Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized?
At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied.
Easier to get an abortion than contraception
Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion.
“In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained.
“You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.”
This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk.
Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others.
Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent.
Teenage mothers getting pregnant ‘again and again’
But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives.
“Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.”
The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed.
“With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.”
The Fight for Autonomy
For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures.
Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030.
“I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.”
“Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said.
With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds.
Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education.
“If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.”
30 Years After Beijing, Women’s Voices Are Still Being Ignored
This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved.
Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference.
“I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.”
Article first published on https://healthpolicy-watch.news/who-decides-the-contraceptive-conundrum-facing-adolescent-girls-in-africa/