Mercy Mbabazi died at the age of 14 from severe infection due to unsafe abortion. Although she attempted to use emergency contraceptives to avoid that pregnancy, Mercy was not given the morning after pills because Rwandan laws say that teenagers need permission from their parents or must be accompanied by their guardians to access reproductive health services. Mercy is just one case in an epidemic of teenage pregnancies sweeping Rwanda. Recent data shows that teenage pregnancies in the country have increased by 200 per cent in the last ten years. In the last four years, 78,000 teenage births were reported in Rwanda. And while there’s been a lot of discussion about the need to improve parent-child communication and overcome our “culture of silence” around teen pregnancies, the reality is that there’s something we can do immediately that could have a dramatic impact on teen pregnancies: Change the law so that girls under 18 years old do not have to involve their parents to access contraceptives. Otherwise, we’ll see a continued rise in teenage pregnancies, poorer health outcomes for mothers and babies, and ultimately hurt our prospects for economic growth. We know from experience that these restrictive laws simply don’t work, and it’s not a problem unique to Rwanda. In 2019, some 23 million adolescents around the world said they would like to use contraception but do not, due to restrictive laws and policies to access contraceptives as teens in their countries. Yet, teenagers will continue to have intercourse, often against their will. A 2016 study by CLADHO, a human rights organization in Rwanda, found that 87 per cent of pregnant teenagers had experienced coerced sex before the age of 18, leading to unwanted pregnancies. These policies also discourage teenagers from accessing other important reproductive health services, including getting tested for HIV and STIs, antenatal care visits, legal and safe abortions, legal and psychological support -- all due to the fear that their information would be disclosed to their parents. Changing the law would save more mothers and babies. A teenage mother--like Mercy--has a 50 to 100 per cent increased chance of dying while giving birth compared to women over 18. Adolescent mothers face higher risks of dangerously high blood pressure, infections, bleeding after birth and uterine ruptures, while their babies face higher risks of low birth weight, pe-term delivery and neonatal conditions. In Rwanda, teenage pregnancies are among top leading factors to unsafe abortions and preterm births. And all these factors contribute to the increase rates of unnecessary deaths among those teen mothers and their newborns. By providing contraception for teenagers reducing teenage pregnancies, we can position Rwanda for stronger economic growth. In 2017, the Rwandan ministry of education reported that early pregnancies in high schools have contributed to 50 per cent of school dropouts among under 18 girls. This report shows that many of those teenage mothers become sex workers, their hospital bills are unpaid and a number of their children are found on the street. Consequently, the government of Rwanda spends 6.4 billion Rwandan Francs to care for children living on the street. If we can provide unrestricted access to contraceptives, our adolescent girls will stay in school longer, enter the workforce, and plan to start a family on their own terms. The data is clear: The United Nations Population Fund found that each dollar invested in teenage girls including free access to contraceptives, can save $2.70 spent in handling the health and social economic burden around teenage pregnancies in Rwanda. Those in favor of keeping this law continue to raise a public opinion that by giving our teenagers free access to contraception, we will be giving them the go-ahead to engage in premarital sex. They argue that we should invest these resources in educating young people about the advantages of not having sex at such a young age. However, research published in the Journal of the American Medical Association found that preventing teenagers from getting contraception without parental consent does not decrease sexual activity. In fact, it only makes it more dangerous. Let’s be honest with ourselves about the cost of this prohibitive law. We’re facing an outbreak of teenage pregnancies, unsafe abortions, preterm births, school dropouts, teens sexual workers, street children and all related the financial and social costs. We as parents, as health professionals, as educators, as policy makers, as community opinion leaders, as church leaders, and teenagers; we call for the government to make an urgent choice and action about the collective future of our teenagers, the new generation and hope of our nation. With our new Minister of Health now in place, this is a great opportunity to prioritize ending the epidemic of early pregnancies by providing safe and comfortable spaces for teenagers and adolescents to access sexual and reproductive health services and rights. This is not a fight against Rwandan culture and social norms, it’s a fight for the future of our nation, and to save the lives of our mothers and children. The writer is a midwife and is the health services coordinator at the University for Global Health Equity (UGHE). The views expressed in this article are of the author.
