By Suleiman Tajudeen
…Continued from last week
CITIZENS COMPASS— Unreported because families bury girls in silence due to stigma.
Causes
Individual factors: Early puberty, curiosity, low self-esteem, lack of knowledge on reproduction, inability to negotiate condom use, substance abuse (tramadol, alcohol), and mental health issues like depression.
Family factors: Broken homes, poor parental monitoring, harsh parenting, poverty forcing girls into hawking and transactional sex, parents who are absent due to work, and lack of sex education at home.
School and peer factors:Peer pressure, absence of guidance counsellors in 80% of schools, transactional sex for marks (“sex for grades”), cultism, and no comprehensive sexuality education.
Societal and economic factors: Poverty – girls exchange sex for money, phones, hair, school fees (“runs” / sugar daddy syndrome), early marriage in the North, gender inequality, and social media pornography.
Health system and legal factors: Restrictive abortion law, judgmental attitude of health workers toward unmarried pregnant teens, lack of youth-friendly health services, stock-out of contraceptives, and high cost of care. Modern contraceptive use among adolescents 15-19 is only 5% (NDHS, 2018).
Effects
Medical effects of teenage pregnancy:
Obstructed labour due to an immature pelvis, prolonged labour, Vesicovaginal Fistula (VVF) – Nigeria has over 150,000 women living with fistula, many started as teenagers, pre-eclampsia/eclampsia, anaemia, malaria in pregnancy, preterm birth, low birth weight, stillbirth, and maternal death. Nigeria’s Maternal Mortality Ratio is 512 per 100,000 live births.
Medical effects of unsafe abortion:
Severe bleeding (haemorrhage), sepsis (infection), uterine perforation, injury to bowel and bladder, incomplete abortion, tetanus, chronic pelvic pain, infertility from blocked tubes, and death. Girls who survive often require emergency hospital care, blood transfusion, and prolonged admission. For complications, immediate referral to a healthcare professional and hospital emergency care is critical.
Psychological effects:
Depression, anxiety, shame, guilt, suicidal ideation, post-traumatic stress, low self-esteem, and rejection. As a clinical psychologist, many teenage girls present with depression after a secret abortion or childbirth abandonment.
Social and economic effects:
School dropout (over 50% of pregnant girls drop out), loss of education, poverty cycle, early forced marriage, stigma and family rejection, child hawking, and repeat teenage pregnancy within two years in 40% of cases. Children born to teenage mothers have higher malnutrition and mortality.
Prevention
Primary prevention:
Comprehensive sexuality education in schools and at home, life skills education (assertiveness, decision-making, saying no), parental monitoring and communication, economic empowerment of girls (skill acquisition, keeping girls in school), delaying early marriage to 18 years per the Child Rights Act, community and religious leader engagement, and providing adolescent-friendly contraceptive information and services at PHCs without judgment.
Secondary prevention:
Early identification of at-risk girls by teachers and counsellors, confidential counselling in schools, early pregnancy detection and referral to youth-friendly clinics, and implementation of the Re-entry Policy 2021 to allow girls to return to school after delivery instead of expulsion.
Tertiary prevention:
Prompt hospital management of complications of unsafe abortion, post-abortion care and counselling by trained healthcare professionals, psychological support and family therapy, fistula repair at National Obstetric Fistula Centres, and social reintegration and vocational training for teenage mothers.
Management
Management must be multidisciplinary, confidential, and non-judgmental:
Medical management: Pregnant teenagers require early antenatal care, screening for anaemia, syphilis, and malaria, and skilled birth attendance. Any girl with bleeding, severe abdominal pain, fever, or foul discharge after a suspected abortion is a medical emergency and must be taken immediately to the nearest hospital for care by a healthcare professional.
Psychological management: Counselling for depression, trauma, and suicidal thoughts, family conference to reduce rejection, peer support groups for teenage mothers, and referral to clinical psychology/psychiatry services where needed.
Social management:School re-entry support, linkage to social welfare, non-governmental organisations supporting girl-child education, legal protection against sexual violence, and vocational empowerment to break the poverty cycle.
Public health Management: Training nurses and teachers on adolescent-friendly care, ensuring contraceptive availability.
Nigerian girls are still dying in silence not because we lack knowledge, but because of stigma, restrictive environments, poverty, and judgmental services. Teenage pregnancy and unsafe abortion are preventable public health problems. When a village, school, family, and health system work together through education, counselling, and compassionate, youth-friendly care, we save lives, keep girls in school, and protect Nigeria’s future.
References
Federal Ministry of Education Nigeria. (2021). _National policy on safe schools and re-entry of teenage mothers_. Federal Ministry of Education.
Guttmacher Institute. (2023). _Abortion in Nigeria: Incidence and health system costs_. Guttmacher Institute.
National Population Commission (NPC) & ICF. (2019). _Nigeria Demographic and Health Survey 2018_. NPC and ICF.[Nigeria]
World Health Organization. (2022). _Abortion care guideline_. World Health Organization.
Dr. Suleiman Tajudeen is Director, Clinical Psychology, LUTH (Retired) & CEO, Clear Mind Psychological Consult, Ojo, Lagos State. +234 803 402 4457
