 |
| About Bioline | All Journals | Testimonials | Membership | News |
|
||||||
|
||||||
Union for African Population Studies, Rapport de Synthese / Summary Report, Numéro/Number 11, March 1995 SMALL GRANTS PROGRAMME ON POPULATION AND DEVELOPPEMENT FERTILITY AMONG ADOLESCENT GIRLS IN SENEGAL : A SUMMARY Nafissatou J. DIOP, Ph.D This document is an abstract of the thesis presented by Mrs N.J. DIOP in 1993 at the University of Montreal. The views expressed in this study are the author's and cannot in anyway be taken as the views of UAPS. Research sponsored by the Small Grants Programme on Population and Development funded by the IDRC, the Rockefeller Foundation, the Mac Arthur Foundation, SAREC and the French Cooperation Ministry. Code Number: uaps95003 TABLE OF CONTENTS FOREWORD FOREWORD Africa is the continent where population problems are most acutely felt. These problems have repercussions in all areas of life. The awareness of these problems and the dearth of african specialists on population issues had led governments to set up, with the help of the United Nations, a number of regional training institutions on Demography. However, despite the large number of demographers trained over the last two decades, the improvements of the demographic date base and the commitment shown by governments, the taking on board of demographic factors in development strategies has remained very tentative. These mitigated results are attributable, in part, to the inadequacy of theoretical and empirical knowledge about the dynamic character of socio-economic and demographic systems and the difficulties in translating policies into a programme of action. Nonetheless, the greater part of the specialists who uderwent training in the field of population often find themselves left to their own devices, isolated in structures ill-prepared to utilize their expertise. Moreover, with the persistence of the economic crisis the continent is going through, african countries cannot meet their research financing requirements. These specialists rarely have the means which would allow them to undertake research work. It is, in an effort to respond to all these problems, that UAPS embarked on the implementation of a Small Grants Programme on Population and Development. This programme's main goal is to help junior african specialists to strenghten their research capacity in the field of the interrelations between population and development. Through this initiative, UAPS hopes to contribute not only to smooth handing-over conditions but also, and above all, to improve the existing knowledge on population issues in Africa, in an integrated and comprehensive perspective. Since its creation, the Small Grants Programme has received over 800 requests for funding. In total 81 researchers have had to benefit from funding, including 29 during the first phase of the Programme (1986-1991) and 52 during the second phase (1992-1995). Researches funded during the first phase have resulted in the production of 26 reports, 8 of which have already been published and 9 others are being edited. These researches cover a wide range of topical issues. They consisted in case studies which deeply explored the problems studied (urbanization, rural migration, street children, women's status, reproduction strategies, etc.). By and large, the Small Grants Programme's harvest is impressive both in terms of research training and the results obtained. This Programme's merits are all the more important as its design and thrust do respond to current concerns. It has adopted an open perspective on population issues which integrates economic, cultural and strictly demographic aspects. What's more, it lays the stress on research training, in the very countries, thus contributing to the maintainance of skilled people on the spot and the development of the capacity of national institutions. Finally, through its philosophy, the Programme works towards regional integration and cooperation between francophones and anglophones. The present study which is part of the reports produced within the framework of the Programme, mainly focusses on fertility among Female Adolescents in Senegal. It basically hinged on the review of the data of the 1986 Demographic and Health Survey (DHS) in Senegal concerning menses, nuptial ceremony and 1st rank fertility among senegalese women before they celebrate their 20th birthday. The main problematic of this study is the analysis of the possible trend of first-fertility before the age of 20 among the different generations under consideration. This is obviously a very important subject and the longitudinal approach used is particularly pertinent, in the present context of international research where "Fertility among Female Adolescents" has become a "problem", thereby an extra argument in favour of the strenghtening of family planning programme. N.J. DIOP's line of argument is interesting indeed, as she strives to demonstrate that fertility among female adolescents raises both problems of health and social acceptability. The conclusions of this study are all the more interesting as they do not always coincide with our expectations and has resulted in pragmatic recommendations. I wish to congratulate N.J. DIOP on the innovative and interesting work she offers us in the following pages. Moreover, I would like to thank all those who, directly or indirectly (donors, grantees' supervisors and research report readers), have contributed to the completion of this study. May this Programme further stimulate research on the complex relationships which exist between population and development and enable researchers to fulfil their scientific responsability in the battle for development in Africa. Finally, I wish to pay tribute to the late Richard HOROWITZ, former regional representative of the Ford Foundation for Africa who, along with Sidiki COULIBALY, the current UNFPA Director in Senegal, have launched the Small Grants Programme. Prof. Mumpasi LUTUTALA I. INTRODUCTION The study of fertility among adolescent girls has for a long time been assimilated to that of general fertility, before it was felt necessary to specifically study this group of women. It is in the United States that the interest in this subject as an object of study was born with the coming into adolescence, in the 1960s, of the "Baby Boom" generations. Under the influence of all sorts of factors these generations adopted behaviours different from those of the preceding generations, in particular a more widespread practice of sexuality before marriage (Furstenberg, 1976; Elder, 1980). A moral, political and legislative debate took place over the recourse to abortion, the necessity for sexual education and family planning services in schools. The reasons behind this debate are diverse: for Geronimus (1986), these are riks for maternal and child health; others justify it by the desire of a more egalitarian policy towards minorities, as it is estimated that about 63% of young black girls in the United States are affected by the problem (Davis,1988; NRC, 1987). For Phipps-Yonas (1980), it is the fact that the problem is not exclusively a problem of sub-culture, as it is increasing among white adolescent girls. The economic cost of teenage pregnancy is also put forward (Moore, 1978; NRC,1987). In Africa, that question is starting to arouse special interest. It is not perceived as a problem everywhere. But for Gyepi-Garbrah (1985), in we place ourselves in the perspective of reduced fertility, the contribution of birth from adolescent girls is considerable. For Nichols and his colleagues (1986), pregnancies before marriage are assuming increasing proportions in Nigeria and in Liberia because of socio-cultural changes. For Senderowitz and Paxman (1986) the social and medical consequences of early fertility are too significant to be glossed over. Bamikale and Pebly (1989) talk of a disorganisation of traditional society. In Africa, urbanization and schooling rates keep increasing. Thus, for two decades now, an increasing number of girls are schooled and urbanized (Nichols and al., 1986). However, these young girls tend to get married later, and they are the most exposed to the dilemma of adolescence (Cherlin and Riley, 1986; Ladipo and al., 1983). Studies have revealed that in this population the rate of sexual activity, pregnancy and abortion (Oronsaye and Odiase, 1983; Oyeka, 1986; Gyepi-Garbrah, 1985; Ladipo and al., 1983; Nichols and al. 1986; Akuffo, 1987) are very high. Some aspects of african culture and the social structure are also reported to influence the behaviour of urban adolescent girls. This greater freedom combined with the images of a sexual freedom coming from the West would lead to greater propensity to having sexual intercourse before marriage (Bamikale and Pebley, 1989; Demehin, 1983). Other studies have shown that cohabitation and promiscuity in the cities were such that they pushed children into the streets, where they were left to their own devices (Jean-Bart, 1988; demehin, 1983). These ideas are taken up by Cherlin and Riley (1986) who, in an effort of conceptualisation, have affirmed that the sexual activity of single adolescent girls today can be accounted for by the two following reasons: "rational adaptation" or "social disorganisation". Social disorganisation is part and parcel of the general theory of modernization which revealed the weakenening of traditional structures and the slackening of the contol by the elders over the younger members of the family. The thus newly born attitudes are geared more towards personal satisfaction and emotional gratification, than towards family responsibility. Within this framework, it would seem that sexual relations are spontaneous and do not respond to any special purpose. Rational adaptation is reported to be rather related to the dependence theory. This model is mainly based on the effects of the poverty of the populations. Adolescent girls who come into town looking for greater economic power often have no other choices but to rely on the help of a "friend" to pay for their studies or to offer them presents, clothes, money or work in exchange for sexual favours (Cherlin and Riley, 1986; Caldwell, 1990; Akuffo, 1987), which may lead into marriage. Engaging into sexual relations is therefore a rational decision. In the literature on childbearing among adolescent girls in Africa, as in developed countries, the fertility of married adolescent girls was hardly studied. The stress was mainly laid on the sexual activity of urban schoolgirls. If this approach can be justified in developed countries where over 90% of adolescent girls are single and still at school, in Africa where more than half of adolescent girls are married and uneducated it is not very efficient as it would not take into account the greater part of the target public for which an intervention programme should be designed. Our study sets itself three major objectives: firstly, to update the definition of the concept of adolescence by putting it into senegalese perspective; secondly, to indicate the determinants of fertility among adolescent girls in Senegal, to design the theoretical framework for socio-demographic research in Africa; and finally to compare the behaviour of adolescent girls to that of older women to determine the reasons for which behaviour, which is the main determinant of morbidity and maternal and child mortality (Hobcraft, 1991; Adelunke and al., 1992; Gernimus, 1987; 1991; Leslie and Gupta, 1991), is more negative among adolescent girls. 2. THE SOCIAL CONTEXT OF FERTILITY IN ADOLESCENCE 2.1. The ambiguity of the term "adolescence" In most dictionaries, adolescence is defined as "the process through which an individual goes through the transition from the stage of childhood to that of adulthood". Adolescence is characterized by efforts made to reach "social, physical, mental and emotional development" (Elder, 1980).While the beginning of adolescence is currently associated in most cultures with the beginning of puberty, the end of adolescence is rarely clearly defined (Senderowitz and Paxman, 1985; WHO, 1986). Senderowitz and Paxman (1985) think that the definition of adolescence may vary from one culture to the other, as long as certain recognized criteria like those of an adult do not manifest themselves. If it is widely believed that adolescence is the period in life when the individual goes through the transition from the stage of childhood to that of adulthood, it is difficult however to determine where this childhood ends and where adulthood starts. However, as is pointed out by Elder (1980), what defines adolescence is not puberty, or sudden development, or still the process of general maturation, but rather the perception of that maturation commonly admitted in the society considered. How do the Senegalese perceive adolescence ? 2.2 Adolescence in traditional senegalese society In traditional senegalese society, the influence of age is in fact paramount and respect for the elder is important, in accordance with the hierarchization advocated by society (Diop, 1981). According to these norms, the education of the child, and that of the adolescent, and the learning of his trade are assumed by the members of the extended family. The latter form the character of the individual and his professional orientation (Miske-Talbot, 1984). The compound is an instrument of control as it regulates the life of its members. Social control is all the more necessary as the behaviour of an individual can earn the entire lineage condemnation or fame (Ayodele, 1983; Miske-Talbot, 1984). The fact that the members look after one another is even more pronounced among adolescent girls who are in the process of learning a woman's role.A girl who does not go to school gets very early into the process of learning her future role both as a woman and mother under the supervision of her mother and the female members of the compound. Responsibilities are gradually entrusted to her, to such an extent that as soon as she reaches puberty, she is given in marriage. However, girls also enjoy relative autonomy within age groups. In fact, the importance of peers in the child's social development is largely recognized by traditional society. As Kelly and his colleagues say (1987), the adolescent girl has, along with the parents, sisters and peers of the same and opposite sex, different relations with the same persons, during childhood. Relations among peers become more intense, and those with the family less strong. Traditional societies also recognize this difference and the age group is an institution in which the child, and then the young girl are going to develop. Under various forms (songs, tales, proverbs) the norms and values of society (honour for her and for her family, sense of decency, dignity, self-respect, and above all tolerance and patience in her future married life) are reminded to the girl, for these are the virtues that are going to make her a good wife. The adolescent girl should remain a virgin and chaste girl, and should abide by a rule of conduct enabling her to protect her virginity and future fertility (Miske-Talbot, 1984; Ayodele, 1983; Diop, 1981). A woman's marriage and sexuality can only been perceived in relation to fertility. Marriage and childbearing are perceived as a duty for the individual, for society's survival and regulation (Miske-Talbot, 1984). Thus, early fertility is encouraged , for it is valorizing for women, men and the lineage. This early nature of marriage and childbearing made people say that adolescence in traditional society is a notion that does not exist, as once the girl reaches puberty she is given in marriage (Chui, 1978), for marriage is synonymous with respectability, maturity and adulthood. Childbearing is also recognized as such. This is when it takes place out of wedlock, the adolescent girl loses all privileges associated with being a young girl, including material and social assistance by the parents.This system has been prevalent for several centuries in Senegal. The changes that took place a few years ago only affected urban areas. 2.3 Adolescence in Modern Society Colonization led to rapid economic, administrative and religious changes in african societies. The manifestation of these changes in the social structure is complex. Modern society is mainly visible in urban areas under the combined effects of the cash economy, the introduction of education, the media, different technological imports and religion. If the family still remains for many people the basic social institution, its authority is reduced however (Caldwell, 1991; Diop, 1985). In modern african societies, relations between parents and children are different from what they used to be in traditional societies. In fact, as society gets more and more technologically advanced, the individual's education passes more through schooling, television and radio, the press and new ideas which create new attitudes. These new attitudes affect society's perception of adolescence. The education of young people, and young girls in particular, passes through the school network and no longer prepare them to nothing but the roles of actors within the family, but to those actors operating in a new environment in which an individual's success is no longer related to his lineage, but results in his/her capacity to assimilate "scientific" knowledge and to innovate. The learning process here is above all longer and thereby disrupts the normative time-table by lengthening the period between childhood and marriage. This is what made Chui (1978) say that there is in it an emergence of the period of adolescence. This period of adolescence is a source of conflicts. In modern society, the activities carried out by groups of adolescents take them increasingly away from adults and the separation of sexes is no longer so pronounced. All new recreational activities such as going to the cinema or dancing parties contribute to the shortening of the period spent within the family. In modern african society the adolescent is starting to look very much like his counterpart in western countries. Thus, his social environment starts perceiving him differently.He becomes economically independent and only starts taking part in the community's decision-making process very late. He becomes increasingly useless and is less and less likely to be entrusted with responsibilities as he behaves less and less as a member of the collective group.Thus, although he is biologically mature, he is socially immature. The adolescent himself goes through a change of attitude. He develops his own culture, generates a different lifestyle with his own codes, his tastes in music and in dance, and his ideas on what morality is all about. The content of these styles changes as time elapses, but it still contains the same message: an expression of segregation and opposition to the society of adults (Kelly and Hansen, 1987). In modern society, the group of peers serves as a stepping-stone for the adolescent to go from childhood to adulthood and from the ascendancy of the family to making personal decisions. Senegalese adolescent girls in urban areas learn by imitating their peers, and mass media play an important role in the popularization of modes of clothing and the new values created by young people in western societies. Moreover, with the introduction of mechanized work following modernization, a population movement from rural to urban areas starts. The migration of adolescent girls towards the cities, be it with their family or by themselves looking for a job, just like the migration of Diola and Serer girls towards Dakar and other secondary cities looking for jobs as domestic workers, leads to the rapid transition from a traditional to a modern system. The adolescent girl is no longer in a position to internalise a coherent system of sufficient normative barriers to forestall certain behaviours. Thus, without reference nor reliable guide as to how to cope with new situations which they find themselves in while living in the cities, adolescent girls start adopting different behaviours. The conflict between traditional values and modern habits is even more heightened by this when their family reamains in the village. These two perceptions of adolescence in Senegal are going to have repercussions on the fertility of adolescent girls. Thus, according to whether we consider one or the other perception, fertility will be perceived differently. In traditional society, teenage pregnancy is accepted and even wished for by society, and it is part and parcel of the traditional normative programme. Therefore in traditional Africa, fertility during adolescence is not a social problem. In modern society where sexual activity seems to have become more frequent, the way young girls view pregnancies has considerably changed. In the case of pregnancy before marriage, childbearing among adolescent girls is considered as a disruption to the mother's normal life cycle. This is what Furstenburg (1976) refers to as the "disruption of the normative programme", insofar as adolescent girls, and to a large extent the entire community, find themselves in a premature status transition, propelling them into positions which they are not ready to assume. These pregnancies are strongly rejected by the family and the social environment, and will create integration difficulties for the mother. To what extent do the two approaches to adolescence thus defined, the resulting social evolution as well as the slackening of family authority affect puberty, marriage and childbearing before the age of twenty ? This is what the next part is endeavouring to study without forgetting to analyse the reasons for which the behaviour of adolescent girls is more negative than that of older mothers regarding the use of heath services. 3. METHODOLOGY 3.1 Analytical framework Model for the study of fertility and its determinants The transition from adolescence to adulthood is studied according to a longitudinal perspective so as to better understand social change. The life cycle approach makes it possible to better understand the links which exist between age and time (Elder, 1980). Three temporal modalities are defined: The effect of age (lifetime); it is more related to the process of the individual's physical development. This study will try and identify adolescent girls. Puberty will be used to understand the effect of age. The effect of the moment (social time); it is more concerned with the age differentiation for the sequence of events and roles. This idea is perceived on the basis of two perceptions of adolescence. In fact, with the evolution of the concept of adolescence, society accepts a chain of roles which is different according to whether one finds oneself in the traditional system or in the modern system. Marriage and childbearing further call for the role and norms of society. These variables are used to understand the effect of the moment, which is used here in an urban-rural context. The effect of cohort (historical time) is rather based on the differentiation and succession of the roles of cohorts, with their influence on lifestyles. This study is aimed at identifying differences in the emergence of events according to generations. As for the study of determinants, given the fact that the Demographic and Health Survey (DHS) has interviewed women aged between 15 and 49 years at the time of the survey, the top limit of the reflection framework will be the age of 20. However, with retrospective data, events took place at any age. One adaptation to the sociological framework developed earlier, which indicates that the end of adolescence is marked by marriage and childbearing, consists in using as a definition "any event which took place before the age of twenty years", without giving any pecision on the lower limit. And this is valid for all the generations covered by the survey. Model for the study of the medical consequences of pregnancy The medical consequences of pregnancy in adolescence are largely a function of the behaviour of mothers during pregnancy. The mother's decision to make use of health services is based, according to the literature, on three sets of factors : predisposing factors, reinforcing factors and on facilitating factors (Green and al, 1980). Predisposing factors are elements anterior to behaviour but which are going to lead to the motivation of behaviour. Facilitating factors precede behaviour and are going to make its achievement possible (personal and community resources). Reinforcing factors are elements which act subsequently. This model is referred to in the health literature as the PRECEDE model. 3.2 Sources of data and Methods of analysis This study uses the data of the 1986 Demographic and Health Survey (DHS). The methodology used for the analysis of fertility and its determinants calls for survival tables.These make it possible to avoid systematic errors, to use all the data and to take advantage of the information from incomplete stories as in a cross-section survey like the DHS one, the experience or exposition of some members of the sample to a risk is interrupted by the survey, that is to say that ulterior events are not seized. 1) For most of the tables where generations are compared,
the gross tables describing the occurrence of events in the absence of disruptive
factors and which make the description of a phenomenon in a pure state possible
are used (Smith, 1980).
4. SUMMARY OF THE MAIN RESUILTS 4.1 Fertility and its determinants Puberty Survival tables did not point out the drop in the age at which menses start for the generations born between 1946 and 1971. Longer observation and more reliable data are needed for one to draw final conclusions. However, according to certain socio-economic characteristics like residence and education, for the generation aged between 15 and 19 years at the time the survey was being conducted, the puberty extinction curve of the most educated women and which are subject to variations in urban areas is the one that decreases more quickly. Suppose the most educated women and who live in urban areas are the best fed ones, the change in this group confirms what has already been verified in several countries. In the other age groups that relationship does not exist or is less marked. This is not surprising insofar as nothing indicates that nutritional conditions in the part were better in urban areas, or for ducated women. Thus, if in the literature it is admitted that age at puberty should have been brought down as a result of improved nutritional level (Burrel, Healy and Tanner, 1961; Gyepi-Garbrah, 1985; Senderowitz and Paxman, 1986), with data on Senegal, it has not been possible to confirm this hypothesis. Relations between age at puberty and age at first marriage The marriage schedule according to the age at which women reach puberty shows that when age at puberty is early, age at marriage follows suit. It also appears that the interval between marriage and puberty is very short. Thus, the coming of an adolescent girl's menses entails a process of marriage organisation or consummation on the part of senegalese parents. In fact, the relation which was established between age at puberty and age at marriage shows that the beginning of menses leads to a recognition by society, for the girl is physically mature for reproduction and thereby for marriage. This confirms that puberty is a non negligible determinant for the formation of families. Age at first marriage Even if marriage is quasi universal, with a few persons remaining definitively singles, it appears that significant changes are taking place in the premarital schedule. The proportion of women before the age of 20 years has regularly diminished as the generations are getting younger. The Khi 2 test confirms this by turning out to be significant around 1%. As marriage socially marks the end of adolescence, the duration of adolescence can be affected by it. If four fifths of the generation born in 1941-1917 were no longer adolescents before reaching their twentieth birthday, it is half of the generation born in 1966-1971 who were not so any longer before reaching their twentieth birthday. There has therefore been a gradual lengthening of adolescence. In urban areas, the lengthening of adolescence was really started with generations born as from 1957. In rural areas, the transition was also set into motion, but with a delay of two five-year groups of generations on the urban environment, it is therefore definitely slower. Thus, adolescence is a short period in rural areas, and a longer one in urban areas. But what the data have been able to show is that this difference, which was not significant with older generations, becomes so with younger generations. This does confirm the study plan which was proposed, namely that in Senegal we have two social systems. While in the past there was only one system, in which the adolescence transition was virtually the same as for the two residential areas, today, this adolescence transition is much longer in the modern system, for the gap widened as the urban environment became preponderant and was modernizing itself. Age at first childbearing The age at first childbearing increased only very little as time went on, the progress having been exclusively brought about by the younger generation. It remained constant for three generations, before it started increasing slightly with the generations born between 1961 and 1966, and started going down with the generations born after 1966. The age at marriage having regularly declined, one could have witnessed a similar trend at the level of the age at first childbearing, instead of witnessing some kind of stability at the age of first childbearing. Adolescent girls in the rural areas continue to have their first birth much earlier than their counterparts in the urban areas. But, the difference is only significant for the first four age groups covered by the survey. For the 40-44 and 35-39 age groups, the difference is not significant. According to the educational level, the same trend seems to take shape in all generations. The more educated women are, the longer they delay their first childbearing. The difference noted at 19 years of age between the educational levels is significant for all three age groups , even if the threshold of significance increases as we move from younger ages to older ones. On the other hand, when one considers separately educational categories, there is no significant difference of age at childbearing between the 40-44 age group and the younger ones. Premarital pregnancies The data available did not confirm the assumption according to which premarital pregnancies increased in Senegal. There was no increase in rank 1 fertility before marriage, but the percentage of women having experienced premarital childbearing as the major event before the age of 19 years is on the increase. In fact, a change was set into motion with the generations born as from 1961. In checking with the place of residence, it has been possible to note that for all women, there is virtually no difference in attitudes. However, when each generation is observed, it can be said that it is above all the generation aged 15-19 years in urban areas at the time the survey was being conducted who seems to have the attitude depicted in the assumption. For the other age groups, the percentages are are more significant in rural areas. Thus, it is in urban areas that a real change of attitude took place as in the younger generation, a greater number of young girls aged 15-19 years reach adulthood after having given birth. What also come out of this analysis is the high rate of this percentage among women having had primary school education. This confirms the theory which has it that the longer the time between the beginning of adolescence - which is characterized by the appearance of menses - and the end of adolescence - which is often assimilated to marriage, the bigger the risk for the young girl to have sexual intercourse before marriage, and probably to become pregnant. The study of the protogenesic interval shows that as the age at marriage increases, the shorter the interval between first marriage and the first birth becomes. There is a clear upward trend of fertility during the first years of childbearing when the age at marriage increases, and it would seem that premarital pregnances also increase in this case. 4.2 The medical consequences of early pregnancies Health care during pregnancy is not yet systematic for senegalese women. Non only one third of the women are not immunized against tetanos during pregnancy so as to forestall neo-postnatal mortality for their child. Even by taking into account socio-economic characteristics, albeit very discriminatory, the difference in attitudes remains very significant for very young mothers aged below 18 years. Moreover, residence in rural areas and illiteracy are the two factors most associated with non immunization. One third of women did not undergo any prenatal medical examination during pregnancy. For very young mothers, the risk of not undergoing any medical examination is highly significant and remains so when one takes socio-economic variables into consideration. The fact of being poor, living in rural areas, being illerate and married is closely related with the absence of quality medical examination. As for assistance when delivering, it is the very young mothers who have the most positive behaviour. However, this positive attitude disappears when the quality of the assistance is taken consideration. Very young mothers, becausae of their lack of experience, are taken in charge by older women, and are therefore more inclined to resort to traditional services. In examining independent variables, service factors are more discriminationg regarding the use of health structures than factors related to the users, for the absence of services in the rural areas can be largely explained by the fact that women resort less to health services. In urban areas a non negligible proportion of women do not resort to health services. For these, it is not because of the absence of services, but perhaps for reasons related to the times when they are available or the quality of the health care, or to education or other cultural barriers. 5. IMPLICATIONS FOR THE POPULATION POLICY It can be said of this study that the putting in place of a health policy more directed towards young mothers would improve the population's health status. Family planning campaigns lay the stress on delayed childbearing during very early adolescence, are reported to also have a positive effect on the mother's health. But any policy aimed at raising the age at marriage should introduce the necessary accompanying measures to make sure the attainment of the objective pursued is not accompanied with increased fertility and premarital pregnancies. It is urgent that 60% of women living in rural areas and who continue mostly to resort to traditional medical services have access to modern health services. It is also particularly urgent that measures be taken to obviate these problems. IEC campaigns are the basis on which the National Family planning Programme rests are mainly a birth spacing message; this means that women who have already given birth are above all targeted. A Family Planning Programme specifically intended for young girls not only from the IEC point of view, but above all from the clinical point of view should be developed. The issue of fertility among adolescent girls and its various consequences might assume increasing proportions in the years to come, insofar as "modernization" of society keeps accelerating. Even international aid and structural adjustment policies contribute to compound this problem. Being educated is more and more necessary, but at the same time, the possibilities of entering the job market dwindle. The schooling of young girls at secondary and higher education levels gets accelerated. The mediatization of a western culture, thus creating a universal "youth" culture establishes itself. The desire, but above all possibilities of getting married dwindle insofar as the latter are closely related to the socio-economic situation, illegal abortion becomes widespread, creating serious health problems. All these factors are going to contribute to make this problem even more serious in the future. BIBLIOGRAPHY
|
| |||||||||
