Marvellous, age 18, and her mother Jacqueline are sitting together in the backyard of a health clinic in Mbare, Zimbabwe. They’re both smiling down at a small, blanketed bundle in Marvellous’s arms.
A tiny infant peeks out from the orange and white folds, her head cozied in a pink beanie.
“In our community, it is taboo for a girl of school-going age to fall pregnant,” said Marvellous. “It is humiliating and shameful to the girl’s family. I did not know what to do or who to turn to.”
Jacqueline added that Marvellous could not continue going to school as a result of the pregnancy, “Her father was terribly angry because he had just paid school fees. We had big dreams for our daughter.”
Marvellous sought care for her pregnancy at the Doctors Without Borders/Médecins Sans Frontières (MSF) Edith clinic in Mbare, which started out in 2015 as an adolescent sexual and reproductive health project. Over the years, as the project grew, gaps were identified in support for young pregnant mothers during pregnancy, safe delivery care, and support for mothers and babies.
“It is not discussed openly”
Mbare and Epworth are two densely populated townships in Zimbabwe. During the COVID-19 pandemic, families in both communities struggled to make ends meet and many teenage girls became increasingly vulnerable to sexual and gender-based violence, child marriages, and reduced access to health care.
These pandemic-era challenges came on top of the barriers girls were already facing in the community due to cultural beliefs, taboos, and myths around sexual health.
“Issues to do with sexual and reproductive health (SRH) or sexuality are not discussed openly in the community space, especially when we look at the relationships of parents and their children,” said Relative Chitungo, an MSF social worker in Mbare. “The moment an adolescent tries to approach a parent and ask [about these issues], they are pointed fingers at, or blamed for being, say, mischievous. The fear of being judged also limits most adolescents from seeking or accessing appropriate information that is very crucial in terms of them making decisions about their own health.”
Since adolescents typically rely on their parents for financial support, and most SRH services are relatively expensive, it can be incredibly difficult for them to keep a trip to an SRH clinic private.
“There are reasons why many girls are not going to health centers to collect protection (condoms) or contraceptives,” said Marvellous. “This is because our communities, and even our own parents, would demand the reason you were at a health clinic.”
“Those who discuss condom use or the benefits of using contraception are labeled as having loose morals or being prostitutes. There are [also] myths that if one uses contraceptives before having babies, they will never conceive.”
The Teen Moms’ Club
For Marvellous, her first contact with an SRH service came in the form of a leaflet from MSF's Edith clinic in Mbare.
“MSF held an outreach program in our community, and they handed me a flyer as they told me how MSF could assist young girls in my situation. They referred me to the Edith clinic, in Mbare. I was welcomed by aunt Relative from MSF.
“It was here that I narrated my story, before she took me through counseling. The following day I went back and joined the Teen Moms’ Club. Realizing there were more girls in my situation gave me a sense of relief.”
The Teen Moms’ Club was set up in 2020 as part of MSF’s existing project in Mbare, developed by a team of midwives, counselors, social workers, and health promoters. Their aim was to support pregnant teenagers to mitigate risks associated with early pregnancy, and to empower young mothers with knowledge about contraception and safe sex, pregnancy, safe delivery, parenthood, mental health, and school and career prospects.
The project also seeks to break down societal barriers—including attitudes, taboos, and costly health care services—which make access to SRH care difficult for young mothers.
“[Marvellous] explained to me what the Teen Moms’ Club is, how good it is for her, how well she was welcomed, and that she was going to attend that club,” said Jacqueline. “She told me that MSF was going to register her pregnancy at a hospital, buy baby clothes, and monitor her health during pregnancy. I was happy to hear that.”
Another of the participants, Miriam, was four months pregnant when she attended a prenatal care consultation at the Edith clinic and was referred to the club. “They educated us on how to protect ourselves from unwanted pregnancies…they said falling pregnant does not mean one is a failure in life,” she said.
“When I was about to give birth, I was encouraged to come for pregnancy reviews at no cost. MSF would provide us with free counseling and testing. In the event that one is found to be HIV positive, they would provide counseling sessions. Those who test HIV negative would be told the effects of being HIV positive.”
The program also recognizes that the young women and their families need to manage their financial situations, which has led to training programs on income-generating skills such as nail technician work and soap making.
Marvellous chose to be trained on how to make dishwashing liquid, and her mother supported her with the production and selling of it. “We would mix the ingredients together, advising each other on the correct measurements,” said Jacqueline. “The dishwash project uplifted my family and we sold a lot during [Marvellous’s] pregnancy. We were able to do a lot with the proceeds.”
Listening to the voices of young people
Key to the project’s success are the “teen mom champions,” girls who have participated in the club themselves and are interested in becoming peer educators. They are trained in health promotion, to reach other girls facing similar challenges, and to lead their peers.
Marvellous was employed by MSF as a peer educator after she began voluntarily visiting girls in her community to pass on the information she had learned. “The assistance I got from MSF inspired me to give back to my community, realizing that I was not the only one with the same problem.”
“[Now, as a peer educator], I am encouraging teen mothers in my community to register their pregnancies in order to deliver in safe spaces.” Marvellous also helps provide sexual health education, information about contraceptives and referrals to the clinic for post-natal care.The formation of this club brought a huge change in reducing maternal deaths within our communities. Those who received help are now spreading the message.”
Chitungo said that as health workers, it is vital they create the space for the young mothers to speak for themselves. “We have been really strategic to say, okay, we want to empower the adolescents…to raise their voices, to let them just be themselves. For us to have effective programs, we need to hear their voices.”
MSF also runs sexual health education sessions with the caregivers of the participants. The project has had success in engaging fathers of the teen mothers, and encourages the girls to bring their partners along, too. Parents have come on board with the Teen Moms’ Club to spread the message to the community, to say, "let’s be there for our children.”
Jacqueline is among them. "I would like to encourage parents to embrace their daughters when faced with such challenges. I accepted this predicament, and I am grateful to MSF because I could see that my daughter’s spirit had been uplifted after a long time,” she said. “I am incredibly happy that she is proud of what she is doing to help others. She is now completely able to look after herself and raise her baby without any challenges.”
Information and empowerment
There are still challenges ahead for many pregnant girls and young mothers in Mbare. While the Zimbabwe government reversed a law in August 2020 which had banned pregnant students from attending school, stigma affecting these students is harder to change—meaning that many still drop out of their classes.
While several of the club’s young moms are returning to learning, MSF plans to work with other organizations to further support their reintegration to school.
“When we go to school, we’re given time to grow physically and mentally, and our minds open,” said Chitungo. “So [for a girl]…she is empowered. She’s in a position to take charge of her body, to make decisions on issues that affect it.”
For the 124 adolescents that have been enrolled, the Teen Moms’ Club is providing the foundation for the girls to regain agency over their health and the health of their babies, and to make choices that work for them.
It’s a feeling Marvellous said she’s gained from finding the club.
“My life has changed for the better because I am now well informed, unlike before.”
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