During my radio session that focuses on the untold stories of teen mothers, Sheila* shared her heart-touching story. After unintentional unprotected sex, she said she was denied emergency contraceptive pills at the health center, and so became a mother at age 15. She is far from alone. The World Health Organization (WHO) reported that in 2023, birth rate among teenagers of 10–14 years was estimated at 1.5 per 1000 women. The same report shows that in 2019, around 21 million teen pregnancies were reported in lower- and middle-income countries and 55% ended up in unsafe abortions. The report also shows the estimated teen birth rate was 97 per 1000 adolescent in the WHO African Region compared to 13.1 per 1000 adolescent girls in the European Region. There is also a variation of teen birth rates in countries, like Zambia where teen childbearing incidence varies from 14.9% in Lusaka to 42.5% in the Southern region. The actual number of teen childbirths continues to rise in Rwanda, where recent data show that teenage pregnancies have increased by 200% in the last ten years . In 2023, Over 22,055 cases of teen pregnancies were reported in Rwanda, with 39. 4% of contribution to school dropout rate among high school girls. Teen birth is troubling for many reasons, including the health risks. Indeed, in my work as a midwife, I see firsthand how fatal risks can arise for both the mother and baby when the mother is a teenager. This can include permanent genital and urinary systemic impairments. An actual impairment happened to Sheila. Teen mothers experience social and cultural discrimination, stigma, family rejection, and gender-based violence and abuse. These issues disturb their mental health, and lead to increased cases of suicide among teen mothers, several times Sheila said attempted. Earlier this year, the WHO shared a clear message around the importance of addressing this problem: “Preventing pregnancy among adolescents ... is foundational to achieving positive health outcomes across the life course and imperative for achieving the Sustainable Development Goals (SDGs) related to maternal and newborn health”. The evidence and realities echo loudly that the issue of teen pregnancy remains an incontrollable public health concern around the globe and in the region, and it requires innovative changes in mitigation strategies. We must do more to address it. Indeed, parents, teachers, and church leaders should not wait until teenagers already have messed up to act. Teaching children early about sexual and reproductive health is one way to prevent teen pregnancies. By the time they go to school, children need to be equipped with competency to make informed choices. This should be done by providing free, accessible, friendly, safe, and comfortable spaces and opportunities for teen audiences to openly discuss sexual and reproductive health and physical, emotional, and biological changes. During COVID-19 lockdowns, I began a radio and television program that reached over 13,000 youth who were stuck at home. “Time for Teenagers” covered a range of reproductive health topics and was very effective. After COVID-19 restrictions, the program continues with a mix of radio/TV sessions and high school-based outreaches. Uncountable positive feedback and stories are day-to-day shared by the audience. Through parental relationships and series of non-judgmental dialogue a teen can establish such correct behaviors towards sexual relationships. The evidence indicates that these early self-awareness skills help a child understand personal values, emotions, and boundaries vis-à-vis any exposure even when she/he is away from guardianship. Further, to achieve a reduced teen pregnancy rate, barriers and other social-culturally constructed sorts of obstacles which prevent teenagers from accessing and utilizing Adolescent Sexual Reproductive Health Services and Rights (ASRHSR) must be removed. This is a very good example of the Government of Rwanda for its proven effort to provide non-restricted access to contraception for teens of 15 years. The full package of SRH services must be offered for free and be accessible at the community and primary health care levels. The terms of affordability, availability, accessibility, accommodation, and acceptability should refer to designed comfortable, confidential, and safe spaces. Unfortunately, in many settings essential ASRH services remain inaccessible due to the high direct and indirect costs involved. For instance, in Rwanda the price of emergency contraception dose is $10 to $15 in private dispensaries, and the kind of option seems unobtainable in public health settings. Yes, it will require collective resilience to win this battle against teen pregnancy and births. We can all play a vital role to safeguard our teen community and prevent such regretful stories and cases of Sheila and many untold ones. The shared vision is to create a world where teenagers make their informed choices, the bridge to their dreams. *Sheila is not the real name of the person whose experience is used in this article. The author is a global health specialist and Aspen New Voices Fellow-2020.
