MOHALE’S HOEK – ’MAMOHLOMI* was just 13-years-old when she fell pregnant. She was in Form B. Young and inexperienced, she felt overwhelmed by fear of pregnancy and her peers laughing at her.

“But my grandmother was very supportive and that’s when I started accepting my situation,” ’Mamohlomi said.

“And I was afraid of aborting thinking it’s unsafe,” she said.

’Mamohlomi told thepost that she had lost her parents at a very young age. Now 22-years old, she is heavily pregnant with her fourth child. She said she was not using any contraception as she was not “clever for such things”. She said her boyfriend at that time was not supportive. When she first learnt of her pregnancy, she said she thought she was sick as she vomited and lacked appetite for certain foods.

“My grandmother advised me to visit the clinic,” she said, adding that “I didn’t accept my pregnancy immediately as I was still a student”.

“I only started my antenatal care after three months when my bump was growing.”

“After my bump started showing, it was pointless to hide it. All I had to do was accept and start attending the clinic.”

‘Mamohlomi said she then dropped out of school without completing her Grade Nine. When her baby was a year and six months old, she said her grandmother advised her to choose between knitting and catering in vocational school as she had lost interest in formal school.

“I decided to do knitting in 2015,” she said.

She said she is still unmarried but the father of her fourth child is “supportive unlike the first one”.

“He supports me in everything but I am not sure yet if I want to get married but if he suggests it then I will go try and see where it leads me.”

She encouraged her peers to use contraceptives to avoid ending in a situation similar to hers. Another teenager, Mpho, who is six months pregnant, said she was hurt after finding out she was pregnant.

“I wasn’t intending to have a baby now. At first, I was afraid to go to school pregnant but now I have made peace with it,” she said, adding that her parents are “very supportive of her as their only child.”

She said she didn’t even use protection and “I realised when we were done that what we did was wrong.” Unlike ’Mamohlomi, Mpho still goes to school doing her Grade 11 and her boyfriend promised to support her and the baby.

She said she knew about contraceptives but “I didn’t think I would be pregnant because I was still a virgin. Unfortunately, on my first attempt, I conceived…it is very painful.” She too called on her age mates to use contraceptives.

“I wish I had listened to my mother when she said I should use them. I wasn’t intending to sleep with anyone before completing my high school…little did I know that my boyfriend would convince me otherwise and end up impregnating me.”

“I don’t really know what happened because it isn’t what I wanted but again he didn’t rape me…I wasn’t ready.”

The Mohale’s Hoek’s Mpharane Health Centre Nursing Officer, Mookho Kotelo, said Early and Unintended Pregnancies (EUP) among adolescents are rife in the villages served by the health centre.

“Teenage pregnancy is very prevalent here and in a month, we see 10 adolescents and most of them are between 15 and 17 years old,” Kotelo said.

She said the main cause is that many people in the area still associate family planning methods with old people.

“They don’t understand even though we educate them about it. Most of the time when we talk about it, they get surprised saying it’s difficult for them to tell their children to use family planning methods,” she said. “This results in high unintended pregnancies among adolescents.”

Selometsi Motikoe, the Mpharane Village Health Workers’ Coordinator, said herdboys, their peers and even older men are responsible for the high rate of EUP.

“All the girls need is money to fight poverty,” Motikoe said.

She said although village health workers encourage the use of contraceptives, parents and some peers discourage it. She said before the advent of the Covid-19 pandemic, the clinic used to have a club for adolescents and cases of early pregnancies were not as high as they are now.

“Every Friday after school they attended the club and they did use contraception but following Covid-19 and the lockdowns that affected the club’s operations, that’s when we started experiencing the problem of early pregnancies,” she said.

Motikoe said they will relaunch the club when schools reopen. The District Health Management Team (DHMT) Sexual and Reproductive Health (SRH) Mentor, ‘Manthabeleng Motumi, said Nkau, Nohana and Mpharane clinics were among the health centres that were handling the highest number of teenage pregnancies in the district.

She said findings reveal that child marriages, including those involving children as young as 14-years-old, “are not seen as a problem” in the area. She said many children are becoming young mothers, adding that they face health problems as a result.

She said being pregnant at such a young age can cause a lot of bleeding during pregnancy (hemorrhage related to high blood pressure). She also said the girls are supposed to give birth at the clinics but when they have complications, they get referred to either Qacha’s Nek or Mohale’s Hoek hospital.

“It causes chaos. It’s about three hours to get to such places and its worse during heavy rains,” she said, recalling a girl who lost a child in Ha-Mootsinyane because the river was overflowing and there was no communication due to bad weather.

“We see it as an emergency but one still has to take three hours to get to the hospital.”

Their experiences are just some of many in a country where six out of 10 girls aged between 15 and 19-years-old are mothers or are pregnant with their first child, according to the United Nations Population Fund (UNFPA)’s 2021 report.

Only Namibia (seven out of 10 girls) has worse figures than Lesotho among East and Southern African countries. The UNFPA Supplies Coordinator, Tšeliso Masilo, said the UNFPA supports the Ministry of Health with several strategies to address issues of sexual and reproductive health.

“We are aligned to the government’s policy relating to SRH issues,” Masilo said.

He said the agency has been assisting the government to buy family planning commodities and ensuring their availability in all government facilities and accessibility to reduce abortions.

“Young women and adolescents should have access to contraception,” he said.

“We work hard to bring services closer to them by introducing user-friendly contraceptives to them such as self-injection depo,” Masilo said.

He said they also promote long term methods of family planning considering Lesotho’s topography.

“Sometimes it takes long for people to go to facilities and long term contraception reduces costs,” said Masilo.

He said the UN agency is promoting user-friendly services to young people through the Comprehensive Sexual Education (CSE) programme in collaboration with the Ministry of Education to avoid teenage pregnancies.

During the launch of the World Population 2022 Report two months ago, Seipati Motšei, the programme manager of the Ministry of Health’s Prevention of Mother-To-Child Transmission (PMTCT) wing, said the challenge is to get the message about early pregnancies and contraceptives to young women.

“Although programmes are introduced, some adolescents still face the trap of early unintended pregnancies. Some community-based distributors are dysfunctional and need to be revived,” Motšei said.

She says teenagers are not actively involved in awareness campaigns but “we plan to extend the service to them if the budget permits”. The UNFPA Representative, Dr Marc Derveeuw, says unintended pregnancies are turning into a crisis in Lesotho as one in three women start childbearing in adolescence.

Dr Derveeuw says nearly half of them are children and unintended pregnancies destroy their lives. Dr Derveeuw says unplanned pregnancies can lead to school dropouts, high risk of post-partum depression and unsafe abortion leading to maternal death and morbidity amongst others. He says Lesotho has to prioritise prevention as unintended pregnancies are preventable.

“We need to empower women to make affirmative decisions about sexuality and motherhood,” he said, highlighting the importance of educating young people about sexuality and reproduction as well as access to contraceptives.

The adolescent birth rate in Lesotho is reported to be high at 94 per 1 000 girls aged between 15 and 19-years, according to the 2003-2018 statistics. The Lesotho Demographic Health Survey (LDHS) 2014, states that teenage pregnancies are highest among girls from rural areas and families in the lowest wealth quintile.

Data from School Report Cards collected from schools participating in the School Improvement Project (SIP) indicates that pregnancy and early marriage are the number one reason for girls dropping out of secondary school.
Meanwhile, the UNFPA says it is working to achieve four transformative results.

These are ending preventable maternal deaths, ending gender based violence and harmful practices like child marriage, ending HIV and other transmissible diseases and ending unmet need for family planning. This will be achieved “by ensuring that more women of reproductive age use long-term contraception methods on family planning in Lesotho by 2023.”

This was revealed during commemorations of World Population Day on Monday. The UNFPA said it is important to keep counting, “but to also look beyond the numbers.”

“The solution is not more or fewer people, but more and equal access to opportunities for the people.”

The United Nations Population Fund (UNFPA) Executive Director Dr Natalia Kanem said World Population Day offers a moment to celebrate human progress.

“Our world, despite its challenges, is one where higher shares of people are educated and live healthier lives than at any previous point in history,” Dr Kanem said.

“Societies that invest in their people, in their rights and choices, have proven time and again that this is the road to the prosperity and peace that everyone wants — and deserves,” she said.

’Mapule Motsopa