8
Conclusions

If adolescent pregnancy and childbearing in sub-Saharan Africa draw increasing social concern, it is not because they are new: Teenage women in African societies have been bearing children for a very long time. In the past few decades, what has changed more than the proportion of adolescents giving birth is the social context in which adolescent fertility occurs, making it, in some instances, considerably more troublesome than in the past. Here, we briefly review the evidence on recent developments described in this report and place the findings into a wider perspective.

The data from the Demographic and Health Surveys (DHS) and other evidence presented in Chapter 2 reveal that overall, teenage childbearing in Africa has not increased recently in most DHS countries. Reported ages at first marriage are increasing in many countries. If, as is usually the case, unmarried teenagers are less sexually active than those who are married, sexual activity in the teenage population may actually be declining. Substantial changes in several domains, however, bear strongly on the circumstances in which adolescent fertility occurs, influencing not only its actual rates but also, most certainly, its consequences. At the beginning of adolescence, some very tentative evidence suggests, the age at menarche may be declining in some countries. At the other end of adolescence, in many countries factors that are socioeconomic in origin are delaying the time when reproduction occurs. The proportion of women who have had at least some secondary education has increased dramatically in some countries such as Botswana, Kenya, and Zimbabwe, and in many countries women



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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa 8 Conclusions If adolescent pregnancy and childbearing in sub-Saharan Africa draw increasing social concern, it is not because they are new: Teenage women in African societies have been bearing children for a very long time. In the past few decades, what has changed more than the proportion of adolescents giving birth is the social context in which adolescent fertility occurs, making it, in some instances, considerably more troublesome than in the past. Here, we briefly review the evidence on recent developments described in this report and place the findings into a wider perspective. The data from the Demographic and Health Surveys (DHS) and other evidence presented in Chapter 2 reveal that overall, teenage childbearing in Africa has not increased recently in most DHS countries. Reported ages at first marriage are increasing in many countries. If, as is usually the case, unmarried teenagers are less sexually active than those who are married, sexual activity in the teenage population may actually be declining. Substantial changes in several domains, however, bear strongly on the circumstances in which adolescent fertility occurs, influencing not only its actual rates but also, most certainly, its consequences. At the beginning of adolescence, some very tentative evidence suggests, the age at menarche may be declining in some countries. At the other end of adolescence, in many countries factors that are socioeconomic in origin are delaying the time when reproduction occurs. The proportion of women who have had at least some secondary education has increased dramatically in some countries such as Botswana, Kenya, and Zimbabwe, and in many countries women

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa now find opportunities in urban employment. Moreover, although most women still report marrying before age 20, several countries have experienced noticeable increases in the age at marriage. How do these changes affect childbearing? Increasing age at marriage, combined with constant or declining age at menarche, suggests that the gap between sexual maturity and socially approved reproduction is growing. To be sure, most teenage childbearing still occurs within marriage, and in many countries early marriage and childbearing remain commonplace, if not highly desired. Yet the eroding connection between marriage and childbearing appears to underlie most of the publicly expressed concerns about adolescent fertility. Together, these trends effectively lengthen the period during which problems that are social in origin may come to bear. Probing further into changes in marriage, Chapter 3 shows that diverse conjugal practices explain some of the disjunction between marriage and childbearing. Further, because entry into marriage is usually less a clear-cut event than an inherently ambiguous process, the birth of a child may be an important step toward a union rather than a logical outcome of it. Changes in economic opportunities, law, religion, and education have introduced further ambiguity into what has long been recognized as a highly fluid status, and have fostered more consensual and ''outside'' unions. One woman may use these ambiguities to advantage, testing out new economic opportunities or using pregnancy to cement a desirable marriage. Another woman who becomes pregnant may find herself stalled in a remote holding pattern of the marital process by an urban man who must maintain a monogamous appearance. What is important for our purposes is that the way a union is viewed, whether with censure or celebration, usually determines how a pregnancy resulting from it is perceived. Families continue to value fertility, but they try to ensure that it occurs within sanctioned states. Numerous ethnographic studies suggest that certain kinds of sexual expression by adolescents may have been more freely tolerated in the past than they are in Western societies; but sexuality was regulated closely by adults, who sought to maintain sharp boundaries between casual sex and reproduction among adolescents. Chapter 4 shows that in most African societies two other criteria are more important than marriage in establishing sanctioned contexts for childbearing: whether a man assumes paternal responsibility, and whether the young parents have prepared themselves for reproduction through undergoing a carefully structured series of rituals or periods of learning. "Premarital" pregnancy, therefore, is not necessarily unwanted or illegitimate. Some evidence suggests that young men are beginning to place more intense sexual demands on their female peers. In the past, young men were said to be less likely to become fathers because they lived under the closer scrutiny of elders. Cultural ideals notwithstanding, it is quite likely that ill-

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa timed pregnancies occurred even in the past. But most could be covered up readily by marriage to eager suitors, either young men or older ones seeking additional wives. Nowadays, attendance at secondary schools in distant cities, adherence to new Christian doctrines that undercut practices allowing limited sexual expression, and the general erosion of elders' control may have given young men greater sexual access to adolescent girls. These trends may have undermined the historical tendency of men to accept the responsibility of paternity whether within or outside marriage. Furthermore, raising and educating children require more cash outlays than in the past. And young men themselves have new agendas that the responsibilities of fatherhood could obstruct. Since so many young men remain in school or trade apprenticeships for long periods, large segments of the young male cohort are not yet considered eligible for the responsibilities of marriage or fatherhood. As for older men, the social and economic pressures of new lifestyles make many men, especially those in urban areas, reluctant to legitimize their unions with loosely attached partners or to support the children these unions produce. In the end, the sexual demands of young men on women may have increased without a reduction in older men's access to young women. Besides acknowledged paternity, the other criterion that marks sanctioned childbearing is preparation for adulthood. Chapter 5 turns to formal education, the most prestigious way of preparing for contemporary adult life. It shows that early fertility sharply curtails young women's chances of higher educational achievements, as indicated by rates of dropping out due to pregnancy. However, education also appears to delay fertility: It often induces young women who wish to obtain further training for adult life to prolong the period between menarche and childbearing. Education also acts more indirectly to make marital status more ambiguous: Young women at certain stages of the conjugal process who previously would have declared themselves to be married are now more ambivalent about doing so. Although rising educational achievements are associated with rising premarital sex, we were not persuaded by widespread arguments that schooling or even the school context increases promiscuity by eroding societal mores. Desires to continue schooling effectively lengthen the gap between menarche and childbearing; but school policies of expelling girls for pregnancy are devised and enforced for the explicit purpose of discouraging early pregnancy. Indeed, many schools appear to be taking on roles that are surprisingly analogous to those of elders in the past, attempting to discourage reproduction among adolescents under their supervision who are deemed unprepared to take on adult responsibilities. Schools' strict policies may in fact deter many cases of early pregnancy. But although formal education is the most visible and prestigious form of preparation for adulthood in contemporary Africa, it is only one of a

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa wide array of training possibilities. Chapter 6 asks whether some of these other forms of training affect fertility in ways that parallel the effects of formal schooling. Combining an unconventional array of evidence—macro-level data from the International Labour Office (ILO), data from the Demographic and Health Surveys, and ethnographic materials—it distinguishes four general economic types of countries in the subcontinent; it shows that the age at which women begin work and childbearing is related to the nature of economic opportunities or demands for women's labor in the wider economy. In countries where their labor is central to agriculture—the majority of sub-Saharan African countries—women make a very early start in the labor force and childbearing begins shortly thereafter. In economies where women's occupations are more varied, especially the West African trading economies, the need to prepare for complex commercial tasks and to create viable business relationships makes women delay both work and childbearing. In the industrially influenced economies of southern Africa, schooling tends to delay a woman's entry into the labor market, and long male absences for migratory labor make it difficult to create stable conjugal ties. Women tend to begin childbearing early, seeking perhaps to cement their relationships with the fathers. Finally, in the pastoral economies of the Sahel, few women at any age are recorded as participating in what either the ILO or male survey respondents regarded as the labor force. Yet if women's main "work" in this context can be interpreted as childbearing and rearing, it should not be surprising that women begin to bear children quite early in their lives. Chapter 6 makes two other observations that reinforce the importance of context in determining fertility outcomes among adolescents. First, although young women themselves are the usual focus for adolescent fertility studies, the time they spend before taking up the responsibilities of marriage, work, and childbearing is ultimately a function of their adult sponsors' willingness to invest time and money in developing their economic potentials before their reproductive lives begin. Older adults are key actors in the scenario of adolescent fertility; their own options and needs exert strong influence on those of adolescents. Related to this observation is the fact that older women must themselves have economic niches for which younger women can train. In economies with marked divisions of labor by sex, it is the older women who train the younger ones in viable skills—or at least withhold them from the marriage market or delay their childbearing while they learn these skills. Second, just as training for adult life can be an expensive, time-consuming proposition for young women, so it is for young men. Though they may have more sexual leeway than in the past, many young men have strong motivations to delay the responsibilities of parenthood that would endanger their economic career strategies or hamper more advantageous

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa conjugal matches in the future. In contrasting two Ijo communities in southern Nigeria, one a large urban area and the other a small town some distance from major amenities, Hollos and Leis (1989:122) make a vital observation that lends support to this contention: [In the small village], the boys' parents have no objection to their sons' sexual exploits and usually welcome a child fathered by him as a member of the family . . . . [I]t is they who pay the circumcision fees and buy the appropriate gifts for the girl's circumcision, thereby affiliating the child to their patrilineage. In [the large town], boys see their futures as somewhat imperiled by having a child because they might have to drop out of school to earn money to help support the mother. In western Nigeria, Berry (1985:156–157) makes a similar point by contrasting young male mechanics' apprentices with young men who are employed in factories: Unlike the factory workers . . . , mechanics [apprentices] do not seem to have been pressured by their families to marry before they were self-employed. Clearly, they were not capable of supporting dependents until they were established, whereas factory workers were perceived by their kinsmen as receiving a steady income and therefore capable of supporting wives and children, regardless of their aspirations toward self-employment. Although there is virtually no systematic research on this issue, cultural logic suggests that a child's status is determined as much by the father's potential tradeoffs in the realm of training and education as by those of the mother. Chapter 7 attempts to assess the risks and consequences of adolescent fertility, concentrating on topics on which there is the most research: health risks. Elements of problematic childbearing fall into two broad types. The first occurs in societies in which marriage and childbearing are supposed to begin early, and thus in which most pregnancies lead to highly valued children. Such problems, as there are, stem primarily from the mother's physiological immaturity: Babies may suffer from low birthweights and birth traumas, and young women may not be mature enough to carry a fetus to term or to give birth. These problems are often compounded by the lack of health care that is adequate to cope with the potential problems of youthful childbearing. Such patterns of early marriage and childbearing arouse relatively little public concern, precisely because early fertility is viewed as normal or at least preferred. The second cluster involves adolescent childbearing in unsanctioned circumstances. Young women in this group are often unemployed of still engaged in training or education. Few have gone far in the marriage process or have reliable conjugal partners. Insofar as these women are very young and physically immature, they face risks of childbearing similar to

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa those for women in the first pattern. In urban areas with better health care facilities, however, social condemnation for what is perceived as "inappropriate" pregnancy discourages young women from seeking the care that might forestall medical problems. The children of very young mothers also suffer heightened risks of mortality and the major health risks of low birthweight. To be sure, in countries where marriage and childbearing begin early, the children of very young women have suffered disproportionate risks for some time. Nowadays, although improvements in medical care are in theory improving levels of mortality for children in many countries, access to medical facilities remains a problem for many children of young adolescents for the same reasons their mothers face. Less well documented than health outcomes are the socioeconomic consequences of early childbearing for mothers and children. Childbearing in unsanctioned circumstances may erode the future social and economic wellbeing of children and foreclose their mothers' possibilities of continuing their education or training. Yet becoming pregnant is often a strategy for obtaining a husband, and most adolescent women in Africa undoubtedly find that the pressing need to find a suitable husband and begin a family far outweighs the costs to their education and career opportunities. It may even outweigh the health risks of early childbearing. Some schoolgirls, in other words, may believe they are better off by becoming pregnant and dropping out of school. The possibility that some girls become pregnant to be allowed to drop out is but one of many other pieces of circumstantial evidence that suggest that for many women, the social and economic consequences of not bearing children are immense. In both socioeconomic contexts we have examined, the outcomes of adolescent fertility are products of social forces: The problems associated with one model stem from pressures to begin marriage and childbearing early; on the other end of the spectrum the deleterious outcomes associated with schoolgirl pregnancy stem from the risks young women often take to avoid the detection of their pregnancies and the sanctions that would follow. The unfortunate irony is that many young mothers lack access to medical care, whether they live in rural or urban areas. In rural areas, they are served by only a few, ill-equipped facilities; and in the cities, many avoid the more numerous and better-equipped facilities for fear of social condemnation. FUTURE RESEARCH NEEDS The social world influences reproduction even under normal circumstances, but situations in which society perceives that things have gone awry bring into sharp focus the strong influence of society on reproduction

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa in general. Because so many of these issues (legitimacy, preparation for parenthood, marital status, economic support for children, and so on) remain unexplored for Africa, policy advice on how to mitigate the deleterious effects of adolescent childbearing—or, equally important, build on the positive aspects—would be superficial. We offer instead a few brief thoughts on several areas that the findings presented here have highlighted as needing more research and analysis. Health Two central issues loomed large under the general topic of health. The first is the health consequences of bearing children at very young ages. Contexts in which early marriage and childbearing are condoned entail special unknowns. To what extent do people actually recognize the health risks of early childbearing and take measures to mitigate them? What factors appear to extend the gap between marriage and regular sexual relations? Under what conditions does this gap collapse? On the other side of the social spectrum is the second issue: abortion. Very little is known about the incidence of abortion in any African country. Do education and abortion covary? That is, do countries with increasing levels of education and ages at marriage also have high rates of abortion? Although schoolgirls are the most common targets of concern about abortion, can we identify any other categories of young women for whom pregnancy is also a problem? If so, do these other young women also seek abortions? If they do not, how do they try to improve their situations? Finally, to link the two issues, are improvements in maternal mortality through a rise in the age at first birth offset by an increase in the rate of abortion-related deaths? Education and Training Several issues in the domain of education and training require further study. One is relatively easy to solve: What proportions of women aged 15–19 are still in school in various countries? Although neither the Demographic and Health Surveys nor the World Fertility Surveys asked this very simple current-status question or the more complex one about when schooling ended, the data they generate can support analysis of current-status variables pertaining to adolescent fertility. Less easily resolved is the question of how much, compared with other factors, fertility contributes to women dropping out of school. That question has seldom been posed, and answers to it could offer a potentially vital qualification for theories that assume education to be the primary causal agent in the fertility/education relationship. A second area of research concerns the effectiveness of family life

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa education. Many countries have begun to invest resources in developing such programs for secondary and (in some cases) primary schools, but how effective are these programs in persuading girls to delay fertility? How effective are they in dissuading young men from putting sexual pressure on young women? Finally, we can now make only the barest speculations about fertility concomitants of training for small and informal businesses, especially for women. The idea that young women delay fertility to pursue nonschooling forms of training that prepare them for adult responsibilities is almost totally unexplored in the fertility literature; it requires considerable exploratory research. And while the topic is important now, it will likely become even more so in the future if, as King (1989–1990) has speculated, small businesses absorb increasing numbers of young people whom the formal sector cannot support. If small and informal businesses proliferate, and if young women delay fertility as they pursue business training, then we may see very little change in fertility levels, even if levels of formal education decline. Marriage and Conjugal Relationships Two kinds of issues related to marriage and conjugal relationships require more research. The first involves more accurate descriptions in different regions of the changing conditions under which sexuality and reproduction in general play out. When, for example, are sexual activity and reproduction supposed to be kept separate, and when should the one lead (or not lead) to the other? Is marriage necessarily the central criterion for combining the two? How does a pregnancy affect relations between the partners? Do sexual partners have the same interests in reproduction? Under what conditions is one partner anxious to proceed with a pregnancy and the other reluctant? The second problem area involves the dynamics of polygyny, a highly distinctive feature that affects the conditions under which early childbearing occurs. More attention needs to be devoted to its varied manifestations and their concomitants in the life cycles of women and men, particularly during adolescence. The issue that our research has stressed concerns the effective marginalization of low-status women and children in certain kinds of unions in order to reduce the costs of reproduction. The requirements of life in new urban settings appear to be consolidating a class system based on access not simply to education and jobs but also to advantageous marriage. Worsening economic conditions may intensify the differentiation of the opportunities a family makes available to its members. As a result, those young women and their children who become defined as "outside" may enjoy less support from men.

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa Men Up to now research has focused on young women when it examines adolescent fertility in circumstances the society regards as inappropriate. The lack of systematic knowledge about the reproductive lives of men—and adolescent men in particular—constitutes a serious gap in our knowledge. Which men claim the responsibilities of fatherhood for which children, and under what conditions? To what extent does having an acknowledging father matter for children's welfare, compared with being born within a sanctioned union? If men's training and education needs are as important as those of women in determining whether pregnancies will be welcomed, what are the fertility goals and behaviors of men in different socioeconomic situations? Although all the DHS asked women a few background questions about their husbands, only four interviewed men and only one was not a subsample of the husbands of married female respondents. This strategy produced obvious biases. At one point in time, many older men are not married so they are ineligible as respondents. Moreover, few men marry before their twenties in Africa, so virtually no teenage men could have been interviewed, although indirect evidence suggests that many young men are sexually active. SUMMARY Adolescent fertility is affected by a wide range of rapidly changing factors acting through multiple, complex pathways we are only beginning to understand. Our investigation of the subject has drawn on studies of crucial areas of change in contemporary African life: education, health, social stratification, politics, employment, and the like. Our research indicates that few adolescents are helpless in the face of these new pressures and changes; they have a broad spectrum of strategies that they can call into play to gain room for maneuver. At the same time, strong evidence indicates that society has a powerful effect on the opportunities and responsibilities that determine when conjugal life and childbearing begin for adolescents as well as on how their pregnancies are received. Because society has such powers—whether expressed as diffuse values or as clear directives in discrete situations—adolescents exercise less control over their own reproduction than fertility surveys directed at women aged 15 and over typically assume. Insomuch as the social world shapes the consequences of early pregnancy and motherhood, trying to treat age as an independent variable in assessing the overall outcomes of adolescent fertility is analytically risky. Whereas we might discern an increase in neonatal mortality among the

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa children of very young teens, a woman who married and became pregnant quite young may have had little choice in the matter. It is similarly difficult to separate the deleterious health outcomes that a young woman's physical immaturity might cause from health risks imposed by the social effects that arise from lack of paternal recognition or the risk of forsaking a school career. For regimes in which fertility is expected to begin very early, we know almost nothing about the consequences of not bearing children as an adolescent. We know equally little about what older schoolgirls lose by avoiding pregnancy. An increase in adolescent fertility outside of marriage is only one of a number of emerging patterns among women. Others are a phenomenal rise in education and labor force participation outside the household. Childbearing outside marriage is increasing at the same time that women's opportunity costs are rising. In other words, many of the deleterious outcomes of fertility among urban schoolgirls arise in conjunction with increasing opportunities for young women. Where ages at marriage and levels of education are rising, and where fertility among adolescents as a whole may even be falling, these very rises in social aspirations foster resentment when opportunities are lost through pregnancies. Therefore, although modernity produces the wonders of formal schooling, contraceptive methods that can delay motherhood, and hospitals that treat emergency abortions and low-birthweight babies, it has equally sharpened public antipathy toward adolescent fertility. In these emerging contexts, adolescent fertility per se is changing less than the social context that judges it.