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Conscience Magazine

Failing the Test

By Alisha Bjerregaard February 19, 2014

For more than 50 years, adolescent girls in mainland Tanzania have been subjected to the degrading experience of forced pregnancy testing in school. Students found to be pregnant face immediate expulsion. “The government strictly does not want pregnant girls in schools. It’s not allowed,” explains the Gender Focal Point at the Tanzanian Ministry of Education.

These practices have a tremendous impact on adolescent girls’ access to education. In the past 10 years alone, the government’s own statistics show that more than 55,000 female students have been forced out of primary and secondary school because they were pregnant. The actual numbers are likely much higher. Government statistics do not capture the many pregnant students who drop out to avoid formal expulsion and the stigma that accompanies student pregnancy.

School and government officials frame the testing and expulsion practices as efforts to prevent adolescent pregnancy. However, the measures are punitive and, instead of providing adolescents with tools to make informed decisions about sex and reproduction, they aim to regulate and control adolescent girls’ sexuality. These practices are not only serious violations of girls’ human rights; they also fail miserably in addressing the factors leading to high rates of adolescent pregnancy in Tanzania.

Nonetheless, forced pregnancy testing and the expulsion of pregnant students are policies that receive broad support from government and school officials, communities and families. They reflect the strong moral and social condemnation of premarital sex among female adolescents in Tanzania. There is no corresponding monitoring and punishment of adolescent boys’ premarital sexual activities.

Mainland Tanzania is far from alone in these practices. Similar accounts of compulsory pregnancy testing and expulsion of pregnant students have been documented in Uganda, Kenya, Ghana, Nigeria and Sierra Leone, among other countries on the continent. This issue does not only affect girls in Africa: a school in the US state of Louisiana engaged in comparable practices as recently as 2012. 

A Closer Look at Testing and Expulsion in Tanzania

“You are called by a female teacher by class—Form 1A, 2A—to go report to a certain block,” 19-year-old Sophia, a former secondary school student, recounted. “They call the [female] students’ names according to the attendance register, one by one. When you get [to the classroom], they tell you that you will be tested. They ask you to lie on the desk…. They release your clothes but you don’t undress fully…. The nurse matron does the testing by pinching [your] stomach and breasts. It hurts.”

Although testing practices vary by school, and not all schools engage in testing, they tend to follow a pattern similar to the experience described by Sophia. Testing is typically a group exercise, with all adolescent girls, not just those suspected of being pregnant, tested on the same day. It is commonly carried out with no advance warning; students often find out just minutes before the testing begins.

In fact, some schools deliberately mislead students about where they are going and why, in order to prevent their “escape” or protest. Students are never asked for their consent to test. A refusal to comply with mandatory testing would be met with disciplinary action. In Tanzania, where corporal punishment is legal, this action would likely be violent. As Joyce, a 17-year-old student, explained: “If you want to be beaten, then you say no. We just have to do it.”

For some adolescent girls, the testing may begin as early as 11 years of age. Examinations may then continue throughout adolescence until graduation from secondary school, typically at age 19. Depending on the school or district, forced pregnancy testing may occur anywhere from once a month to once a year. The testing is not limited to particular types of schools—public and private, religious and secular, rural and urban, boarding and day schools all engage in this practice.

Public and private, reli-gious and secular, rural and urban, boarding and day schools all engage in mandatory pregnancy testing.  

The most common form of pregnancy testing is a physically invasive process of manually pressing on the abdomen, sometimes accompanied by a squeezing and pinching of the breasts and nipples to gauge sensitivity. Many students have described this procedure as painful. One student stressed: “If it was up to me, I would say no, because it’s painful when the nurse is doing it.”

A healthcare provider typically does the testing, although students have reported teachers conducting the tests. Test results are routinely shared with teachers, parents and sometimes other students, often before being shared with the student herself. The disclosure of test results occurs without the student’s consent, a serious violation of patient confidentiality.

As one healthcare provider who performs these evaluations explained, the objective of the testing is solely to “find pregnant girls.” Schools seek to identify pregnant students and ensure their immediate removal from school. No one provides care or counseling to the student, even in cases of sexual violence—pregnancy is treated exclusively as a disciplinary offence, to be condemned and punished.

Expulsion is immediate, and there are no exceptions. All pregnant students are automatically and permanently excluded from the school in which they were enrolled. Once forced out for pregnancy, students are not permitted to return to any public school to continue their education, effectively locking all but the wealthier students out of the formal education system.

Being cast out of school does not always mark the end of a pregnant student’s ordeal. “Impregnating” a student is criminalized under Tanzanian law, and so some schools may also bring pregnant students to the nearby police station. There, they or their families may be unlawfully harassed, detained and imprisoned until they reveal the name of the man or boy who “caused the pregnancy.” Media reports reveal that some girls have been detained for days and even imprisoned for up to six months for failing to reveal a man’s name. These adolescents sometimes face harsh detention conditions and may be denied parental or guardian visitation.

One regional commissioner in Tanzania recently took these appalling tactics a step further. He ordered the arrest of all pregnant students, apparently in an effort to reduce the high numbers of pregnancy-related dropouts in his region. But his rhetoric reveals the punitive intent: “I think the practice of arresting only those who make girls pregnant is not enough, we now need to also arrest those who get pregnant; we’ll only leave out someone who was raped, not someone who did it voluntarily.”

Turning a Blind Eye to Rights Violations

These practices—forced pregnancy testing, expulsion, arrest and imprisonment—constitute serious human rights violations. In addition to clearly infringing on adolescent girls’ right to education, they violate their rights to nondiscrimination, dignity, privacy, liberty and security, health, information and life, as well as freedom from torture and cruel, inhuman or degrading treatment. These are entirely unacceptable responses to adolescent pregnancy.

What this oppressive system does achieve, however, is a convenient abdication by government and schools of their responsibility to girls. By focusing exclusively on blaming and punishing adolescent girls for their pregnancies, and by removing pregnant students from the school environment at the earliest opportunity, officials permit themselves to turn a blind eye to the very real causes and consequences of adolescent pregnancy.

Photo of Catholics for Choice's Nairobi Billboard
In April 2013, a billboard in Nairobi and two newspaper ads brought a life-affirming message to Kenyans: “Good Catholics Use Condoms.” The ads, sponsored by Catholics for Choice as part of our Condoms4Life campaign, rebutted attempts by the Kenyan bishops’ conference to ban an ad supporting condom use. It sparked a national conversation about the Vatican’s ban on the use of condoms and the fact that Catholics can, in good faith, protect themselves and their partners with condoms.

According to UNICEF, Tanzania “has one of the highest adolescent pregnancy and birth rates in the world.” More than 44 percent of adolescent girls have either given birth or are pregnant by the time they turn 19; many of these pregnancies are unplanned or unwanted. There are many reasons for the high rate of adolescent pregnancy. Principal among them is the failure to provide young people with access to the information and services that would allow them to prevent and plan for pregnancy.

Comprehensive sexuality education, a critical tool in addressing adolescent pregnancy, is glaringly absent from Tanzanian primary and secondary schools. Vocal religious opposition has effectively shut down government plans to introduce a national sexuality education curriculum in public schools. Current curricula largely fail to offer students any meaningful information about sex, reproduction or contraception.

Where sexuality (or “life skills”) education is offered, the focus is on abstinence. One government-issued teaching guide, for example, instructs teachers to simply inform adolescents that premarital sex “is strictly prohibited.” As studies have repeatedly shown, abstinence-only education is entirely ineffective: it not only fails to delay sexual activity, but may lead adolescents to expose themselves to unnecessary risks by discouraging those engaging in sex from using contraceptives.

Sometimes schools provide misinformation: one set of government teaching materials on HIV & AIDS unabashedly declares that “contraception causes infertility, promiscuity and prostitution.” Teachers lack the training to teach “life skills” and have expressed discomfort about discussing sex and sexuality with students, leading them to avoid the subject altogether.

Many adolescents, therefore, are unaware of contraceptive methods that would prevent pregnancy. Sophia’s story is representative: “I didn’t know how to use contraception and didn’t have the idea of using it. I just [had sex] once and then I got pregnant.” Pregnant at 19, she was forced to drop out of secondary school.

For those adolescents who attempt to seek reproductive health information and services at local healthcare facilities, another set of challenges awaits. Some providers in public and private healthcare facilities in Tanzania unlawfully deny adolescent girls access to reproductive health services, acting on their personal biases about female sexuality and premarital sex. Many decide that unmarried adolescents are not entitled to services because—according to social norms—they should not be having sex. Access to information and contraception, many believe, will only “promot[e] promiscuity among th[is] age group.” Providers may also stigmatize adolescents who seek services, berating them for requesting HIV tests or asking for pregnancy-related advice.

The government’s failure to provide adolescents with the information and services they need is considerable. Despite repeated policy commitments, adolescent-friendly health services have not received the resources necessary to make them available and accessible to young Tanzanians. As of 2010, these services were virtually nonexistent. Data from 2010 further reveals that only 10.7 percent of sexually active adolescents between the ages of 15 and 19 reported using a contraceptive method.

Against this backdrop lies the reality of adolescent sex. In mainland Tanzania, early marriage is legally sanctioned (approximately 40 percent of adolescent girls are married by 18), and poverty routinely forces young women into coercive sexual relationships to meet basic needs and educational costs. Sexual violence—particularly in or en route to school—remains pervasive. It is not uncommon for teachers to be the perpetrators of this violence. Adolescents’ ability to negotiate safer sex or prevent pregnancy in these contexts is severely constrained.

Pregnancy is treated exclusively as a disciplinary offence, to be condemned and punished.  

Adolescent pregnancy requires a holistic, rights-based approach that tackles both its causes and its consequences. The solution lies in efforts not only to protect adolescents’ rights but also to respect and fulfill those rights. Strength-en-ing protections against sexual violence and early, forced marriage, for example, are crucial steps—but they are not sufficient.

Governments must also ensure respect for and fulfillment of adolescents’ rights to sexual and reproductive health information and services, including through comprehensive sexuality education and accessible, adolescent-friendly services. Schools must accommodate pregnant and parenting students and guarantee their right to education. This requires respecting adolescents’ evolving capacity and autonomy to make independent decisions about their sexual and reproductive lives—and giving them the means to do so.

This last piece is the most critical. It requires adults—government and school officials, teachers and healthcare providers, parents and grandparents, community members and civil society activists, religious and political leaders—to face their own discomfort with adolescent sexuality and address this reality head on. It necessitates a shift from a model of blame and punishment, regulation and control, to one that treats adolescents as rights holders, entitled to actively participate in decisions that will shape their lives.

This shift will not happen easily. It goes to the core of deeply entrenched social and cultural norms, which are often the strongest source of resistance to change. But incremental change is already underway. Tanzania is currently considering a new national educational policy framework that will facilitate pregnant students’ return to school. Although many aspects of this proposed framework remain problematic, it nevertheless represents a significant first step towards acknowledging both adolescent sexuality and adolescent rights.

Alisha Bjerregaard

is a former legal adviser for Africa at the Center for Reproductive Rights (CRR) and the author of CRR’s recently published fact-finding report, Forced Out: Mandatory Pregnancy Testing and the Expulsion of Pregnant Students in Tanzanian Schools.