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 Tuesday 26 February 2008
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Beyond ABC: The challenge of Prevention

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  • Prevention for the HIV Positive
  • Centre for AIDS Development, Research and Evaluation (CADRE)
  • Female Health Company - Female Condom
  • Family Health International
  • International AIDS Vaccine Initiative
  • Alliance for Microbicide Development
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BOTSWANA: Young women choose single motherhood

Photo: Mercedes Sayagues/IRIN
There is little social sanction against young men who impregnate women and take no responsibility for their offspring
Last year, 27-year old Tshepiso Modikwa stopped using a condom with her boyfriend of eight months. "I wanted a baby so badly, I didn't think right. I got a baby, and the virus - I messed up my life."

The stylishly dressed receptionist noted that although she had tested negative for HIV before she stopped practising safe sex, her boyfriend had refused to be tested.

A subsequent routine test at the antenatal clinic revealed that she was HIV positive, her boyfriend returned to his wife, and Modikwa moved from Gaborone, Botswana's capital, to Francistown, the country's second city, to live with her mother.

Despite having a healthy baby after using the anti-AIDS drug, Nevirapine - a single dose given to an HIV-positive pregnant woman just before labour, and a few drops administered to the newborn in the first 72 hours halves the risk of HIV transmission - and finding a new job, Modikwa remains bitter over what happened to her.

At a youth HIV/AIDS awareness project in Gaborone, several peer educators are experiencing a similar triple whammy - pregnant, single and living with HIV/AIDS.

"They know all about prevention but after a few months in a relationship trust kicks in and the condom is out," said project manager Irene Maina.


According to the 2003 HIV Surveillance Report by the Botswana government, nearly half the pregnant women aged between 25 and 29 years were HIV positive, and eight out of 10 pregnant women of all ages were single.

The recent Botswana AIDS Impact Survey (BAIS) found that HIV prevalence among girls aged 15 to 19 years was nearly 10 percent, rising to 26.2 percent in the 20 to 24 age group, and to 41 percent among those aged 25 to 29 years.

The fourfold increase in HIV prevalence in women between 20 and 29 years old is often attributed to their engaging in sex with older men, who are likely to be HIV-positive.

Less has been said about the women choosing to have babies when they are not married or in a stable relationship. In 2003, only seven percent of pregnant women visiting antenatal clinics lived with a partner, 12 percent were married and 81 percent were single.

"The institution of marriage has been losing ground in Botswana for the last 20 years," said UN Children's Fund (UNICEF) official Waheeda Loterring.

People were now marrying later and less often, the 2003 UN Population Fund (UNFPA) Country Report observed. Three-quarters of people aged between 35 and 54 have been married, but only one-third of those aged 20 and 35 have tied the knot.

The high prevalence of premarital and early childbearing has led to an "increasing phenomenon of single-parent family formations as well as female-headed households," said a 2005 report by Childline.

According to the 2001 census, just under half of all households in Botswana were headed by a woman.

Experts warn that young people are reproducing the pattern of a family unit composed of a mother with her children and an absent father. Moreover, since many single mothers have boyfriends, whether serial or casual, children grow up surrounded by adult role models who have multiple sexual partners.

In the last 20 years, development, urbanisation and migration have weakened the traditional social mechanisms that used to control sexuality and organise family relationships.

According to a 1997 government study, the incidence of family desertion had become quite common in both rural and urban areas, while cohabitation and casual liaisons added considerably to the number of children whose fathers took no social and financial interest in them.


Today, there is little social sanction against young women who have babies out of wedlock or with different men; the same goes for men who impregnate women and take no responsibility for their offspring, which is seen as a deplored yet accepted element of masculinity.

A variety of factors drive young women to get pregnant: ignorance about contraception, the inability to obtain it at pharmacies or clinics or negotiate safer sex with male partners, and shyness due to young age.

In African tradition it is important for women as well as men to prove their fertility, and families put increased pressure to have children on women in their 20s and men in their 30s.

"A woman still has high chances of marrying after proving her fertility, although lobola [the traditional bride price] will be lower," said Maina.

Motherhood also fulfils deep emotional needs. "We need to acknowledge that some women decide to get pregnant, then blame it on an accident," said Ludo Letebele, of Population Services International.

As Batswana women become more educated and independent, raising children alone has become more acceptable. "You hear [people say]: 'Men are too much trouble, dump them. My child is my child," added Letebele.

But this attitude allows men to escape their responsibilities. Traditionally, families would enforce social sanctions against such behaviour. Today, young people lack both the traditional solutions and the comprehensive social security and educational systems that help single parents in Western countries.

"Many boys grow up without good male role models, attended to by mothers and sisters, with few limits put on them, and as adults believe they are entitled to control and use women," said Dr Kwame Ampomah, UNAIDS Country Coordinator.

Annie Mathew, a counsellor with the Botswana Christian AIDS Integrated Programme, noted that some young men longed for their children but the mothers pushed them away, out of resentment. "Our value and cultural system is under stress," she commented.

One hot morning in early November, a support group for HIV positive people in Gaborone's Bontleng township had a lively discussion on whether men run away from babies or women chase them away. Finally they agreed that in three-quarters of the cases men were shying away from their responsibility, and in one-quarter the women rejected them.

But the high prevalence of premarital childbearing has public health and social welfare implications, as households headed by single females tend to be poorer and have a higher number of children, including orphans.

The country's last sentinel survey found that HIV prevalence was higher among single women (40 percent) and cohabiting women (47 percent) than among married women (28 percent). The 2003 Surveillance Report concluded that this created "a potential pool for a large number of orphans."

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