Posted April 1998
The purpose of this paper is to provide an insight in the cultural dimension of adolescence and very early pregnancy and to propose ways in which it can be translated into operative programmes. It intends to show that adolescents need specific strategies in order to be effectively reached, for they have distinct social and psychological characteristics that vary greatly across cultures, and that if the cultural dimension is overlooked, programmes will lose effectiveness. The paper will look into how the concept of adolescence has been constructed culturally, with its meanings and characteristics varying across cultures. The aspect of gender and power relations between the genders will be dealt with in some detail, for it plays a crucial role in adolescent fertility and its differential consequences for adolescent girls and boys.
In a number of contemporary societies it does not make sense to talk about adolescence. In many rural areas of the developing world, for example, adult responsibilities including family formation and labor force participation are taken on very early in life, without any significant transition period. In many languages, neither the word nor the concept exist. In India, for example, adolescence is a controversial notion. It is viewed as an artifact of the extended formal education in the West, and language-wise females are "girl children" until they marry (Greene, 1997). Adolescence itself is a cultural construct that varies across settings and contexts.
The preparation time for entry into adulthood has greatly increased with the specialization of tasks and the increasing education needed to perform them, which have been related to the process of urbanization. At the same time that the attainment of economic independence has been postponed due to the longer time devoted to education, the attainment of biological adulthood has either not changed much (boys) or is starting earlier, through a significant decrease in the age at menarche [3]. In some societies, the duration of adolescence has been increasing and can plausibly continue to increase. How long is the period of transition? In rural societies with very early marriage and little or no education necessary for performing adult roles the period is either inexistent or very short, while in an urban milieu the standard definition comprises ages 10-19 [4], and in post-industrial societies suffering from acute problems regarding entry into the labor force among the young it might be expanding into the early twenties.
As the culture of adolescence being constructed in some societies --including norms of conduct, dress code and language-- becomes more visible, it is easy to assume its universality and to infer its existence in every culture. However, the fact that adolescence itself is a cultural construct that varies significantly from society to society and across time, has to be kept in mind when designing policies and programmes directed to the adolescents, for needs vary with the different contexts and so should approaches. The incorporation of a socio-cultural component will aid in the identification of needs and in the determination of the most effective approaches.
Definition
Although the references to adolescence have become widespread in the literature on reproductive health and psychology, many times they allude to different phenomena, for the definition of adolescence presents serious obstacles. Being culturally determined and presenting large cross-cultural variations, it does not make much sense to talk about adolescence as a world-wide phenomenon. Due to the difficulties to provide a meaningful definition, the result is that for the most part, the adolescents are defined as all of those belonging in a particular age group (whose limits vary). This is a definition that makes little sense from a cultural point of view. Available data, however, is usually organized by five-year age groups, restricting the possibilities of more profound analysis. The classical 15-19 grouping that demographers tend to use hides enormous heterogeneity from the health, social and psychological points of view. The meaning of a pregnancy for an unmarried 15 year old, for example, is entirely different from that for a 19 year old married woman [5].
When setting up programmes or formulating policy, it is important to have an appropriate definition of their target group, and in the case of adolescents this definition is context-dependent. A national adolescent policy should be sensitive to the specific needs of groups such as rural adolescents (in those places where it makes sense to talk about rural adolescents rather than young adults), urban school-going adolescents, urban school drop-outs, young married mothers, unmarried mothers, refugees, displaced persons and the like.
Age at marriage
In most contexts, acceptability of teenage pregnancy is associated with marriage. In several countries of sub-Saharan Africa, for example, adolescent fertility is sanctioned and valued within the adequate ritual framework (marriage), but strongly condemned when out of wedlock (Bledsoe and Cohen, 1993). In a few countries, however, mostly those in the infertility belt (Central African Republic, South-west Sudan, Congo, Gabon and Cameroun), a pregnancy constitutes a prerequisite to marriage, and adolescent girls who cannot prove their ability to conceive, find no partners. In some of the Andean cultures also, the custom of serviñacu, used to be (Balán, 1996) a sort of trial period before marriage (about one year) to prove fitness of the couple, fertility being one core aspect.
Early marriage in fact is favoured in different contexts to prevent the undesired effects of premarital sexual activity and pregnancy. In the Gambia, for example, age at marriage has been reported to be as low as 10 years (Jeng and Taylor-Thomas, 1985). In rural Ghana early marriage shortly after puberty rites is the norm to ensure chastity and genital mutilation, performed at several ages, would provide proof of virginity and guarantee long time fidelity (Bulley, 1984). In rural Niger, 47% of women aged 20-24 during the DHS survey, had married before 15 and 87% before 18. In this context, where early pregnancy is welcome, 53% of the women had had children before age 18. In the Islamic areas of Africa, early marriage is favored in order to prevent extramarital pregnancies (Locoh, 1994).
Legal codes governing family law usually establish the minimum age at first marriage, but they sometimes conflict with each other. For example, in Tanzania the Penal Code states that anyone of African or Asian descent may marry or allow the marriage of a girl under age 12 as long as it is not intended that the marriage be consummated before she is 12. At the same time, the Law of Marriage Act establishes 15 as the minimum age at first marriage for women (CRLP, 1997). In spite of the existing legal minimum ages for marriage, more often than not these are not enforced, especially in the rural areas. The cultural definitions of acceptability usually have much more force in the resulting outcomes than those imposed by law and removed from the realities of the people they are supposed to apply to.
Age at marriage is a significant factor in women's lives, not only because of its association with overall completed fertility and with the meaning and consequences of adolescent fertility, but also due to its relation with the status of women. Early marriages are usually performed without the informed consent of the girl and often involve important age differences with the spouse, one element of unequal power relations between the spouses and of difficulty for empowerment.
Cultures also define who is entitled to access reproductive health services, sometimes by social control and sometimes by laws, policy restrictions or other measures. In many African societies only married women have access to family planning and other health services, and unmarried pregnant adolescents are particularly affected (Bledsoe and Cohen, 1993). In Gambia, provision of contraceptives is legally restricted to married couples and unmarried women with at least one child (Jeng and Taylor-Thomas, 1985).
Three current processes have had a particularly strong influence on teenage fertility outcomes: globalization, urbanization and education, in particular girl's education. As an overall effect, the three tend to postpone age at first marriage or union, without postponing initiation of sexual relationships [6]. During these processes the binding force of the traditional social controls on womenís premarital sexuality is weakened, but no alternative control mechanisms have been generated and the result is an increase in unplanned pregnancy (although not necessarily in the absolute numbers of pregnancies) that is unwanted and socially not accepted, a rise in illegitimacy rates and in abortion, mostly unsafe (cf. section on gender). Among the same groups, the same event, a pregnancy, that would have generated status and respect, can generate stigma for the woman and/or her family if it happens out of the traditional norms of accepted behavior. It can also have dire health consequences, for access to health services is in this case limited by cultural restrictions.
Source: US Bureau of the Census, 1996 |
Impact of westernization and urbanization
The process of urbanization and the increasing influences of western cultural precepts on many population groups, but especially the young, are seen to be responsible for thebreakdown of traditional customs. In this sense, the increase in premarital sexuality and the increase in unmarried teenage pregnancy is seen by many authors as a consequence of the introduction of "western" values and ways of conduct, which expand more easily in the urban context and through the media available in this context. In Botswana, for example, until about 30 years ago, traditional teachings and social practices including strict gender segregation for certain activities, taboos, and a universal social disapproval of teenage pregnancy, made it a very rare phenomenon. Urbanization and detribalization have loosened those social practices, and in the process sexual behavior among youths has become more extended and unmarried teenage pregnancy more frequent (Linchwe, 1992). The disappearance of polygamy, too, has been cited as a factor in the higher prevalence of premarital sexual activities in Botswanian society (Letamo, 1993). Westernization has had an important influence in the disappearance of certain taboos and certain practices like initiation ceremonies, and in the transformation of the family structure, generalising the nuclear family.
In Senegal, where women traditionally acquire full status only through marriage and childbearing, although unmarried motherhood is considered a disgrace, a survey among 764 urban working women aged 16-21, showed that a significant proportion (31%) were unmarried mothers. In this case, economic factors are seen as largely responsible for the rejection of traditional customs, given that due to unemployment and economic hardship marriage is postponed and premarital sexual relationships rise (Jean-Bart, 1985).
In the process of urbanization, two factors are especially relevant in the changes in sexual practices and outcomes: education and the changes in the traditional systems of social controls. In Latin America, the enormous rural-urban migration flows of the 60s and 70s provided young women a physical way to escape the traditional controls on their sexuality, for with the change of location, young women (who comprised most of the flows) were able to flee the controlling eye of the father, the local priest and the community. While entering the labor market as domestic servants, a large proportion became single mothers.
With urbanization the socialization processes shifts from being entirely the responsibility of the direct or extended family to being partially dominated by social institutions like the school, under the ever stronger influence of the media. The introduction of western systems of thought --within the power relationship that is generated by a dominant culture-- often destroys local taboos, along with the elements that legitimize them within the local belief systems. In the same manner, other forms of social control lose relevance, as the weight of western values, attractive to the young, cannot be countered by local propositions.
Early marriage and childbearing continues to be mostly a rural phenomenon
(Figure 1). In the urban areas young women have their first child significantly
later, although this does not necessarily mean later first pregnancies,
for abortion is much more widely practiced among urban adolescents. Urbanization
has meant later marriages and first births, but for those who do become
young mothers, higher proportions of children born out of wedlock.
Source: US Bureau of the Census, 1996 |
Impact of education
Although there is still much to be said regarding the reasons for it to happen, education has been proven to have the undisputed effect of delaying the age at marriage and first union.With the postponement of first union, and even if no significant change in sexual practice takes place, the exposure to the risk of premarital pregnancy is greatly increased. On the other hand, with higher levels of education, as data from the DHS for all surveyed countries shows, the incidence of adolescent pregnancy decreases (see Figure 2). However, part of this reported decrease may be just an effect of attrition, given that pregnancy usually leads to the end of the educational process for the girls.
Locoh (1994), links the decline in the number of very early marriages and pregnancies present in most of the African countries where survey data is available for more than one year to urbanization and school attendance rather than to any specific policy measure.
The lower rates of pregnancy and births are due to the fact that educated women are more likely to use contraceptives, and are also more likely to resort to abortion, rather than to a significant difference in the exercise of sexuality. One of the determining factors in this outcome is the way in which the woman projects herself into the future, and the extent to which she feels she guides her own destiny, i.e. that she can have control over what happens to her own life. Education provides alternate means of creation of status for women, as well as a source of self-esteem and self-value. It thus provides the motivation to use contraception, facilitates its putting into practice, as well as the motivation to terminate the pregnancy if unwanted. The programme implications of this are clear: a) education should be made widely available for teenage girls --not a new proposition, of course--, and b) programmes that are specifically targeted to the reduction of adolescent pregnancy should build on the factors that the educational system provides and that have been shown to be effective (for example, to build on self esteem and self value), without going through the entire educational process when this is not possible.
The ethnic factor
The importance of ethnicity has been largely overlooked in relation to adolescent fertility. Few studies address it directly, most of them carried out in the United States, where it is sometimes undifferentiated from the racial factor, and where recent events have made it a piercing political issue. Ethnicity is of prime importance in defining age at marriage, acceptability of sexual behavior, initiation of sexuality, use of contraception, and the resolution of pregnancies when these occur.
A study of Nepal, singled out ethnicity as the single most important factor in the determination of the timing of marriage and of the first birth, much more important than education, religion, urban/rural childhood residence and ecological region. Women's mean age at marriage varied from 13.5 among the Brahmins to 17.8 among the Tamangs, while the difference among the literates and illiterates was very small (15.4 and 15.2 respectively), as well as that for the ecological region (14.8 for the terai to 15.7 for the mountains) (Thapa, 1989). Other studies for other parts of Asia have reported similar findings (Hirschman, 1985; Rindfuss, Parnell and Hirschman, 1983).
In Kenya, where adolescent fertility is reported to be among the highest in Africa, sexual custom varies greatly among ethnic groups, with differing values on virginity, consequences of premarital pregnancy, practice of genital mutilation, level of knowledge and use of contraception, among other characteristics. While among the Luhya and the Luo the woman who remained virgin until her wedding was given gifts of goats and cash, among the Kamba, women were ritually deflowered by elder men from whom they received sexual teachings. Contraceptive knowledge varied from 56% among the Kalenjin to 94% among the Kikuyu, and while contraceptive use also varied greatly along ethnic lines, it was much lower than knowledge for all groups (Ocholla-Ayayo et al., 1993).
In the United States, African American teenagers are much likelier (about five times) to have a child before the age of 19 than are whites (Furstenberg, 1987), even after controlling for socio-economic background factors (Maxwell and Mott, 1987). A study on ethnic differences between non-Hispanic whites and Mexican American female adolescents (Aneshensel et al., 1990) concluded that the Mexican Americans who had been born in Mexico tended to initiate sexual intercourse later than the non-Hispanic whites, but that they had the highest rate of early births because they were the most likely to become pregnant if sexually active and the least likely to terminate the pregnancy. The non-Hispanic whites had the lowest rate of early births and the US born Mexican Americans were in between. Other studies corroborate these differences, adding the effects of family structure, age at first conception, family size, education and the fact of having a working mother (Cooksey, 1990; 1988). The effect of social controls in the initiation of sexual intercourse was found to be significant among whites but not among African Americans (Udry and Billy, 1987). Indexes of acculturation (language spoken at home, place of birth of individual and father and residence) were found to be more important than socio-economic background for fertility expectations (Sorenson, 1985).
To sum up, this section has shown that culture determines the meaning of pregnancy among young women, as well as its consequences such as those regarding social status, health and gender relations. The defining principle is not so much the age at which it occurs, but the cultural acceptability of the pregnancy, and this is often linked to marriage. Age at marriage is thus a central variable for analysis, both the actual age at which it takes place in different settings, as well as the prescribed legal age and the differences between the two. The norms of behaviour and the way in which specific behaviour is interpreted are cultural constructs and vary over time. Major sources of change have been education, urbanization and globalization, for they have a direct impact on the values, beliefs and practices. These processes have had a much stronger effect in the determination of age at marriage than on the initiation of sexuality, creating a separation in which pregnancy becomes unacceptable.
2. This, however, does not refer to the physiological transition from puberty to the end of physical maturation. Athough all human beings undergo this biological process, there is no recorded evidence of its social meaning, i.e. it does not have a social reflection, such as in rites of passage.
3. Earlier menarche is attributed to a steady improvement in the levels of nutrition
4. WHO, Health needs of adolescents, Geneva, 1977 (WHO Technical Report Series No. 609).
5. Both WFS and DHS use the 15-19 age group. Because of this, given that they are major sources of demographic information, this paper also is restricted into using it for some of the analysis.
6. There is however some recent evidence that among more educated women the age at first intercourse would be slightly postponed (MacCauley and Slater, 1995).
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