When ignorance leads to pregnancy
Namali was a bright and promising student from Anuradhapura. She excelled at her Ordinary Levels and was hoping to score high marks for her Advanced Levels as well. She knew education was her ticket out of a life of poverty and abuse. Her dreams, however, were shattered when she discovered she was pregnant at the age of 18.

It all started when her abusive father – who had abandoned his family -- decided to return home. In his absence, his wife was left with the sole responsibility of caring for and supporting the children. As a single mother she was unable to pay for extra Advanced Level classes for her eldest daughter, Namali. Namali’s boyfriend, Amila, a 22-year-old from Matale, encouraged her to study and paid her tuition fees.

But when Namali’s father returned home, he drove Namali out of the house in a senseless fit of rage. Here again Amila came to her rescue and took her to his home. Amila’s mother and sister, however, did not take kindly to this development. 

Soon after Namali moved in, Amila’s sister warned her against using contraceptive pills. She told Namali that the pills could make her infertile in the future. The last thing Namali wanted was to get pregnant; she knew it would affect her education, so she suggested that Amila and she had intercourse only during 
her ‘safe days’. 

The safe day practice isn’t a very reliable form of contraception, and it was not too long before Namali found out she was pregnant.

She was soon expelled from school because of her pregnancy. Namali made several unsuccessful attempts to abort the baby by herself and to take her own life. It was at that stage that Namali the was referred to the Matale hospital for 
psychiatric intervention.


Reproductive Health
Dr. Sumithra Tissera, Director (Medical) of the Family Planning Association (FPA) Sri Lanka, says that while rape and child marriages are causes of child pregnancy, the lack of comprehensive reproductive health education is also a matter of grave concern.

She says that some teenagers she has interviewed are confused by myths about pregnancy and contraception. “Some seem to think that you need to have intercourse several times before you can get pregnant. Some of them understand pregnancy - but they still don’t use contraception because they don’t believe they will get pregnant. Some even think it will cause infertility, weight gain, or  cancer.”

In her view, age appropriate comprehensive reproductive health education can help dispel these myths and keep teenagers safe. She added that however hard parents try to protect their children, some teenagers may end up having sex. The best way to protect them would be to arm them with knowledge about contraception and sexually transmitted infections (STIs).

On a positive note, when it comes to adolescent fertility in South east Asia, Sri Lanka has the third lowest rate of pregnancies for those aged between 15 to 19 years - and the number is on the decline. 

The lowest is the Maldives, and Myanmar comes in a close second. The highest is Nepal, then India, followed by Bangladesh, according to the World Health Organization (WHO)2014 publication Adolescent Pregnancy.

However, Sri Lanka cannot take comfort in having a low rate of teenage pregnancies. The aim should be to arm every teenager with necessary knowledge that can protect them.


Teenage Pregnancy in Sri Lanka
Dr. Sumithra says that she has come across girls as young as 11 years old who had become pregnant. Once, a mother had brought  a young teenager to her, to find out if  her daughter had lost her virginity to a married man.

“The girl didn’t understand that some of the acts she has done with the older man was intercourse. We had to explain it to her” she says, stressing that the lack of knowledge on reproductive health among teenagers was a dire problem.

She adds that while the lack of awareness of reproductive health and contraception is a problem, rape and incest are causes as well.

Causes aside, the WHO publication indicates that teenage pregnancy is more of a problem among teenagers who lack an education. Incidence of childbearing among those who attended school are almost half the number of those who did  not attend school. 

Teenage pregnancy is prevalent in the rural areas of Sri Lanka and areas affected by the war. According to the UNFPA fact sheet, Ensuring Women’s Health, teenage pregnancy is highest in Trincomalee, Batticaloa and Mullativu districts. The lowest rates of teenage pregnancy were recorded in Matale and Colombo.
Dr. Sumithra corroborates these findings saying that from her experience, children are given in marriage early in rural areas. Some parents go so far as to create false birth certificates to show their children have reached the minimum legal age for marriage (which is 18 years for both men and women). 

“Even if they get married young if you tell them not to get pregnant till they are at least 20 years old, they say: ‘No I’ve been married for so long and I want to get pregnant now, that’s what my husband wants, as well as my parents and in-laws,” elaborates the doctor. 

Speaking about the pressure the newly wedded teenager is under, she says: “The girl’s body is too immature for pregnancy at that age. If you tell the mother and mother-in-law, they say they had delivered 10 children and I was 15 years old when I started. But then if you ask them if they had the chance of completing their education before becoming a mother, they would say yes, I would have liked to go to school”.


Health risks 
“It’s like babies giving birth to babies” is how Dr. Sumithra describes teenage pregnancy. A teenage girl’s body is not ready for the 9 months of pregnancy and rigours of delivery.

There are a number of medical complications that can arise from early child-bearing. These include the high risk of miscarriage, pre-term labour, low birth weight, anaemia and the risk of the mother dying as well. The possibility of dying during pregnancy for those under 19 years – when compared to those between the ages of 24 to 25 – is four times greater. There is also the danger of fistulas forming in the vagina, and other health issues that may not affect the mortality of infant or the mother, but will lead to post-pregnancy complications – post 
partum depression. 

On a sociological level, most young mothers don’t know how to care for a new born child. “Then the burden is on their mother (child’s grandmother)”.  This can cause tension at home and affect the new born’s well-being. 

Comprehensive Reproductive Health Education can undoubtedly help abate the number of teenage pregnancies in Sri Lanka, and ensure safer, healthier lives for future generations. With free education, almost all girls and boys receive their primary and secondary education. 

By introducing reproductive health knowledge, we can hope that a majority of adolescents would not be misled by myths and misconceptions, and that they could understand the health risks of teenage pregnancy.

Note: All individuals’ names have been changed to protect their privacy. Namali’s story was sourced from MediScene, 
The Sunday Times.

This article has been prepared by the editorial team of Kiyanna.lk, a blog dedicated to population and development issues initiated by the United Nations Population Fund (UNFPA) Sri Lanka. Readers are invited to join the conversation at: Kiyanna.lk