'Our children are fatherless': exploring experiences of adolescent pregnancy and motherhood in Rwanda
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A presentation by Ernest Ngabonzima and Rebecca Dutton, FIGO Africa Regional Kigali Conference, November 2020
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'Our children are fatherless': exploring experiences of adolescent pregnancy and motherhood in Rwanda
- 1. “Our Children are Fatherless”: Exploring Experiences of Adolescent Pregnancy and Motherhood in Rwanda Ernest Ngabonzima, Rebecca Dutton November 2020 Adolescent mother, Rwanda © Nathalie Bertrams /GAGE 2020
- 2. Gender and Adolescence: Global Evidence (GAGE): A longitudinal research programme (2015-2024) By finding out ‘what works,’ for whom, where and why, we can better support adolescent girls and boys to maximise their capabilities now and in the future. We are following 20,000 adolescents, the largest cohort in the Global South
- 3. GAGE 3Cs Conceptual Framework
- 4. Setting • Kigali- Gasabo (urban) • Southern- Huye (semiurban) • Northern- Gakenke (rural) • Western- Nyabihu (rural)* • Eastern- Ngomba (rural) * *Qualitative only
- 5. Sample and Methods • Qualitative interviews with older adolescent girls ages 15-19 who were currently pregnant or had given birth before 18 years old (n=24) • Focus groups with female adolescents aged 15-19 years • Key informant interviews with government and community organizations, para- social workers (n=20) • Qualitative: thematic analysis Qualitative • Quantitative survey with 117 older adolescent girls (50 mothers and 67 non- mothers) • Quantitative: linear regression analysis Quantitative
- 6. Willingness of engaging in first sexual intercourse ‘I was like an idiot because it was the time I came from countryside. I entered in his house and then he directly closed the door because there was no one else around there… So, because there wasn’t any one around, it [rape] was done.’ (Adolescent aged 18 years, raped by an acquaintance) ‘Before we slept together, we were in love and he usually was telling me that he needs to take me to his family, to show them that he has a girl he wants to marry.’ (Adolescent aged 17 years, rural, cohabiting consensual relationship) Reported willingness of engaging in first sexual intercourse Willing 18.0% Somewhat willing 8.0% Not willing at all 74.0% Reported desire of first pregnancy Wanted the pregnancy 10.0% Wanted to wait until later to become pregnant 62.0% Did not want children 28.0%
- 7. Adolescent mothers limited return to school Mean Overall Adolescent mothers Non-mothers Difference (all significant at p<0.001) Age 17.03 17.58 16.61 0.97 Currently attending formal school 33.0% 0.0% 58.0% 58.0% Highest Grade Attended 7.21 6.40 7.81 1.4 ‘If she's pregnant, then that means that her dreams fade away. If she's pregnant before she completes her studies, then she goes home to raise the baby. It's like her vision has just been erased.’ (KII, community health worker, Kigali) ‘It was not a problem for my mom to take care of my baby because she is the one who requested me to go back to school. The baby used to stay at home with my mother and at school they used to give me permission to go and breastfeed her at noon time.’ (Adolescent aged 19 years, raped by her boyfriend)
- 8. Adolescent mothers have increased symptoms of depression ‘All my friends rejected me when they saw what happened. I was alone and I could see it, and I started to hate myself. I was worried, and I feared to go in public and wished to stay at home all the time.’ (Adolescent aged 19 years, non-consensual sex with her boyfriend) Means Adolescent mothers (n=50) Adolescent non-mothers (n=67) Significance Not depressed (PHQ ≤ 4) 28.0% 50.8% p<0.05Mild depression (PHQ 5-9) 34.0% 38.8% Moderately or more depressed (PHQ ≥10) 38.0% 10.4% Reported suicidal ideation in the past two weeks 20.0% 9.0% p<0.05
- 9. Limitations We can only compare how adolescent mothers and non- mothers differ at the time of data collection Inability to establish whether adolescents who are mothers were – before they became mothers – different from adolescents who are not (yet) mothers. Adolescent pregnancy and motherhood is highly stigmatized and made systematic sampling of mothers from the survey for qualitative interviews not possible. We do not know if the adolescent mothers who refused re-contact are systematically different from those who consented to re- contact and interview.
- 10. An adolescent mother, Simbi, Rwanda © Nathalie Bertrams / GAGE 2020 Policy and programming implications
- 11. Policy and programming implications •Social and economic support for adolescent mothers Access to contraceptives for adolescents Supporting adolescent mothers to return to school Norms of community members and service providers Comprehensive sexual and reproductive health education
- 12. Authors • Ernestina Coast – London School of Economics • Marie Merci Mwali - FATE • Roberte Isimbi - FATE • Ernest Ngabonzima - FATE • Paola Pereznieto - GAGE • Serafina Buzby - LATERITE • Rebecca Dutton – The George Washington University • Sarah Baird - The George Washington University
- 13. Contact Us WEBSITE www.gage.odi.org TWITTER @GAGE_programme FACEBOOK GenderandAdolescence About GAGE: Gender and Adolescence: Global Evidence (GAGE) is a nine-year (2015-2024) mixed- methods longitudinal research programme focused on what works to support adolescent girls’ and boys’ capabilities in the second decade of life and beyond. We are following the lives of 20,000 adolescents in six focal countries in Africa, Asia and the Middle East.
Editor's Notes
- (:30) Welcome and introductions Today we will briefly be sharing from ‘Our Children are Fatherless’: Exploring Experiences of Adolescent Pregnancy and Motherhood in Rwanda, mixed-methods case study of Rwanda in which we explored how and in what ways adolescents’ capabilities: education; health and nutrition; freedom from violence and bodily integrity; psychosocial well-being; voice and agency; and economic empowerment, are influenced by pregnancy and motherhood. Rebecca, a DrPH candidate from GWU and myself, from FATE consulting, will be presenting on behalf of our team.
- (:20) This research is part of the broader Gender and Adolescence: Global Evidence (GAGE) project. GAGE is a nine-year (2015-2024) mixed-methods longitudinal research programme exploring the gendered experiences of young people aged 10-19 years. We are following the lives of 18,000 adolescents in six focal countries. Please visit our website to learn more about the research. GAGE aims to generate new evidence on ‘what works’ to transform the lives of adolescent girls and boys to enable them to move out of poverty and exclusion, and fast-track social change. GAGE research involves the most vulnerable adolescents, including adolescent refugees, adolescents with disabilities, those out of school, married girls and adolescent mothers. The results will support policy and programme actors to more effectively reach adolescent girls and boys to advance their wellbeing and what is needed to meet the Sustainable Development Goals, including the commitment to Leave No One Behind. The GAGE consortium, managed by the Overseas Development Institute, convenes 35 research, policy and programming partners globally and is funded by UK Aid from the UK government.
- 3 CS Conceptual Framework
- (:15) Data collection took place from October-November 2019 in the five regions for qualitative and three for quantitative. These locations were selected to represent different regions and urbanization levels in Rwanda, and---- Quantitative and qualitative City of Kigali: Gasabo district (urban), Kinyinya sector Southern province: Huye district (semi-urban), Simbi sector Northern province: Gakenke district (rural), Muzo sector Qualitative only Western province: Nyabihu district (rural), Jomba sector Eastern province: Ngoma district (urban), Remera sector
- (1:15) ** include how the purposive sample was done- see notes below. Qualitative data from key informant interviews [n=20], qualitative interviews of female adolescents aged 15-19 years who had given birth before age 18 or were currently pregnant [n=24], and 5 focus groups with female adolescents aged 15-19 years who had given birth before age 18 or were currently pregnant [n=24] were collected from 5 sites. Key informant interviews were conducted with 20 individuals, drawn from a range of government and community organisations, including para-social workers (community health workers). Individuals were purposively selected for working with or on adolescents, in education and health. Qualitative IDIs were conducted with 24 female adolescents aged 15–19 years who had given birth before the age of 18 (n=22) or were currently pregnant before the age of 18 (n=2). Quantitative sample Quantitative surveys were conducted with 117 adolescent females aged 15–19 years, of which 50 had given birth or were pregnant before the age of 18, and 67 were non-mothers. To identify adolescents aged 15–19 to sample in the three quantitative sites, village leaders and community health workers prepared lists of all households in their villages that had adolescent girls aged 15–19 as members. Community health workers were also requested to list adolescent girls who had given birth or were pregnant and under 18. Enumerators visited the identified households to confirm eligibility of the adolescent girls and enroll them in the study. Adolescent mothers were selected through purposive sampling. It proved difficult to re-contact surveyed adolescent mothers, reflecting the stigma of adolescent motherhood and the demands on adolescent mothers’ time. In the two sites where there was no quantitative survey (Jomba and Remera), the research team purposively sampled adolescent girls who had given birth before the age of 18, and two interviews were conducted with adolescents who were pregnant. These were recorded and used community and institution mappings to stimulate discussion.
- (1:00) Adolescent became pregnant or mothers through a range of different scenarios- some within long-term consensual relationships, some through transactional sexual, others described being forced or tricked. One 18 year old adolescent explained: I was like an idiot because it was the time I came from countryside. I entered in his house and then he directly closed the door because there was no one else around there… So, because there wasn’t any one around, it [rape] was done. While another said shared about getting pregnant while in a consensual relationship… Before we slept together, we were in love and he usually was telling me that he needs to take me to his family, to show them that he has a girl he wants to marry. The quantitative data indicates that 74% of the sample were not willing to have sex at the time of their first sexual encounter and only 10% stated that they had waned their first pregnancy.
- (1:00) Adolescent pregnancy and motherhood appears to have dramatic effects on education. There were no respondents in the quant sample who were currently in school, while 33% of the non mothers were still attending. Mothers, on average also had 1.4 less years of school compared to those who were not mothers. (only partially explained by difference in age) This finding was echoed in a KII with a community health worker who said: If she's pregnant, then that means that her dreams fade away. If she's pregnant before she completes her studies, then she goes home to raise the baby. It's like her vision has just been erased Despite this troubling finding, one adolescent in the qualitative sample explained: It was not a problem for my mom to take care of my baby because she is the one who requested me to go back to school. The baby used to stay at home with my mother and at school they used to give me permission to go and breastfeed her at noon time. Demonstrating the importance of support from family and community institutions in aiding mothers to continue their education.
- (1:00) Out findings show a negative relationship between adolescent pregnancy and motherhood and mental health. Qualitative findings indicate that adolescents who become pregnant are isolated from their communities and friends as one 19 year old shared: A girl, we studied in the same class, she saw what happened to me and she is no longer my friend because she may say that I can lead her into bad behaviours and she gets pregnant too because I gave them a bad example. (Adolescent mother, FGD) Linked to this rejection was increased social isolation: All my friends rejected me when they saw what happened. I was alone and I could see it, and I started to hate myself. I was worried, and I feared to go in public and wished to stay at home all the time. (Adolescent aged 19 years, non-consensual sex with her boyfriend)
- (1:00) Out study had a few limitation, which included We can only compare how adolescent mothers and non-mothers differ at the time of data collection, so we are not able to determine from this data whether adolescents who are mothers were – before they became mothers – different from adolescents who are not (yet) mothers. As mentioned while describing the methods, Adolescent pregnancy and motherhood is highly stigmatized and made systematic sampling of mothers from the survey for qualitative interviews was not possible. We do not know if the adolescent mothers who refused re-contact are systematically different from those who consented to re-contact and interview.
- (:30) Despite these limitations, our mixed-methods analysis suggests that adolescent motherhood has negative implications for adolescent girls’ trajectories and their likelihood of being further left behind. Concerted and multisectoral efforts – across education, justice and health – are critical to prevent unwanted adolescent pregnancy and to support adolescent mothers, to reduce the likelihood that adolescent mothers and their children are left behind.
- (1:15) Based on our findings, we will conclude with five policy and programming implications and recommendations Social and economic support for adolescent mothers -Adolescent mothers face multiple barriers to economic empowerment, as childcare reduces their income-generating options. Unplanned pregnancy and motherhood negatively impact girls’ economic trajectories, with less opportunity to earn but more demands on any income. The potential for intergenerational transmission of poverty to children of adolescent mothers is high, and perpetuates who is left behind. Access to contraceptives for adolescents -This includes policy changes to ensure that adolescents have access to contraceptives as well as shift in norms and implementation of policies by health workers who limit contraception. The current policies also criminalize consensual sex between minors, limited access. Supporting adolescent mothers to return to school - Rwandan education policies make no mention of how to support adolescent mothers’ return to school. The need to provide and care for a child makes it exceptionally difficult for adolescent mothers to achieve this. Adolescent mothers’ experiences of stigma and exclusion by their peers and teachers compound barriers to continuing education. Norms of community members and service providers - Adolescent mothers’ experiences of stigma and exclusion by their peers and teachers compound barriers to continuing education. That adolescent mothers experience negative psychosocial outcomes is clear from our evidence; they are significantly more likely to be depressed compared to their peers. Programming to change norms to reduce the stigma around adolescent pregnancy to promote mental health and psychosocial wellbeing National policy also makes no provision for an adolescent mother and her child if they are rejected both by the child’s father and the girl’s family; the implicit assumption is that families will provide. 5. Comprehensive sexual and reproductive health education - To include impact of contraceptives on future fertility.
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