Author: Kritika Walia, National Health Authority, Government of India Understanding the Unique Health IDs: The landscape of healthcare is evolving towards a…
Author: Prossy Namyalo is a Ph.D. Candidate of Health Services Research (Health Policy Specialization) and Global Health Specialization at Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto.
Sustainable Development Goal (SDG) 4, “Quality Education” places education at the heart of the realization of many other SDGs including Goal 5 “Gender Equality”. Empowered learners with knowledge and skills can lead the way to stay healthy and being valued [1, 2]. A peaceful and prosperous world is among others created through providing quality education for all. However, the COVID-19 pandemic caused a global education crisis. This happened when the education system was disrupted due to the closure and reopening of schools for approximately two years in some countries like Uganda, Nepal, and India . On the other hand, the COVID-19 pandemic caused unprecedented disruption in efforts related to Sustainable Development Goal (SDG) 5.6 “Ensure universal access to sexual and reproductive health and reproductive rights . The Lancet Commission’s 2015 issue to “ensure women are healthy and have equity in all aspects of life” clearly shows how healthy, valued, and empowered women contribute to achieving sustainable development. Stating that what is good for a woman is good for society at large, the Commission recognizes women’s role as agents of change. This kind of appreciation of women’s worth in society requires an investment in their health and other facets that affect them directly. Thus, the need to invest sustainably in their meaningful empowerment. Although it’s contended that empowerment is not tangible as such it’s not clear how to invest in women, key elements of empowerment include control of resources, education, physical safety, and decision-making authority [5-7]. Investing in girls pays dividends since each additional year of schooling reduces the likelihood of early pregnancy and marriage, raises an African woman’s earnings by 14%, and can lead to higher standards of living .
World over, girls and young women have been facing fundamental gender and age-related hurdles and discrimination to access essential health services and education/information and ensure their rights are protected [4, 8]. The COVID-19 pandemic exacerbated those vulnerabilities with short and long-term impacts on girls and young women. Significantly, the restrictive measures by many countries to limit and contain the spread of the pandemic negatively impacted access to essential sexual and reproductive health and rights (SRHR) services. The closure of social spaces including health clinics, schools, and community centres affected those who were schooling and those out of school. These are spaces where many of them were receiving SRHR education and services  consequently increasing the incidence of teenage pregnancies. Scholars have also documented a disproportional increase in girls dropping out of school due to pregnancies during the COVID-19 lockdown measures .
The closure of schools resulted in exposure to sexual exploitation and abuse resulting in unwanted pregnancies and early motherhood and becoming child brides, and with limited prospects to resume school [9, 11]. For example, a study in Kenya indicated that school-going girls experienced a threefold risk of dropping out of school, twice the risk of falling pregnant prior to completing school, 3.4 times the risk of changing schools, one in two COVID-19 cohort girls becoming sexually active, and one in ten becoming pregnant before sitting their examinations . Likewise, Aidoo  reported a 40% increase in teenage pregnancies during the three-month school closure in Kenya. In Malawi, a study that used longitudinal data reported a 30% drop-out rate for older girls aged 17-19 years during the pandemic  and one in three girls did not return to school due to pregnancy . Similarly, in Uganda 551,235 pregnancies were reported in 2020 and the first six months of 2021 . And 30% of the pregnant girls were not planning to return to school . Zimbabwe recorded 4,959 teenage pregnancies from January to February 5th, 2021 . Relatedly, a study conducted in Ethiopia , indicated a considerable increase in teenage pregnancies to 13.1% from 7.5%, and teenage abortion care use increased from 21.3% to 28.5%. In South Africa, the Department of Statistics reported that out of the 899,303 children born in 2020, 34,587 births were from teen mothers aged 17 years or younger . Ghana Health Services recorded about 13 teen pregnancy cases every day in 2020 during the peak of the pandemic and had young mothers of 10 years .
A single predictor of family health is completing primary school by girls of 7 to 12 years thus girls dropping out of school is catastrophic to them, their children, and their communities. A loss in the education of young mothers threatens the national and labor market and it is estimated that the economies of sub-Saharan Africa might suffer from a further US$10 billion loss in the gross domestic product (GDP) on top of the immediate, crippling effects of COVID-19 if the young mothers do not continue their education [7, 21].
Against the above premise, several African countries took stronger actions to support the right to education of young mothers and pregnant students. In November 2021, South Africa’s Department of Basic Education adopted a policy that allowed girls to remain in school during and after their pregnancy. In the same vein, the Ministry of Education of Tanzania in November 2021, ended the country’s ban on adolescent mothers when it adopted Circular No.2 of 2021 on the “reinstatement of students who dropped out of secondary education”. The policy affirms adolescent mothers’ right to return to public institutions and instructed those schools to accommodate them. Uganda revised the guidelines on pregnancy prevention and management in schools and so did Kenya when they both adopted the national re-entry guidelines in 2020 .
However, although those and many more countries have acted, there are still gaps in such approaches. Laws and policies alone have been deemed not enough in ensuring young mothers’ return and retention in school . For instance, in Uganda, the ministry of education directed schools to allow young mothers back into schools after delivering ; but the leadership of some faith-based primary and secondary schools openly declined this directive citing it was not morally upright to allow them to class with other students [22, 24].
Furthermore, after the pandemic, many private schools were shut down permanently since they had loans to service but did not receive any support from their respective government. This scenario was noted in Uganda and Kenya [ 25, 26]. The closing of private schools had a greater impact on the general education system; a) It hindered or delayed the return of young mothers to school since they had to be admitted to new schools, b) The closure resulted in students shifting to public schools which created another problem of overcrowding, affecting the level of interaction between teachers and students, c) Some public schools were not nearby having been the first reason why children enrolled in private schools as such students had to walk far distances, d) There were problems with sanitation facilities due to increased student enrolment [25, 26]. All those could directly or indirectly exacerbate young mothers’ return and or retention in schools. More evidence indicated that young mothers are prone to dropping out of school or might fear returning to school because of stigma, unkind words, and harassment from fellow students, health workers, teachers, and the community. They suffer serious emotional disturbances with social and health consequences. Their emotions are normally unattended and yet they are susceptible to mood disorders leading to depression [27-31]. Those that resume must juggle the triple role of being a mother, a parent, and a pupil/student. Some get involved in street vending and work as maids, and others are forced into early marriages. To some, it becomes difficult to adjust to motherhood and schooling [28,31]. Therefore, even with good re-entry laws, policies, and strategies, learning might never be the same for young mothers; thus, many end up dropping out.
Nevertheless, in countries where the education ministry spearheaded rigorous back-to-school campaigns for young mothers, outcomes were undeniable. For instance, in Kenya, the education Cabinet Secretary said, “pregnancy isn’t a disease”, and ordered chiefs and other officials to immediately track down pregnant schoolgirls who had not reported back to class . Consequently, in 2021 the ministry saw a 131% increase in the number of girls that had sat their certificate of secondary examination in hospitals after giving birth .
Collective responses that engage African governments, development partners, and civil society organizations are needed. For instance, development partners like the International Development Research Centre have funded interventions in many Sub-Saharan countries that aim at empowering youth and women by ensuring that the post-COVID-19 strategies they support involve policy change . Additionally, countries like Rwanda and Ethiopia have encouraged the participation of other stakeholders including civil society organizations in the field of educational interventions in promoting return-to-school campaigns for young mothers .
December 2022 made it three years since the first COVID-19 case was announced in Wuhan, China. However, for some countries life post-COVID-19 seems to have returned to business as usual with no special attention to wreaked unprecedented disruption related to SDG 4 and SDG 5.6. Women and girls deserve better, and they need effective supports that ensure they are valued and empowered through sustainable investments. Investing in girls’ education pays dividends not only to them but also to their families and society.
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