Skip to main site content.
"Teen connector" for Marie Stopes Zambia Catherine, with her daughter Trisha.
"Teen connector" for Marie Stopes Zambia Catherine, with her daughter Trisha.

High stakes

Preventing teen pregnancy can be a matter of life and death

By Pamela M. Norick on July 18, 2016

On an AeroMexico flight earlier this year, Pope Francis made headlines when he moved away from traditional Vatican policy against contraception and told reporters that, with the dangerous Zika virus leading to birth defects, women can use contraception because “avoiding pregnancy is not an absolute evil.”

The Pope’s ideological shift brings him into closer alignment not only with those of us in the field of women’s healthcare, but also with an increasing number of government officials, religious leaders, public policy planners and global strategists. Contraception, they believe, can counter the disempowerment and unnecessary deaths of women and girls, the economic stagnation of countries and families, and the overburdening of our global environment.

In the United States, the teenage birth rate has dropped by 55 percent over 20 years to about two teens in every 100, but still too many girls are getting pregnant, and in other parts of the world the statistics are woeful. Worldwide, from Zambia to Indonesia, girls are dying due to a lack of basic family planning information and services. The stakes are high: Pregnancy is the second leading cause of death for girls aged 15 to 19, according to the World Health Organization, with early pregnancy among the factors contributing to the new number one cause, suicide. These girls give birth to an estimated 16 million, or about 10 percent, of the world’s estimated annual 145 million births. Some one million girls below the age of 15 give birth every year.

New realities about the deadly Zika virus and its links to birth defects underscore the risks that women and girls face. More widely, early pregnancy threatens girls’ childhoods, schooling and dreams, not to mention their safety. To meet this crisis, professionals in women’s healthcare are turning to an unorthodox cadre of experts — from specialists in “human-centered design” to teen game developers and teen mothers — to devise new strategies for reaching youth from Cambodia to Kenya.

In Bolivia, young software developers recently released an entertaining but educational app, in which the main character tries to zap invading sperm before they reach fertile eggs. If they lose, a crying baby pops up, a reminder of the consequences of an unplanned pregnancy. The game has already had about 4,000 downloads, with plans to translate from Spanish to English and French by summer’s end.

In Tanzania, health educators launched a youth campaign called, “Chagua Maisha,” or “the Good Life,” in the local language of Kiswahili, with a Miss Tanzania Top Model and other celebrities making it a social media hit, educating girls and boys about their sexual health and contraception. In Africa and elsewhere, healthcare educators use mobile health vans to draw youth who don’t want to be seen walking into traditional clinics.

In Kenya, where almost one of three girls has had her first baby by age 18, “youth connectors” fan out in Nairobi and elsewhere to educate peers in a new program whose slogan, shouted out by girls, is, “I own my future!” The program runs a free hotline for girls to talk to “Aunty Marie,” a trained counselor. Last summer, healthcare providers hosted a girls only talent show where teen educators talked to girls about their reproductive health.

Five years ago, in Kalandila, a farming village in Zambia, one of those young educators, Catherine, then an 18-year-old student, snuck out of her grandmother’s home at dusk one evening to secretly meet an elder in the village. She slipped the woman a bar of Lifebuoy soap and a packet of Boom, a detergent. In exchange, the woman led her to the village’s edge and dug up the dried root of a climbing plant, nkalamba. Catherine stood guard, darting her eyes across the fields for passersby who might learn her secret: she was pregnant.

That night, as her grandmother slept, Catherine crushed the nkalamba and mixed it with a painkiller, boiling the brew in Coke, before gulping it. Girls had told her she could end her pregnancy this way. It is a myth, but the recipe has made its way into chatrooms and social media. Catherine waited for abdominal pain and bleeding. She had never been taught even basic family planning,

“I was scared. I heard girls died,” she told Women in the World.

Stories like Catherine’s are even more alarming as the largest generation of adolescents in history now attains sexual and reproductive maturity. Of the world’s population, about one in four people – or 1.8 billion of 7.3 billion people today – is under the age of 25. In many developing countries, youth aged 10 to 24 represent up to one-third of the population. The youth bulge will become starker in the years ahead with demographers predicting the world population will increase to as much as 11.2 billion by the year 2100.

Doctors in Morocco and Syria report they are seeing pregnant girls as young as 10 and 12, according to a report, “Shelter from the Storm,” released this past December by the U.N. Population Fund. Girls under the age of 15 are five times more likely to die from pregnancies than older women. Girls married young are also at greater risk of HIV infection, domestic violence, and obstetric fistula, with child marriage one of the key reasons for early pregnancies.

Three years ago, the U.N. Population Fund issued a report, “Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy,” chronicling the sobering reality of child brides getting pregnant—girls like Kanas, 18, in Ethiopia, who is quoted, saying she had been married earlier when she was “little.”

“It’s my husband who brought me up,” she said.

An estimated 38 million of the 252 million girls aged 15–19 in developing regions are sexually active and want to avoid pregnancy, according to a new report released recently by the Guttmacher Institute, a reproductive health research organization. However, 23 million of these girls have an “unmet need” for modern contraception and accurate reproductive health information. A survey released last year of best practices by the International Center for Research on Women acknowledged that the evidence for effective strategies for reaching youth aged 10 to 14 is “particularly thin.”

Dinnah Nabwire, a family planning policy expert from Uganda, says that as a girl she would walk on muddy pathways through her village, alongside homes, calling out to girls to join her as she headed to elementary school. Over the years, her group of six girls started dwindling, as the girls became pregnant and dropped out of school. Finally, only Nabwire was left, going to college. She has prayed at the grave of a local girl who died after unsuccessfully trying to end her unplanned pregnancy in an effort to stay in school.

“The future of girls like my friends can be saved,” Nabwire says. “We are facing a global crisis with adolescent pregnancies. Now, girls are getting pregnant at 10. We need to awaken to this reality and make reproductive health services accessible to women and girls globally.”

Fortunately, as with the Pope’s policy shift, we see a growing recognition of the health risks that women and girls face when they don’t have access to contraception.

In 2012, government officials, nonprofit leaders and others met at a London Summit on Family Planning, led by philanthropist Melinda Gates and the U.K government, and outlined bold new goals, now known as Family Planning 2020, or “FP2020,” to provide women and girls far greater access to contraception by the year 2020. We need to make sure the global community is able to meet this ambitious goal, including with youth friendly initiatives that “demedicalize” family planning, while maintaining the highest quality clinical standards. Our success depends in great part on public policy reforms, medical innovations and new communications technologies and strategies for outreach, engagement and education. In addition, family planning and reproductive health commodities are in dangerously short supply and drastically underfunded by the global community.

In reproductive healthcare globally, we are seeing significant breakthroughs in reducing the stigma of using contraception, and the removal of policy restrictions that have often limited access to contraception, revolutionizing the way health care is provided in communities from Cambodia to Kenya and, most significantly, empowering women and girls. And we now need to close the funding gap.


The homemade concoction that was a last resort for Catherine, the Zambian teenager, failed to end her pregnancy. Her father ran her out of his house when she broke the news to him, telling him, “I didn’t know what I was doing. It was the work of the devil.” Recalling the incident, she explains: “I had just never gotten any information about how my body works.”

A healthcare clinic worker turned her away when she went with her mother, Monica, for aid, shouting at her mother, “How could you let her get pregnant?” Eight months later, at the age of 19, Catherine went into labor.

“Mommy, help me!” she yelled, as the sharp pains of labor pierced her body.

The doctor decided to perform a caesarean operation. Catherine gave birth to a healthy baby girl, Trisha. She put aside her dream to finish her studies to be a nurse, and failed to immediately bond with her daughter because of feelings of shame. She turned her face away when her mother brought the infant to her.

When Monica held baby Trisha to Catherine’s breast for feedings, Catherine recalls, “I would look the other way.” When her baby cried in the night, she pretended to sleep so her mother would awaken instead. Eventually, she began to stare at her baby while she was sleeping, and, over a few months, she fell in love with her daughter.

Not long after, Monica (separated from Catherine’s father) also gave birth, to a son. Monica then died suddenly, leaving Catherine to raise her own baby and her new brother. Catherine eventually learned that her mother had been secretly battling AIDS.

Now, Catherine kisses her daughter and brother goodbye each day before heading off to work as a “Teen Connector” for Marie Stopes Zambia, educating girls about reproductive health. She shares her story with girls in her community, teaching them about family planning and contraception to help them rewrite the script that threatens so many of their lives: early pregnancies.. She hopes one day to return to school to become a nurse.

“I am lucky to be alive,” she tells the girls. “Don’t risk your lives. Realize your dreams.”

The young educator misses her own mother, but sees her often in her dreams.

Catherine says: “She is very proud of me. She is smiling at me.”

Pamela M. Norick is executive director of Marie Stopes International in the United States. Founded in 1976, Marie Stopes International is a London-based nonprofit dedicated to providing contraception and reproductive services to women and girls around the world. She can be contacted at Follow Marie Stopes at @MarieStopes.


Suicide is now the leading cause of death among teenage girls

Colorado initiative leads to big decline in teen pregnancy

Pregnant girls, exploited after the Ebola crisis, remain banned from Sierra Leone schools