The Sunday News
Dr Davidzoyashe P Makosa
“MY people are destroyed or perish for lack of knowledge . . .” (Hosea 4 v 6). The World Health Organisation considers adolescence as the period from ages 10-19 years. In simple terms it is the process of developing from a child into an adult. A teenager by strict definition is one aged from 13-19 years.
In this article the words teenage and youth are used loosely as synonyms of adolescence and not in their strict definitions. Recently, there has been a lot of discussion with regards to the sexuality of adolescents or teenagers in Zimbabwe. This article seeks to shed light on some of the health consequences of teenage or adolescent sex so that decisions can be made from an adequately informed perspective. Teenage sex and teenage pregnancy are both health and social problems and it is difficult to discuss the health problems without referring to the social problems. It’s a chicken-egg situation.
A colleague once said something regarding sexual behaviour that I thought was quite wise; “If we lived the possible consequences of our actions in our minds before making a decision, we would probably make the right decisions most of the time. As such,we shall start off by discussing the possible adverse health consequences of adolescent or teenage sexual indulgence”.
n Risk of sexually transmitted infections.
Teenagers are vulnerable to acquiring sexually transmitted infections (STIs) including HIV. Research has shown that the majority of adolescent girls are involved in sexual relationships with men who are much older than them (trans-generational sex or partner-age disparity) and are usually unable to negotiate safe sexual choices.
n Risk of cervical cancer development
Beginning sexual activity before the age of 20 years is a risk factor for developing cervical cancer later in life. The human papilloma virus (HPV) which causes cervical cancer is sexually transmitted and the young girls are vulnerable as the cells of the cervix (its building blocks) which it infects are exposed at this stage of development due to the effect of hormones being produced by the girl. The girl will have no symptoms and the virus will continue to multiply as the cells of the cervix develop, eventually leading to cancer several years later.
n Risks associated with teenage pregnancy
1 Increased risk of death in pregnancy
The risk of dying due to pregnancy related complications is at least double between 15-19 years compared to 20-24 years and between ages 10-14 it is at least five times higher compared to women greater than 20 years. Other sources quote even higher risks than these.
2 Adolescents are at higher risk of seeking unsafe and illegal abortions with resultant loss of reproductive capacity at a tender age (some may lose their wombs as a result of severe infection following termination of pregnancy or end up with blocked tubes affecting fertility for life) and or tragic loss of life either from excessive bleeding or infection.
3 Molar pregnancy — this is an abnormal pregnancy which tends to occur at extremes of the reproductive age in the very young (below 20 years) or the old (above 40). It is associated with a number of complications including severe bleeding. High blood pressure in early pregnancy and risk of developing a type of cancer known as choriocarcinoma later in life.
4 Poor or non attendance of antenatal care.
Adolescents are likely to seek medical attention late in pregnancy either because they were “hiding” the pregnancy or simply had not realised they were pregnant.
They are likely to suffer from iron deficiency anaemia because the baby’s needs will be competing with those of the mother who herself also needs the iron for her own growth.
6 Hypertension in pregnancy
This age group is also prone to the life threatening hypertensive disorders of pregnancy. This condition can result in disability such as visual impairment, stroke, kidney failure and death.
7 Pre-term delivery and low birth weight babies
8 Obstructed labour (difficulties in delivering the baby normally) — this is especially so in the very young as the bones of their birth canals are still maturing. These difficulties in labour can have long term effects such as leaking urine and difficulties in walking.
9 Increased perinatal death and morbidity
The babies born to teenage mothers are at higher risk of illness and death in the first month.
10 Post natal depression
Often teenage mothers have difficulties in breastfeeding and may suffer from depression after birth.
The adverse social outcomes of adolescent sex include stigmatisation by peers and adults, pregnancy, possible interruption of education and possible socio-economic deprivation. A teenage mother has a 25 percent chance of another teenage pregnancy and a higher risk of multiple sexual partners. They are also at higher risk of sexual abuse, domestic violence, incest, homelessness, vulnerability to criminal activity, child neglect and forced adoption. Sadly the offspring of teenage parents are prone to lower educational achievement, criminal activity, abuse, behavioural problems and becoming teenage parents themselves. It has also been noted that the siblings of teenage parents are also prone to teenage sexual indulgence.
Psychological and emotional consequences
A significant number of people who have indulged in sex outside marriage have been known to suffer from both psychological and emotional problems. This is even more pronounced in the younger population and in a society where moral values are still upheld. They are often plagued with feelings of guilt and sometimes worthlessness. Some of them end up making life changing decisions such as deciding to marry prematurely and or for the wrong reasons. Some have plunged into depression to the extent of suicide. Others end up with serial multiple partners further exposing them to disease. The so-called phenomenon of “heart break” after a break-up is worse in those that have indulged in a sexual relationship than in those that have not.
It is often difficult to quantify the magnitude of these psycho-emotional problems as the majority often suffer in silence due to the shame, guilt and condemnation they experience, either as a result of the decision they would have made to indulge or in the case of sexual abuse especially if it was by a close relative, family friend or someone in authority.
If appropriate counsel is not given and or received, adolescents who indulge in sexual activity may be plagued with severe relational problems, including sexual dysfunction in adult life which could negatively impact their marriages. It takes a lot of discernment for a counsellor, health provider or the affected person to be able to establish the root cause of these problems and link it to past sexual behaviour.
It is only appropriate that having discussed the adverse outcomes of adolescent or teenage sex; we highlight some of the factors that have been shown to predispose some adolescents to early sex. These are not exhaustive and some sexually active teenagers may not fit into any of these categories:
n Sexual abuse
A significant number of teenagers who indulge in sexual activity were initially forced or at best co-erced by an adult. A major contribution to this is partner-age disparity or what some would call trans generational sex. What are the chances of a 15-year-old girl being able to say “no” to a 30-year-old “boyfriend”? I remember the sad story of a 14-year-old girl who apparently had “agreed” to have sex with a man in his 20s in exchange for some packets of popcorn, popularly known as maputi. One of the tragedies of sexual abuse is that the survivor may end up with such a low self-esteem of themselves that they end up engaging in sexual activity prematurely and with multiple partners because they feel, they have “nothing to lose”. A significant number of teenagers with sexual behavioural problems would have been sexually abused at some point. Parents, guardians, counsellors and teachers always ought to consider this possibility when dealing with a child involved in premature sex whether or not she claims to have consented. I came across an 11-year-old girl who was accused of delinquent behaviour and abusing a three-year-old boy. On further probing it turned out she herself had been sexually abused since the age of eight years. When the abuser was away she decided according to her own words that she would teach the three-year-old boy how to “play this game” that an adult in his 20s had taught her. In her 11-year-old mind it was a “secret game”.
n Socio-economic deprivation
Children from a poor social background, especially girls are likely to indulge in sexual activities earlier than their relatively privileged counterparts. This includes orphaned and or homeless children.
n School drop outs
Although leaving school prematurely is usually a result of socio-economic deprivation, it is such an important factor that it deserves special mention. In fact research has actually shown school attendance to be a protective factor against early sexual indulgence and consequently pregnancy. In other words school attendance can be considered a “vaccine” against teenage sex and pregnancy.
l Poor transition from school to work
l Having had teenage parents
l Mental health problems
l Cultures that allow child marriages
l Inadequate child protection law enforcement measures
l Adults’ discomfort with discussing issues of sexuality with their children
l Adolescent ignorance on issues of reproductive health
l Drug abuse
l Exposure to sexual material on various sources of media
Usually when we discuss the consequences of teenage sexuality, the tendency is to focus on teenage pregnancy, but the latter is only a symptom or a consequence of a deeper problem. The root of the problem is teenage sex. However, we cannot tackle this problem without introspecting on the deeper issue of societal morality. Therefore, teenage sex is essentially a moral issue with social, economic and health consequences. The solutions are multidisciplinary but there has to be a focal point. That focal point is probably the family led by the parents because this is the place where morals are first introduced.
In general, children learn what they live. As such parents and guardians have a critical role to play in implementing the solutions. Simple measures like limiting what children watch on television or surf on the internet and freely discussing age appropriate issues of sexuality with children may go a long way. Having said that it is important that society takes an integrated approach; families, pastors, cultural leaders, education, religious leaders, policy makers, law enforcement, social workers and health providers ought to consider both predisposing factors and adverse outcomes in mapping out trans-generational life-preserving solutions that will focus on preventing adolescent sex or teenage sex.
From a health perspective, prevention is always better than cure. However, the necessary and appropriate support is always available to all youths including those who may have already indulged willingly or against their will. Some health institutions have special “Youth Friendly Corners,” specifically designed for the youths, where appropriate counsel and treatment is offered to this vulnerable group.
It is important that all sectors including education, the church, family, health etc work together in coming up with comprehensive approaches to helping our younger generation in this regard. These should include both preventive and the appropriate supportive aspects for those who may have already indulged. We each have needed another chance at one point or another in this journey of life.
It is hoped that this article has been useful in ensuring that the people of this nation are not destroyed for lack of knowledge regarding adolescent or teenage sexuality. I shall conclude as I began with a quote from the undisputed record best-seller.
“My people are destroyed for lack of knowledge; because you the (the priestly nation) have rejected knowledge, I will also reject you that you shall be no priest to Me; seeing you have forgotten the law of your God, I will also forget your children”(Hosea 4 v 6 Holy Bible —Amplified version).
- Dr Makosa is a Bulawayo-based gynaecologist and obstetrician.