CAPE TOWN

After six months of dating, Tumi [not her real name], 17, is running out of reasons why she can't have sex with her boyfriend, a fellow 10th grader at her school in Athlone, a poor suburb of Cape Town, South Africa.

"I make excuses like, I'm on my period or I have a stomach ache," she said. "I tell him I get my period for a month! I have to lie, because if I tell him the truth he'll drop me."

The truth is that she simply does not feel ready to have sex, but the pressure is mounting and the sex education she receives at school does not provide all the answers.

"He told me he wants a baby," she said. "He says, 'I love you, you are the one', but I think the reason is because his friend has two kids already."

In an age when teenagers are bombarded with HIV-awareness campaigns and have better access to contraceptives than ever before, media reports citing dramatic increases in the number of South African schoolgirls falling pregnant have sparked a national debate.

At one rural school in Eastern Cape Province, 144 girls fell pregnant in 2006, and KwaZulu-Natal Province reported a total of 5,868 teenage pregnancies in 2006, the highest in the country. Other provinces appear to be catching up fast. In Gauteng Province, the nation's economic hub, schoolgirl pregnancies doubled from 1,169 in 2005 to 2,336 in 2006.

Experts like Rachel Jewkes, who heads the gender and health unit at South Africa's Medical Research Council, cautioned against drawing conclusions from incomplete data, saying there was no systematic process for tracking teenage pregnancies in South Africa and that the rising numbers were probably the result of previous under-reporting.

More reliable indicators, such as population surveys, actually showed a steady decline in teenage pregnancy rates over the last 15 years. "Nobody's saying there isn't a problem," Jewkes told IRIN/PlusNews. "I just don't think there's a growing problem."

She attributed falling teenage pregnancies to young people's increased access to and use of contraceptives, especially condoms, and a greater willingness to discuss sexual matters with children, partly as a result of the AIDS epidemic.

At the same time, she said, the quality of sex education in South African schools was still "patchy" and rife with mixed messages as to whether teenagers should abstain or use contraception.

Skills for life?

Sex education, including information about HIV and AIDS, mainly falls under 'Life Skills' in South Africa's school curriculum.

"The Life Skills curriculum runs from Grade 1 to Matric [Grade 12, graduation]," explained Lynne Herrmann, an HIV/AIDS coordinator with the Western Cape Education Department. "It's age-appropriate, so we'll move from talking about relationships generally to sexuality, and from there to HIV and AIDS, and also issues like rape and teen pregnancy."

All primary school teachers are trained to teach Life Skills, while high school teachers can specialise in the subject, but additional training in HIV and AIDS education is voluntary and requires teachers to attend workshops over weekends.

"Not everyone can teach it," said Herrmann. "Some aren't comfortable, and it has to be people the pupils can relate to easily." The right approach was also vital. "It can't just be preaching. Young people want to talk and we don't create enough space for them to do that."

Jewkes, who has been researching the effectiveness of an HIV prevention programme among young people in rural Eastern Cape, agreed that "they want to know how to have good relationships and how to deal with problems with boyfriends, and you can't do that in a lecture."

The Life Skills class Tumi had just attended was far from a lecture. Her teacher led the class in a lively discussion about what to do if they were sexually harassed by someone in a position of authority.

The situation was taken from their course books but the teacher, sometimes struggling to be heard above the enthusiastic responses of her learners, did her best to make the class participatory and relevant. Despite her efforts, Tumi is not convinced that such classes make a difference.

"Most teenagers, you tell them not to do something, but they do it anyway, so it's not useful," she said. "You tell them to abstain from sex, but they do it because they think it's cool. Or if a boyfriend comes to you and tells you 'I love you, I want a baby', you will do it just for them, for their love."

Parents aren't talking

According to Jewkes, the assumption that teenage pregnancies are always unwanted is incorrect. It is common for boys to encourage their girlfriends to get pregnant and there is pressure on both sexes to prove their fertility at a young age.

"My sister got pregnant when she was in Grade 12," Zandile Mkonto, 16, a schoolgirl from the Cape Town township of Khayelitsha, told IRIN/PlusNews. "Her boyfriend was working and she decided she wanted to get pregnant."

Mkonto blames her sister's decision on the reluctance of her parents to discuss issues regarded as sensitive. "My parents will never sit me down and tell me about HIV and AIDS," agreed Tumi. "My mother doesn't want to talk about boys even though she herself was a teenage mum. She doesn't talk to me about nothing."

Teenagers doing the talking

Where parents and teachers fail, the next line of defence used by a number of nongovernmental organisations (NGOs) are young people trained to convey safer sex messages to their peers.

Mkonto has no intention of following in her sister's footsteps. She is one of 30 peer educators at her school trained by sexual and reproductive health NGO, Planned Parenthood Association of South Africa (PPASA).

At a recent training session, a PPASA facilitator led a discussion about whether condoms should be available in schools. The current national policy is to leave the decision to the school's governing body. According to Herrmann, about 50 percent of schools in Cape Town opt to provide them, but usually at the discretion of the school's nurse or guidance counsellor.

"At school, they teach us how to protect ourselves from STIs (sexually transmitted infections), so they have to provide condoms," said one participant.

"If there are condoms, learners will take them and go and have sex in the toilets," said another.

Youth-friendly services

At PPASA's youth-friendly clinic in Khayelitsha, teenagers can access reproductive health counselling and services after school hours, when most government-run family planning clinics are closed.

"I get guidance here," said Sibusiso Soga, 18. "At school they just talk and talk; they only give you information and expect you to use it. Here they give you a chance to speak your mind."
On the advice of the clinic's counsellors, Soga is taking double measures to protect herself from HIV and pregnancy with a three-monthly contraceptive injection and condoms.

But not all teenage girls take such precautions. "A lot of girls get the injection so they won't fall pregnant - they don't think about HIV," said Thembele Nofemele, another PPASA peer educator.

Youth-friendly clinics like the one PPASA runs are rare, and many teenagers come up against disapproving staff when they try to access family-planning services at government clinics.

"There are still nurses at clinics creating barriers to teenagers getting contraception," said Jewkes. "They feel it is their job to prevent them being sexually active."

The spur of the moment

For teenage mothers like Olivia Mboma, who says she had access to both contraceptives and information on how to use them, the question of why she nevertheless became pregnant is more complicated. She admits that she and her boyfriend were not using contraception of any kind.

"At the back of your head you know that you're not supposed to do it," she said. "It's a spur of the moment thing. I didn't think about HIV in the moment; the thought crosses your mind afterwards, the next day when you wake up."

In years past, the price teenagers paid for a "spur of the moment thing" was pregnancy. In the age of AIDS, the cost can be much higher.

Persuading teenagers to think about consequences has never been easy, but Jewkes believes prevention efforts have a better chance of succeeding when young people see other possibilities in their future besides child bearing. "In many parts of the country, kids leave school and there's precious little for them to look forward to."