Early childbearing has during the last decades received increasing attention as a threat to the health and development of girls, and an increasing body of public health research documents the health risks of early pregnancy [
1‐
3]. Early pregnancy is intimately connected with early marriage and school drop-out producing dynamics perceived to have substantial negative implications for girls’ life courses [
4]. Sustained high levels of pregnancy and birth rates among adolescents are found to be particularly dominant in sub-Saharan Africa [
1], and are obstacles that prevent young girls and women from fulfilling their potential. Gender equality and girls’ right to reproductive health lie at the heart of diverse initiatives to fight adolescent pregnancy [
1,
5]. The WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries spell out a comprehensive multi-sectoral approach to combat early pregnancy through marriage law reform. It includes interventions targeting community norms pertaining to the timing of marriage, the empowerment of girls and increasing educational opportunities. Through such initiatives countries in sub-Saharan Africa are supported to develop strategies to decrease adolescent pregnancy and school dropout [
1].
Another and partly interlinked body of literature focuses on the dynamics at work behind early pregnancy and motherhood [
2‐
4,
6,
7]. The literature reveals that dynamics leading to adolescent pregnancy are complex and entangled, and commonly highlights a series of interlinked socio-cultural and structural factors. Customary early marriage, the bride-wealth institution and gender norms have been pointed out as central to the understanding of early pregnancy [
8‐
12]. A number of ethnographic sources have moreover illustrated a substantial customary value placed on child bearing and fertility in sub-Saharan African societies [
13‐
20], and have explored the dynamics behind the timing of pregnancy [
9,
13,
21‐
25]. Explanations of early pregnancy focusing on ‘culture’ or ‘cultural disintegration’ have been coupled with economic- or structural explanations addressing contexts of poverty and marginalization, a lack of proper sexual- and reproductive health education and poor access to and appropriateness of public health services for the young [
2,
4,
7,
12].
There are important examples in public health publications that deal with early pregnancy in nuanced ways, paying attention to early pregnancy as desired and having social benefit, such as the works of McCleary-Sills et al. [
26]. Nonetheless, there is a tendency of approaching the ‘problem of teenage pregnancy’ from a relatively narrow health-oriented angle in public health. This has importantly been problematized in the broader literature. Preston-Whyte has for example discussed the massive international and national policy pressure to fight early childbearing in the southern African region. Through fine-grained ethnographic studies she has focused on the dynamics of fertility and early premarital pregnancy from South Africa [
20,
23‐
25], and has demonstrated how many teenagers and parents perceive premarital early pregnancy as a rational strategy to achieve a set of important goals. Preston-Whyte and others have argued that ‘teenage pregnancy’ cannot automatically and unequivocally be represented as an individual or social problem. The studies of MacLeod [
10] and Mkahwanazi [
27,
28] investigate the historical, political and social power relations and discursive practices that construct adolescent pregnancy as harmful. The authors argue that in view of socio-economic conditions and normative patterns found throughout the sub-Saharan region, early marriage and pregnancy have often been desired and are perceived as a rational choice.
Jewkes et al. [
22] have pointed out that in exploring factors behind early pregnancy, one will often encounter strong co-existing discourses. In this paper we explore prevailing parallel discourses on early pregnancy, early marriage and school dropout as encountered among community members in rural Zambia. The main aim of this formative study was to expand the knowledge base on socio-cultural and structural dynamics at work behind early pregnancy and school dropout, including perceptions about early pregnancy as a social phenomenon. The study findings have been used to inform school based intervention research targeting early pregnancy in rural Zambia (‘Research Initiative to Support the Empowerment of Girls’).
The study context
In Zambia, childbearing starts early and teenage pregnancy is common, particularly in rural areas. According to the latest Demographic and Health Survey (DHS) of 2013/14, one third of Zambian women have given birth by the age of 18 and more than half by the age of 20 [
29]. Adolescent pregnancies are considerably higher in rural than urban areas (30% vs 17%), and in the lowest wealth quintile compared to the highest (37% vs 6%). The age of birth giving is moreover associated with education, and the age at first birth increases with education. Women with no education give birth around 2 years earlier than women with secondary education. Education is stated as a right and all school age children are expected to go to school in Zambia [
30], but school enrolment and drop-outs are highly unequal between boys and girls and between rural and urban areas.
Early pregnancy is closely related to early marriage. The legal age of marriage is 21 unless parents provide consent to marriage before this age [
31]. Nevertheless, the DHS 2013/14 reports that 45% of women in the age group 25–49 were married by the age of 18 [
29]. Early marriage and early pregnancy are associated with poverty, and the scale of adolescent marriage and childbearing is perceived to be a societal challenge of substantial proportions in Zambia. Poverty is again particularly widespread in rural areas where about 70% of the population is categorised as poor [
29].
Zambia is by constitution a Christian Nation, and the Christian discourse tends to permeate public debate and promote religious values that may constrain people from accessing sexual and reproductive health (SRH) services including family planning [
32]. Comprehensive Sexuality Education was nonetheless introduced in the country in 2014 [
33], but preliminary evidence indicates implementation challenges and limited support from parents and the general public.
The government has defined schooling of girls as a major strategy to prevent teenage pregnancy and as a condition for girls’ social and economic development [
34,
35]. A prime challenge is however that increased schooling does not necessarily lead to employment. Waged labour is scarce in rural Zambia and subsistence farming is the most common activity in rural areas. Beyond employment in the public sector as educated teachers and health workers or in private ranching, farming or mining companies, relatively stable employment opportunities are limited. In recent years public employment has become more cumbersome than earlier, with large numbers of educated teachers remaining unemployed for years before they get their first job. Small scale business and petty trading remain the most viable paid opportunities for many.
In the effort to address teenage pregnancies and early marriage, Zambia has moreover committed to a number of international and national policies and declarations. Among others it has ratified the UN Convention on the Rights of the Child and the African Charter on Human and People’s Rights on the Rights of Women. In line with the Sustainable Development Goals agenda, the country has committed to Goal 5 on gender equality to eliminate child, early and forced marriage by 2030 (target 5.3). In relation to Goal 3 on health and wellbeing (target 3.7) Zambia has moreover committed to ensure universal access to SRH services [
36]. Access to sexual and reproductive health services (SRH) is nonetheless found to be very limited and again unequally distributed with a huge urban bias. The unmet need for contraceptives is high, especially among teenagers aged 15–19 years where it is estimated at 25% [
1].
This paper is based on qualitative formative research to inform the development of interventions within the ‘Research Initiative to Support the Empowerment of Girls’ (RISE) [
30]. RISE is designed as a cluster randomised trial (2015–2020) and aims to measure the effectiveness of a school based intervention targeting early childbearing, marriage and school drop-out among girls in rural Zambia. The RISE project is run by the University of Zambia in collaboration with the University of Bergen, Norway. It is anchored within the Centre for Intervention Science in Maternal and Child Health (CISMAC), an international consortium performing research to develop, test and implement interventions to improve maternal and child health outcomes in low and middle income countries (
https://cismac.uib.no/). Nichter et al. [
37] call for qualitative formative research to develop, monitor or critically assess interventions in public health. A thorough mapping of the perceived dynamics surrounding early pregnancy and school dropout was deemed important for the development of the RISE intervention study [
2,
20,
21]. The main research question asked in this formative project was: How does official discourse on early pregnancy as a problem and schooling of girls as solution, play out and articulate with local understanding of early pregnancy, early marriage and school dropout in rural Zambia?