MOHALE’S HOEK – Child marriage and lack of comprehensive sexual education has seen Mohale’s Hoek leading the country cases of early unintended pregnancies. As a result, the district has recorded the highest number of admissions of obstetric and gynaecological admissions due to abortion. Nkau, Nohana and Mpharane health centres have recorded the highest number of admissions due to abortions.
’Manthabeleng Motumi, sexual reproductive health mentor from the District Health Management Team Mohale’s Hoek, said the reason the three centres have recorded high numbers is because of a high incidence of child marriages from the ages of 14, which doesn’t seem to bother most community members.
“Even though we give sexual reproductive health services we still find high cases of unsafe abortions from a young age; in a month we deal with about two patients who have complications due to abortions, on top of that a lot of them test positive for HIV,” said Mookho Kotelo, Nursing Officer at Mpharane health care centre. One of the village health workers, Selometsi Motikoe said a lot of the young girls are vulnerable because they do not have the means of survival therefore they drop out of school and, because they have nothing to do, they start engaging in sexual activities and child marriage.
“There is an incident where a teenager has four children with different fathers and she had her first baby at the age of 13. A majority of them are being impregnated by herd boys or men who work at Ceres,” she added. ’Makamohelo Tekete aged 22 from Mpharane in Mohale’s Hoek was married in her teenage years. She dropped out of school while she was in Form B because her parents could not afford to pay for her fees so she worked as a domestic worker and that is where she got married. “I got married because that was the only thing that will help me survive. My husband works in Ceres in South Africa and I am a stay-at-home mother with my baby,”
Tse’liso Masilo, United Nations Population Fund (UNFPA) supplies coordinator, said they help the government in ensuring that more women of reproductive age use long-term contraception for family planning (FP) in Lesotho by 2023, ensuring multi-month dispensation of pills for women that prefer these as their method of choice and also to capacitate village health workers to distribute less skill intensive methods like pills and condoms.
“We are also aiming at improving long-term methods of FP, such as implants and less used methods such as intrauterine device IUD through the following high impact practices; Postpartum Family Planning on selected hospital as pilot sides and targeted integrated outreach services focusing on hard to reach areas and those facilities not offering FP,” he added. According to the UNFPA State of World Population 2022 under the theme: Seen the Unseen, in Lesotho 1 in 3 women start childbearing in adolescence, nearly half of adolescent mothers are children and unintended pregnancies destroy the lives of young girls.
From the ages 10 to 14 there is 35.7 percent of obstetric and gynaecological admissions due to abortion with Mohale’s Hoek recording the highest number at 154 followed by Maseru with 110. Unsafe abortion is a leading contributor to maternal death and morbidity. It also shows that Lesotho has greater focus on prevention of HIV with Prep and VMC, and less focus on contraception. Moreover, in LDHS 2014 shows that Mohale’s Hoek is the second highest district in unmet need for family planning at 22% while Mokhotlong has the highest at 25%.
In a Youth Advisory Report about SRHR compiled by Sesotho Media Development under the project “Using Facilitated Film Discussions to Strengthen Youth-driven informed demand, uptake and linkage to SRHR services” that started in 2021 ending in 2023, the report has been produced from data collected for peer-to-peer youth consultations in communities which shows there is 25% of teenage pregnancies and 25% child marriage.
Another factor contributing to early unintended pregnancies among the youth is lack of information about and access to contraceptives. Some participants indicated that they live in rural areas where it is difficult to travel to get information about and access to contraceptives to prevent unwanted pregnancies.
For example, one said: “The health post is far and located on the other side of the river, which makes it difficult to get to during the rainy season.” Another one added: “Lack of roads makes it difficult to travel and some people are still so conservative that in this day and age you find some with eight or even 14 children.” In some cases, the contraceptives are inaccessible because of sheer distances to health centres where they can be found.
One participant said: “Last year I advised some of my peers to use contraceptives but I noticed that the problem is that the places from which they can get them are far.” Because of the inaccessibility of contraceptives because of the long distances to the places where they are stocked, some youth end up leading a careless sexual lifestyle. One participant even noted that even though this might be the case “one should not stop trying to educate them until they can see the benefit of using SRHR services and products.”
Some explained that they live in areas where the main health service providers are the church owned clinics and hospitals which, on the basis of the church tradition and laws, do not provide contraceptives while in some areas, there are no health posts at all. Therefore, knowledge about contraceptives and access to them is non-existent in such areas. In some cases, participants believe myths and stereotypes about contraception even if people are knowledgeable about them contribute to unplanned pregnancies.
For instance, some youth do not use contraceptives to prevent unwanted pregnancies because they believe contraceptives distort their body shapes. To explain this, one of them said: “There are those who have knowledge about contraceptives and know how to use them but choose not to do so because they believe contraceptives distort their body shapes,” the report states. Unintended pregnancies are preventable if we empower women and girls to make affirmative decisions about sexuality and motherhood.
For this to happen there must be: Education of young people about sexuality and reproduction, not only about HIV; guaranteed access to the broadest range of contraceptives and quality sexual and reproductive health care; and, investment in newer contraceptive methods to reduce gender inequality. Increased access to education and employment opportunities for women and girls will encourage them to postpone pregnancy and ensure dual protection – HIV/STI prevention and prevention of unintended pregnancies.