More knowledge will reduce teenage pregnancies

"It makes an impression on you to see how, often due to poverty, girls as young as 12 to 14 years of age become pregnant and have babies, while they are still children themselves," says Ingvild Sandøy.

Ingvild Sandøy is a postdoctoral research fellow at the Centre for International Health and is also Deputy Director of the Centre for Intervention Science in Maternal and Child Health (CISMAC), one of four Norwegian Centres of Excellence (SFF) at the University of Bergen (UiB).

Marrying at a young age

Early pregnancy represents a serious health risk for both the girls themselves and the children they are carrying. Many children and young people in Zambia grow up in tough conditions and if they drop out of school, there is a particularly high risk of them being married off and/or becoming pregnant at an early age.

"In Africa it is normal that the family receives a bride-price in the form of money or cattle from the husband and his family when he marries their daughter, and many poor parents marry off their daughters at an early stage in order to supplement their family's income," Sandøy explains.

After having completed her medical studies and her internship in 2004, Sandøy started work on her PhD project studying trends in the prevalence of HIV and sexual behaviour in Zambia. This started many years of cooperation with Southern Africa, where she has since worked on evaluating the effects of home-based HIV testing and other reproductive health challenges in low income countries.

Risky pregnancies

In autumn 2015, Sandøy's most recent project was awarded a prestigious GLOBVAC (Global Health and Vaccination Research) grant of NOK 25 million from the Research Council of Norway. The GLOBVAC programme supports research that can contribute to sustainable improvements in health for poor people and thus provide more health equity in low income countries. 

She leads the project entitled, "The effectiveness of a girl empowerment programme on early childbearing, marriage and school dropout in rural Zambia: A cluster trial", in collaboration with Patrick Musonda from the University of Zambia. Working with them is an interdisciplinary team of researchers from the University of Bergen, University of Zambia,  Chr. Michelsen Institute (CMI) and the Norwegian School of Economics (NHH).

The goal of the project is to increase the proportion of girls who complete junior secondary school and to reduce the number of teenage pregnancies. Currently, it is estimated that as many as 35 per cent of Zambian girls from rural areas have experienced at least one birth by the age of 18.

"When girls become pregnant before they turn 18, there is a greater risk of having a premature baby and a baby with low birth weight. As children, these babies have an increased risk of suffering complications, disease and even death when they are still infants. The girls themselves are also at risk. Pregnancy and illegal abortion are the most common causes of death among adolescent girls in poor countries. In Zambia and many other poor countries, it is rural girls and girls who have dropped out of school who are at greatest risk of becoming pregnant at a young age," Sandøy explains.

Offer financial support

As part of the project, a package of support measures will be implemented to help girls continue at or return to school, and also assist those who are not able to return to school by helping them to delay becoming pregnant. One of the problems in Zambia is that the country only has a limited number of school places at secondary level and not everyone can be given the opportunity to attend junior secondary school.

"It has been shown that dropping out of school and early pregnancy are associated with poverty, so we would like to see whether it helps if girls and their parents are provided with financial support . The money can be used to cover school-related expenses or other necessary items," Sandøy says.

The GLOBVAC financing will enable the project to test whether engaging in dialogue meetings in the local communities in addition to providing financial support will have an even more positive effect. The idea behind this is to start a discussion in the local community about how education, and postponement of marriage and pregnancy, may benefit girls and their future children and to increase knowledge about the use of contraception. The hope is that this can contribute to promoting supportive beliefs and norms that will make it possible for girls to delay marriage and pregnancy until they are more physically and cognitively mature.

Myths and lack of knowledge

Sandøy highlights that "On paper, Zambia has a comprehensive school curriculum for sexual and reproductive health, but the practical implementation is often something completely different. Teachers mostly talk about sexual abstinence. There is a lack of knowledge about modern contraception. For example, there is a wide-spread myth that you can become infertile if you use hormonal contraception before you have had children.".

She works closely with the University of Zambia, which is responsible for the project implementation. In the coming year, she will herself make monthly trips to Zambia to follow-up and support the local team.

"The long-term hope is, of course, to contribute to improving the health situation of young girls. There is beginning to be a considerable amount of research showing that if you do something about the health and opportunities for young girls, this will have positive repercussions for their families in the future," Ingvild Fossgard Sandøy says.

Research that means something

Ingvild Fossgard Sandøy has always had a desire to use her education to do something meaningful and to help others.

"It is incredibly exciting to always learn new things. I have the opportunity to immerse myself in what I'm interested in. In one way, it is like being an eternal student. With the important projects we carry out in CISMAC, our work can actually contribute to improved health for girls, women and children," she says.

International health is something that she has always been interested in, even before she started studying.

"I have always been interested in international challenges and injustice in the world and wrote an assignment in secondary school about Norwegian development aid in Kenya. I consider it extremely meaningful to study measures that can improve health in countries where people live more challenging lives than we do. The greater the challenges, the greater the potential for improvements," Sandøy emphasises.