of 77 929; compared to the previous 2002 census which recorded a
population of 48 912, this is quite a sharp increase for a country that has not
been performing well in almost all sectors of the economy, industry and
agriculture especially; population control is of chief importance in reducing
poverty especially amongst the female population. Chinhoyi hosts quite a number
of High Schools, Colleges and Universities where most female adolescents
attend, these form a significantly large part of the town’s population and
there is therefore need to safeguard this demographic dividend for development
purposes. Chinhoyi houses the largest and modern referral hospital in
Mashonaland West Province as well as a number of public and private clinics in which
reproductive health care can be accessed, (Pindula, 2015). There are several churches and places of
worship belonging to different religions and denominations just as any other
town in Zimbabwe. Chinhoyi largely thrives on informal trade, a large part of
the population, mostly female adolescents reside in the low socio- economic
status residential areas or in the high density, this in itself exposes them to
various societal and religious attitudes that are unique to these communities,
one of them being the castigation of the use of contraceptives by young
unmarried females.
1.2
Problem Statement
This
study utilised the World Health Organisation’s (WHO; 2018) classification of
adolescents who are individuals ranging from 10- 19 years of age. Female adolescents
in Chinhoyi are hindered from assessing birth control by factors that include but
are not limited to socio- legal, cultural and religious attitudes, health
worker bias and or lack of willingness to acknowledge adolescents’ sexual
health needs, lack of knowledge, transportation, and financial constraints, (WHO;
2018). These hindrances are influenced mostly by the unclear parameters surrounding
the legal age of consent to sexual intercourse, whether or not contraceptives be
sold or served to those below the age of consent which is currently 16 in
Zimbabwe. With these unclear parameters or lack of knowledge, most health
workers fear breaking the law and so hinder female adolescents below the age of
consent from accessing these. There is therefore the need to review and reform
policy and the law governing reproductive health care and adolescents by
clearly stipulating grey areas on voluntary access to family planning by
adolescents below the legal age of consent to sexual intercourse.
Health worker bias is largely predisposed to
ones belief’s system, some service providers offer unsolicited advice to
adolescents seeking birth control services, shaming and encouraging them to
abstain, this contributes to some of the reasons hindering adolescents from
accessing family planning. Some constraints are also influenced by people’s criticism
of the idea of pre- marital intercourse, most people are of the view that
engagement in pre –marital sex is tantamount to prostitution and having loose
morals. Members of the community also have conflicting views on the exact legal
age of consent to sexual intercourse, most respondents were not aware of it, they thought
it is 18 or 21 years and such misinformation from one of the agents of
socialisation can be a major factor constraining female adolescents from
accessing family planning. These hindrances have subjected a high number of
sexually active adolescents to the risk of teenage pregnancies, child marriage,
dropping out of school, unsafe backyard (illegal) abortions, teenage birth
complications, reproductive health illnesses, maternal mortality and neo- natal
mortality in Zimbabwe.
1.3
Research Objectives
Ø To
ascertain if adolescents have access to birth control in Chinhoyi
Ø To
find out if there is a law that prohibits adolescents from accessing
contraceptives
Ø To
find out other factors that limit adolescent access to birth control
1.4
Assumptions
Ø Female
adolescents have limited access to birth control
Ø Religious attitudes limit female adolescents’
access to birth control
Ø Societal
attitudes exacerbate the limit on female adolescents’ access to birth control
Ø The Public Health Act prohibits female
adolescents from accessing birth control
Ø Chinhoyi Health facilities’ policies limit
female adolescents from accessing contraceptives
1.5
Research Questions
Ø Do
female Adolescents have limited access to birth control?
Ø Do religious attitudes limit female
adolescents’ access to birth control?
Ø Do societal attitudes exacerbate the limit on
female adolescents’ access to birth control?
Ø Does
the Public Health Act prohibits female adolescents from accessing birth
control?
Ø Do
Chinhoyi Health facilities’ policies limit female adolescents from accessing
contraceptives?
1.6
Scope of the study
The
study was an investigation on female adolescents’ (10-19years) access to birth
control methods in Chinhoyi. The interviews’ respondents included female
adolescents who learn at Chinhoyi 2 High, ordinary persons from a high density
residential area called Cold Stream, leaders and women from mainline churches
in Chinhoyi, staff from the Zimbabwe National Family Planning Council (ZNFPC), staff
from a pharmacy in Chinhoyi Central Business District (CBD), local Municipality
Clinic and Chinhoyi Provincial Hospital Nurses. The aspects looked into were
the provision of birth control to adolescents by local clinics or hospitals, if
adolescents knew any of the birth control methods and if they had any problems
in trying to access these. The other aspects looked into were socio- religious
attitudes, the study gauged if these aspects influenced adolescent’s uptake of
contraceptives. These interviews and focus group discussions stretched over a
period of 5 days.
1.7
Delimitations
The
study was limited to Chinhoyi and interviews were conducted with 20 female
adolescents between the ages’ 10-19years, 20 residents from Cold Stream, 2 Nurses,
1 pharmacy and 1 ZNFPC staff.
CHAPTER
2
LITERATURE
AND LAW REVIEW
2.0
Introduction
A number of studies have been carried out in
Zimbabwe and in other developing communities about contraception and the
general population, I will only review the studies that regard adolescents and their
access to contraception. The review will start with legal and policy frameworks
that give female adolescents rights to acquire contraceptives and obligate the
state and its arms to ensure provision. I will also review studies that have
been carried out that reveal the contraceptive uptake behaviour of adolescents
and the factors which influence this.
2.1
International, National Legal and Policy Frameworks
Zimbabwe is party to the following international
frameworks without any reservations, it is obliged to fulfil the obligations so
as protect the rights of female adolescents to reproductive health care as
stipulated. The Convention on the Rights of the Child (CRC) Article 3, 17 and
24 stipulate that States parties should provide adolescents with access to
sexual and reproductive information, including contraceptives and the dangers
of early pregnancy. To this end, States
parties are encouraged to ensure that adolescents are actively involved in the
design and dissemination of information through a variety of channels beyond
the school, including youth organizations, religious, community and other
groups and the media.
Protocol to the African Charter on Human and
Peoples' Rights on the Rights of Women in Africa (Maputo Protocol) Article 14
(1a, b, c, & g) stipulate that States shall ensure that the right to health
of women including sexual and reproductive health is respected and promoted,
this includes the right to control their fertility, the right to choose any
method of contraception and the right to have family planning education.
Sustainable Development Goals (SDGs) also known as
the 2030 Agenda is one of the international policy frameworks Zimbabwe is
committed to achieving. With regards to adolescent access to reproductive
health care, SDGs 3 and 5 have a comprehensive guideline with targets and
indicators to achieving good health and well-being. Governments are to ensure
healthy lives and promote well-being for all at all ages. Through these goals,
the target is to significantly reduce the maternal mortality rate, end preventable
deaths for new-borns and children under five years of age, they aim at
promoting global access to sexual and reproductive health services and
achieving universal health coverage.
The Constitution of Zimbabwe Section 81(1f) and 76
stipulate that every citizen and child that is those below the age of 18 are
entitled to reproductive health care.
The National Family Planning Council Act (1985) is
the legislation that established and mandates the National Family Planning
Council (ZNFPC) and other structures related to it. This legislation stipulates
the procurement and distribution of all methods of family planning throughout
Zimbabwe, the ZNFPC is also mandated to provide comprehensive information and
services with regards to family planning to everyone, female adolescents (10-19)
included through its programmes. The ZNFPC runs a number of short term
programmes including but not limited to
the Zimbabwe Family Planning Strategy (ZFPS) 2016 -2020 and the
Adolescent Sexual Health and Reproductive Strategy (ASHRS) 2016- 2020. Through its
ASHRS, ZNFPC targets to among other objectives, tackle the challenge of teenage
pregnancy in Zimbabwe and reduce the unmet need of contraceptives to them.
2.2
Adolescents’ Contraceptives Uptake in Zimbabwe
According
to the 2015 Zimbabwe Demographic and Health Survey (2015; ZDHS) cited in (UNFPA
NEWS; 2018), it is estimated that in Zimbabwe about 51% of young people (15-19
years) access their contraceptives from private pharmacies, these private
pharmacies constitute 22% in the distribution of family planning commodities.
However, Pharmacists are concerned with the high use of emergency
contraceptives by young people, (UNFPA NEWS, 2018). Only 3% of adolescents have
access to family planning advice when they come in contact with health services
either in outreach or static facilities (Zimbabwe Family Planning Strategy,
2016- 2020). More than half of the girls aged 10-19 years who ever had sex did
not have access to family planning services. 67% of female adolescents could
not identify a comfortable and friendly place to access sexual and reproductive
health services. Adolescents engage in sexual activity, yet contraceptive
prevalence among these young people is very low.
2.3
Consequences of Poor Contraceptive Uptake
According
to the National Teenage Fertility Study (2015) cited in (UNFPA, 2017), Zimbabwe
has the highest teenage pregnancy rate in Sub- Saharan Africa. Twelve percent
(12%) of the population comprises adolescent girls aged 10-19 years, that is
about 1 800 000 and of these 800 000 teenagers fall pregnant every year, nearly
half of them. Teenage pregnancy remains a huge problem in Zimbabwe with an
adolescent fertility rate for women aged 15-19 years at 110 per 1,000 women.
This means that 1 in 10 adolescent girls gives birth every year (UNFPA, 2017). All
the ills that ensue teenage pregnancy hinder a girl child’s potential to be an
asset for her country, as UNFPA Head Representative in Zimbabwe, Cisse purported,
“… A young adolescent girl can be an asset for her country if she is not forced
to either leave school or marry because of an unplanned pregnancy…”
Teenage pregnancies in most cases force adolescents
to enter into some sort of formal or informal unions whilst they are still
children, in Shona they call it ‘Kutizira’, whereby the family of the
impregnated girl force her to elope or the girl herself elopes to the father of
the unborn child. Parents do this out of a number of reasons, the most common
ones are out of anger, shame, and wealth seeking, concealing the matter or just
fulfilling custom. Just as teenage pregnancies, child marriages are a societal
ill that have the potential of breeding more ills such as regression, more
unplanned pregnancies, HIV/ AIDS, sexually transmitted infections, poverty, all
forms of violence and unrealised potential or talent.
Currently students in Zimbabwe are suspended from
school for at least one year if they fall pregnant whilst in school, some girls
drop out on their own because of shame and very few go back to school after
giving birth, only the strong willed and those with a solid support system find
their path to a productive career or life at least. An estimated 5% to 33% of
girls aged 15 to 24 years who drop out of school in some countries do so
because of early pregnancy or marriage. Based on their subsequent lower
education attainment, may have fewer skills and opportunities for employment,
often perpetuating cycles of poverty. Dropping out of school reduces future
earnings of girls by an estimated 9%. Nationally, this can also have an
economic cost, with countries losing out on the annual income that young women
would have earned over their lifetimes, if they had not had early pregnancies
(WHO, 2018).
Zimbabwe’s laws namely section 48 (3) and the Termination of Pregnancy Act
(1977) protect the lives of unborn children and only allow abortion in the case
when the pregnancy is a threat to the life or health of the mother and the
unborn child, or when the pregnancy is a result of incest or rape. However, 62% of Zimbabwe’s population is below the age of 25
years, 17% are already mothers and others are sexually active adolescents who have
no access to birth control and are at risk of having unplanned pregnancies.
With stringent legal measures as the above, most unplanned pregnancies are
terminated in unsafe ways. These backyard abortions may cause imminent death,
barrenness, infections or long term reproductive problems. Additionally, some 3.9 million unsafe abortions
among girls aged 15 to 19 years occur each year, contributing to maternal
mortality and lasting health problems, (World Health Organisation, 2018).
Adolescent mothers face higher risks of eclampsia,
puerperal endometritis, and systemic infections than women aged 20 to 24 years.
Furthermore, the emotional, psychological and social needs of pregnant adolescent
girls can be greater than those of other women. In low- and middle-income
countries, babies born to mothers under 20 years of age face higher risks of
low birth weight with long-term potential effects, preterm delivery, and severe
neonatal conditions (WHO, 2018). Girls who become pregnant during their
adolescence are too young to cope with the toll of pregnancy and they face
serious risks during the course of their pregnancy and childbirth. . The head
Nurse of the family planning unit who is also a midwife at Chinhoyi Provincial
hospital expressed concern over the inability of adolescent girls to
effectively push out their babies during labour, most of them give up, “they
just cannot handle the physical pain,” she said, this inevitably results in
either neo- natal or maternal mortality. In developing countries, babies born
to mothers who are under the age of 20 are 50% more likely to be stillborn and
to die in the first weeks of their life, they are also at significant risk of pregnancy-related
complications, 65% of all cases of obstetric fistula occur in girls under the
age of 18 (WHO, 2016 cited in Girls Not Brides). Pregnancy and childbirth
complications are the leading cause of death among 15 to 19 year-old girls
globally, with low and middle-income countries accounting for 99% of global
maternal deaths of women ages 15 to 49 years. Teenagers who fall pregnant run
the risk of developing anemia which may result in the death of either the
mother or compromised fetal development, (WHO, 2018).
2.4
Factors influencing Uptake
Despite
the intensified efforts by the Government of Zimbabwe and interested non-
governmental organisations through various programmes to increase the uptake of
contraceptives and consequently reduce teenage pregnancies, there has been an
increase in the number of pregnant teenage girls and few adolescents who know
about birth control as well as their sexuality. There is need to dig deeper into
these factors so as to come up with long lasting effective solutions to this
paradox. According to a study carried out by Langhaug, Cowan, Nyamurera &
Power (2003) on behalf of Regai Dzive Shiri, adolescents’ access to birth
control services is poor partly because of the nurses’ reluctance to provide
such services which is influenced by fear of condoning adolescent sexual
activity and the lack of clarity on legislation governing this area. The study
also revealed that service delivery was perceived to be judgemental and lacked
confidentiality. All this depicts the cultural context in which birth control services
are provided. In most Zimbabwean cultures, adolescents are seen as children and
are regarded as having few rights. Langhaug, et al (2003) unearthed a general
consensus in the communities they studied that enlightening young people about
sex will promote immorality and sexual activity amongst adolescents.
Another
factor influencing the uptake of contraceptives is the level of friendliness
and professionalism of service providers. A study conducted by Katswe Sistahood
revealed that most public clinics and hospital staff did not have youth
friendly services, teenagers shun from accessing contraceptives from these
because each time they do they meet pastors in nurses’ uniforms and not every
teenager can afford the marked up prices of contraceptives at private
pharmacies. Youth friendly services are key to young people’s uptake of important
services such as birth control, (UNFPA, 2018).
The
teenage fertility study (2015) cited by UNFPA (2016) revealed that factors significantly
associated with poor uptake of birth control measures were a lack of
comprehensive knowledge and poor attitudes towards sexual reproductive health
among teenage girls, only 4% of those aged 10-19 years had comprehensive
knowledge on pregnancy and 77% believed that “contraceptive (condoms and pills)
use is a sign of promiscuity”, highlighting the need for increased
Comprehensive Sexuality Education (CSE) among this extremely vulnerable
demographic. Other studies unearthed that adolescents may know where to get
family planning services and afford them but the uptake may be constrained by
stigma centred on non-marital sexual activity. Adequate knowledge of
contraception is often lacking among adolescents in Africa due to negative
attitudes regarding sexual activity before marriage. Adolescents are not
educated about contraceptive use because most African cultures believe that
adolescents have to wait until marriage for them to have sex. Adolescents may
lack knowledge of, or access to, conventional methods of preventing pregnancy,
as they may be too embarrassed or frightened to seek such information from the
parents or health facilities, (UNFPA, 2016).
CHAPTER
3
RESEARCH METHODOLOGY AND METHODS
3.0
Introduction
This
section encompasses the methodology of this study, the logic that informed this
inquiry and the methods the researcher used to collect data, (Nkiwane, 2011).
The research was largely influenced by the human rights theory, legal feminist
reasoning and radical feminist thinking. The researcher utilised mostly random
sampling, focus group discussions and interview guides in the data collection
process.
3.1
Research Methodology
3.1.1 Human Rights
Theory
Human
rights theory entails that human rights are a very fundamental aspect of human
existence, this means that rights are inalienable and that they are natural
entitlements. There are various schools of thought that demystify this
discourse, academic literature reveals that human rights are not conceived in
the same way by everyone, (Dembour, 2010). The Naturalist scholars such as
Aquinas (Aquinas theory of Natural Law) claimed that rights are given by the
Creator, one is born endowed with them and that humans are governed by basic
innate laws or rather laws of nature and these have heavily influenced
legislated laws of today’s governments, (Lisska, 1996). Many natural rights
that are codified in legal terminology are part of natural law, as a case in
point, the Bill of Rights coded in Chapter 4 of the Zimbabwean Constitution as
well as the Universal Declaration of Human Rights (UDHR) of 1948. The Natural theory encompasses universal
ideas of morality, fairness, rationality, equality, and the clear distinction
from right and wrong. Naturalists concur that human rights occur naturally and
others know when they are infringing or when they are respecting the
entitlements of others.
There
is also the Protest school of thought which contends that human rights are a
result of social struggles; an answer to societal ills. Human Rights are fought
for, they are just and rightful claims that are made by or on behalf of the
general populace (the oppressed, poor, uneducated, unprivileged, etc. Protest
scholars such as Gramsci purport that the only thing that can challenge the
status- quo is the claiming of these human rights. Martin Luther King Junior is his letter from
Birmingham Jail dated 16 April 1963 purported that people should not sit idly
and not be concerned about what happens elsewhere because injustice anywhere is
a threat to justice everywhere.
The
deliberative scholars depart on the point that Human Rights are agreed upon,
liberal societies agree to adopt them as the best possible legal and political
standards that govern society. For example the making of constitutional law is
one way of expressing human rights values that are agreed upon, different
interests groups, ordinary individuals including the government agree in its
drawing up and final adoption through a referendum.
Even
though these schools of thought agree and clash with one another on different
aspects of the human rights discourse, they have one thing in common that a
human has certain entitlements which ought to be realised, respected and
upheld. These rights are universal, inalienable, and indivisible as well as
interrelated. Human rights have equal status, and cannot be positioned in a
hierarchical order. Denial of one right invariably impedes enjoyment of other
rights. For instance the failure to uphold adolescents’ right to contraceptive
or reproductive health in general leads to various generational cycles of ills,
one of the inevitable ones being poverty and lower standards of living, this in
itself impedes on other rights such as the right to a decent meal and accommodation,
affordable health care, education amongst other rights. Human rights are
interdependent and interrelated in that one right often depends, totally or partly,
upon the fulfilment of others. For instance, fulfilment of the right to health
may depend, in certain circumstances, on fulfilment of the right to
development, to schooling or to information.
3.1.2 Feminist legal
reasoning
This
study was conducted with the knowledge that the presence of the law and
policies that stipulate the rights of female adolescents and guidelines for
governments to follow are not an outright guarantee that the female adolescents
will be able to claim and enjoy that right. Whilst some may be able to, others
may not because of various social or lived realities that they may be trapped
in. Female adolescents are not a homogenous group they lead different paths in
life because they are from different cultures and backgrounds thus they are
affected by laws differently (Tsanga & Stewart; 2011; p4-6). The law has
its own limits. In this study, I put into cognisance the lived realities these
female adolescents may be experiencing and how these could actually affect
their behaviour towards the uptake of contraceptives.
3.1.3 Radical Feminism
Radical
feminist thinking is a bedrock to this study because it acknowledges that
women’s bodies are controlled by male centric laws one way or the other, these
range from restrictive reproductive laws such as abortion legislation, as a
case in point, Zimbabwe’s Termination of Pregnancy Act. Radical feminists also agree
that motherhood in a way is oppressive as it is viewed in most societies as the
rule rather than the exception, (Tsanga & Stewart, 2011; p18-19) women face
societal and family pressure to prove their fertility. Female adolescents ought
to have the freedom to access contraceptives, that is choose to have a baby or
not, when to do so and the spacing of their choice. This can only be attained
if female adolescents have access to correct information and services
pertaining contraceptives.
3.2
Research Methods
3.2.1 Sampling
Techniques
I utilised Simple Random Sampling in selecting
respondents in the community, in this study it was Cold Stream Residential
Area. In selecting these 20 adult respondents, I ensured that the sex quota
sampling was maintained whereby 10 of the respondents were male and the other
10 females. This was to make sure that the views of both sexes were taken into
account with regards to adolescents’ access to birth control measures. The same
technique of simple random sampling was used in selecting student respondents,
the pharmacy and ZNFPC staff as well as the nurses.
3.2.2 Target
Population
The
study targeted -:
Ø 20
female high school students from Chinhoyi 2 High who fall in between 10 – 19 years.
(20)
Ø Church
leaders from mainline churches (10)
Ø Church
Women (5)
Ø 20
Male and Female Adults (20)
Ø Nurses
from the General Hospital and local Municipal Clinic (2)
Ø Staff
Member from ZNFPC (1)
Ø 1
Pharmacy Owner (1)
3.2.3 Research
Instruments
Ø Interview
Guides for female adolescents, Nurses, Pharmacist, ZNFPC staff and community
adults
Ø Focus Group Discussions for church pastors and
women
CHAPTER
4
DATA
PRESENTATION AND ANALYSIS
4.0
Introduction
This
section will discuss the findings from this study, the researcher will attempt
to analyse the data obtained using emerging themes from the research questions.
4.1 Summary of
Participants
The
study targeted -:
Ø 20
female high school students from Chinhoyi 2 High who fall in between 10 – 19years.
Ø Church
leaders from mainline churches (10)
Ø Church
Women (5)
Ø 20
Male and Female Adults (20)
Ø Nurses
from the General Hospital and local Municipal Clinic (2)
Ø Staff
Member from ZNFPC (1)
Ø Pharmacy
Owner (1)
4.2
Field Research Constraints
I
encountered a few challenges through refusals from respondents such as a local
pharmacy located in Cold Stream, I managed to secure 1 interview with a
pharmacy in the Central Business District (CBD) and that one interview
sufficed. The key person from the Ministry of Health in Chinhoyi was not keen
to be interviewed I had to dig much deeper from the Nurses at Chinhoyi Hospital
and Gadzema Municipal Clinic whose information proved to be invaluable. Lastly,
the Guidance and Counselling teacher from Chinhoyi 2 High blocked my access to
the in school adolescents, she said the contraception topic was not allowed to
be discussed within school territory because the syllabus for guidance and
counselling recommended abstinence, any other methods would be encouraging
students to be naughty. I then decided to interview these students from their
homes, since the school is in Cold Stream residential area, and most of the
students from this school reside there.
4.3
Presentation of Data
4.3.1 To
ascertain if adolescents have access to birth control in Chinhoyi and if there
is a law that blocks access
To
get information for this, I interviewed 4 key persons who would give me valid
and reliable data as they would be speaking as representatives of key
authorities. These were 2 Nurses from the Provincial hospital and the local
municipal clinic as well as a staff member from ZNFPC, a Government parastatal
and a Pharmacist in the Central Business District. The female Nurse is the head
of the Family Planning Unit at Chinhoyi Provincial Hospital, she gave out important
information. She was very passionate about this particular subject, she said
that they served contraception to adolescents even those from 10 to 19 years.
She said the instruction from the Ministry of health registers enabled them to
do so. These registers have clearly demarcated columns for the patients’ ages,
the lowest age column reads 14 years and below. She expressed concern over this
issue, she said adolescents rarely come to the unit before they fall pregnant,
most of them come after giving birth, which might be a little too late for those who end up caught in teen pregnancies, child
marriage or lost education opportunities.
At
Gadzema Municipality Clinic, I spoke to a female Nurse who was really keen to
provide information and required statistics. The Nurse initially said that they
do give to all adolescents, however, those below the age of consent to sexual
intercourse (16) have to approach the clinic in the company of a caregiver or
appropriate authority, others they refer to youth friendly centres and she said
that this was their clinic policy, this was a new view opposed to what the
nurse at Chinhoyi Hospital had indicated. After continued conversation, she
slightly deviated from her initial response, she said that with the change of
times, more and more girls are engaging into early sexual intercourse and
commercial sex work, she said even those below 15 to an extent that that they
are left with no choice but to help them with birth control when they come to
the clinic alone. Very few manage to gather guts to come to the clinic and ask
for birth control, to solve this, the clinic put a box of condoms at the
reception written in vernacular, “torai
zvenyu” meaning “you can take”.
The Nurse said that some come in to take especially the young commercial sex
workers, those as young as 15. More of this discussion on unclear legal
parameters on age of legal consent to sexual intercourse and their access to
contraceptives below.
I
secured an interview with a male staff member in the ZNFPC administration,
ZNFPC is a Parastatal of the Government of Zimbabwe that oversees the procurement
and distribution of birth control all over the country. The male staff member
indicated that female adolescents those from 10-24 years of age have an open
and free access to all methods of contraception through their Adolescent Sexual
and Reproductive health program. The
male staff member indicated that there is no law in Zimbabwe that prohibits
adolescent (10-19) from accessing contraceptives, he made reference to the
National Family Planning Council Act of 1987 which established the ZNFPC and
stipulates the provision of all types of family planning to everyone.
The
Pharmacist in the CBD along Harare road was cooperative, I asked him if they
sold contraceptives to adolescents those between the age 10 – 19 years and he
said yes, I continued to ask which law or policy guided them in doing so, he
made mention that there was no law that prohibited them to sell these to
adolescents. He spoke of the Drugs and Allied Substance Control Act which
guided them in the provision of all medicines to the public. He, however,
mentioned that of all the females that visited their pharmacy for
contraceptives, the majority were adults, in a month only 1 or 2 adolescents
would visit either for themselves or under the guise of a parent’s instruction.
4.3.2 To
find out other factors that limit adolescent access to birth control
For
this information, I interviewed the female adolescents, cold stream residents,
the church women and Pastors. Their responses indicated that there are other
factors indeed that hindered adolescents from accessing birth control measures,
these are ignorance by adolescents, societal and religious attitudes as well as
school’s policies.
Ø Adolescents’
Ignorance
Of
the 20 female adolescents I spoke to, only 2 indicated that they had no idea
what birth control measures were even when explained to in vernacular. Of the
18 respondents who knew what birth control is, very few about 3 knew what the
law stipulated about adolescents access to birth control. The rest indicated
that the law stipulated that girls can only access these at 18, some said 21
others said when they are married or when they have children, otherwise it
would be breaking the law if any one who is not in that category is found
accessing birth control.
When
asked if adolescents should be given access to these birth control measures,
only two (2) indicated that yes they should and when asked why, they said that
it would protect them from unplanned pregnancies, child marriages and from
dropping out of school. The rest of the respondents, that’s about 80% of them
indicated that these methods where not to be given to school children for they
would encourage them to be naughty and sleep around, one respondent indicated
that being given access would lead to child marriage. My findings go hand in
glove with the National Teenage Fertility Study (2015) cited in UNFPA (2016)
which unearthed that 77% of adolescents believed that “contraceptive (condoms
and pills) use is a sign of promiscuity”, which highlights the need for
increased Comprehensive Sexuality Education (CSE) among this extremely
vulnerable demographic.
Ø School
Policies
As
I mentioned earlier that my attempt to interview female adolescents within
school grounds failed because of the Guidance and Counselling Teacher who
disapproved of my research topic. She said that their guidance and counselling
curriculum only taught abstinence as the only method of birth control and my
topic would do nothing but encourage immorality. From the conversation I had
with the Guidance and Counselling teacher, I deduced that schools were the
major factor influencing less uptake of contraceptives. School demonise any
sexual relations between unmarried individuals, they teach already sexually
active individuals to abstain instead of enlightening them about other viable
methods contraception so that they finish school, avoid child marriage and teen
pregnancies.
Ø Religious
Attitudes
I
initially went to the Anglican Church in the CBD to interview the Church leader
or at least get an appointment, the Reverend was absent at the premises, he was
attending a meeting with other fellow mainline church leaders under the banner
of the Zimbabwe Council of Churches (ZCC) at Evangelical Lutheran Church in
Chikonohono. I was expecting him to schedule me for another day, he instead invited
me to the meeting so that I would also talk to other mainline church leaders
present at that very meeting. My main aim was to collect data on religious
attitudes, whether or not they limit adolescent’s access to birth control. ZCC
is a group of mainline churches in Zimbabwe, which include but are not limited
to Methodist Church in Zimbabwe, Salvation Army, Anglican, and Lutheran
Evangelical Church. At that ZCC meeting I managed to conduct 2 focus group
discussions, one with the church pastors and the other with a group of women
from the host church who were catering for the Pastors. The Pastors group agreed
that girls between 10-19 years are not to be allowed to access contraceptives
because they are too young, not only that but sexual intercourse is for the
married. Another Pastor from Salvation Army indicated that sexual intercourse
before marriage is adultery, it is against church doctrine and hence is subject
to punishment by the church itself. One female Pastor from United Methodist
Church vehemently declared that the church does and will not support
adolescents to have access to contraceptives because it is tantamount to giving
them the right to engage in adulterous affairs that perpetuate moral decadence,
only one male Pastor said that it was necessary for them to be given access to
birth control so as to reduce teenage pregnancies and child marriage.
The
focus group discussion I had with women from the Evangelical church expressed
similar sentiments to those of the various church leaders, they further added
that as women of the church, they would not want their adolescents to take
contraceptives because they increase the chances of sterility in young women.
From these two focus group discussions, I observed that the church’s aim was to
preserve morality not only in its structures but in the community as a whole.
Those girls that are generally known for engaging in premarital sex are
castigated by the church. I asked both groups the age they deemed appropriate
for girls to start taking contraceptives, the women’s group had mixed feelings,
some said the appropriate age was maybe when the girls are at tertiary
education level or after they finish, at about 24 and 25 years, others
indicated that it was better for one to fall pregnant than use contraceptives
at a young age and others said only the married should have access.
From both discussions I deduced that it is
these religious attitudes that are passed on to female adolescents as the
church is a major agent of socialisation. Pastors and church women who are also
parents have a hand in demonising premarital sex in the eyes of the adolescents
and this contributes to low uptake of contraceptives and consequently all the
generational cycles of societal ills discussed above.
Ø Societal
Attitudes
From
the 20 interviews I conducted with adults from Cold Stream residential area, which
is a high density area in Chinhoyi, all the adults when asked if adolescents
should be given access to birth control methods disagreed. All the adults I
spoke to concurred that adolescents 10 to 19 years should not be given access
to birth control except for 1 male Journalist who said they should be given so
as to avoid teen pregnancies, complicated deliveries and child marriage. Others
said that it was against the law of the land for adolescents to have such
access whilst others said African culture prohibited premarital sex and hence
it was wrong for them to have access. I asked the individuals who said it was
against the law of the land for adolescents to access birth control on the age
they thought was appropriate and what they thought the law said about it, very
few gave an answer to this, the majority didn’t know, and of the few answers
given, very few were correct, most indicated 21 or when they get married.
Ø Unclear
Legal Parameters Governing Age Of Consent To Sexual Intercourse
This
study’s findings are in tandem with Langhaug, Cowan, Nyamurera and Power’s
(2003) findings on unclear legal parameters governing age of consent to sex by
service providers as factors that cause poor uptake of contraceptives by female
adolescents. The nurse at Gadzema Municipal Clinic is one example of a service
provider who was clearly unsure if she would be breaking the law serving
adolescents below the legal age of consent with contraceptives. Her responses kept on changing when asked at
different intervals whether or not she would give an adolescent birth control. Such
grey areas in the legislation governing age of consent and access to
contraceptives has led to more adolescents being turned away from their right
to access contraceptives.
4.4
Conclusion & Recommendations
The
study’s findings indicate that adolescents in Chinhoyi and Zimbabwe at large
are allowed access to contraceptives by the legislation governing reproductive
health. However, there are several factors that hinder access, these are grey
areas within the legislation, school policies, societal and religious attitudes
as well as adolescents’ ignorance.
It
is recommended that the Government Ministries responsible for making laws that
provide for adolescents’ access should also take up the task of disseminating
the information and laws to the public because there is a knowledge gap within
the community on the benefits of birth control measures and dangers of teenage
pregnancy. That knowledge gap coupled with other factors discussed above
contribute to ignorance and fear within the adolescents and they end up being
victims of teenage pregnancy and other ills that come with it. The relevant
government bodies and other interest groups should embark on a participatory
approach whereby they enter into communities to break down the taboo centred on
sexuality issues through community programmes because currently any
conversation supporting pre- marital sexual intercourse is tantamount to tip-
toeing in a land minefield.
There
is an urgent need to clearly articulate the grey areas in handling matters
relating to the legal age of consent to sexual intercourse, for example, should
those adolescents below 16 be given
access, do they need to be accompanied by a guardian or caregiver or should they
just be counselled and given access. These grey areas may cause service providers
who might be misinformed to them turn away and thus hinder female adolescents’
access to birth control methods.
There
is need for the Government to review and reform its school policies, abstinence
as the only encouraged method of contraception in these modern times is no
longer a viable method. Adolescents are sexually active as unearthed by my
research and many others before and if Zimbabwe is to have an empowered woman who
contributes productively to her nation’s annual income, adolescents’ sexual
needs should be acknowledged and they have to be taught about other methods
other than abstinence that is comprehensive sexuality education.
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