MORE THAN THOUSANDS OF TEENAGE PREGNANCIES IN TEN YEARS, MOTHERS AT FOURTEEN: CHILDREN GIVE BIRTH TO CHILDREN

"THE ISSUE OF TEENAGE PREGNANCIES IS COMMON IN RE COMMUNITY, CONSIDERING THAT CHILD ARRANGEMENT MARRIAGE IS CLOSELY CONNECTED WITH EARLY PREGNANCY, " JOVANA KNEŽEVIĆ, PSYCHOLOGIST FROM THE CENTER FOR ROMA INITIATIVES, STATED

Several thousand minors have given birth in the last ten years in Montenegro, among them 14-year-old girls. The interlocutors of the Center for Investigative Journalism of Montenegro (CIN-CG) point out that these are primarily members of the Roma and Egyptian (RE) population since teenage pregnancies are tied to arranged marriages.

"They get married early, and girls are expected to give birth to their first child at 15 or 16. Fathers are also immature peers, so none of them understand the seriousness and complications of early pregnancy", Sadije Holaj, the director of the Ulcinj Health Center and a gynecologist, warns.

The United Nations Children's Fund (UNICEF) warns that girls who marry early are exposed to health risks due to frequent childbirth, unplanned pregnancies, sexually transmitted diseases, and abortions. Early childbearing is the leading cause of mortality for girls aged 15 to 19 due to complications related to pregnancy and childbirth.

Dr. Holaj also points out that teenage pregnancies carry a higher degree of mortality for both mother and child. "In addition, there are serious complications from diseases such as premature birth, hypertension, anemia, and toxemia," she explains.

The Institute for Public Health (IPH) told CIN-CG that early pregnancy leaves health consequences in the form of a risk of giving birth again and that it is also characteristic that due to the physical immaturity of the mother, births usually end with cesarean section.

"Also, adolescent parenthood most often affects the social life of a minor. Teenage pregnancy most often leads to rapid mood swings, irritability, depression, a distorted perception of oneself and the newborn, disruptions in peer relationships and schooling," the Institute has stated.

Research conducted by UNICEF in Bulgaria also shows that families are neither concerned nor aware of the risks of early pregnancies. Most Roma, for example, believes that young mothers give birth to healthy children and that early pregnancy is not risky for either her or the baby. Even when the mediators present them with data on the negative consequences of early childbearing, this does not significantly impact the practice of child marriage, which, according to the UNICEF document, means that customary norms are still followed.

In our country, UNICEF, in cooperation with the Statistical Office of Montenegro (MONSTAT), conducted research on multiple indicators in Roma settlements in Montenegro (MICS) several times in the last ten years. The study showed that 18.2 percent of female and 6.5 percent of male respondents entered marriage or union for the first time before age 15. For those under 18, that percentage is 56.4, or 34.9 percent.

The percentage of young people aged 15 to 24 who had sexual relations before 15 was 19.5 percent for women and 11.4 percent for men.

One of those surveys showed that 36.9 percent of respondents in the age group of 20 to 24 gave birth to at least one child before their 18th birthday.

IPH submitted to CIN-CG data on the total number of births in Montenegro and the share of pregnant women up to 19 years old at the delivery time. The IPH said that they do not have data on the teen birth rate. According to the World Health Organization, pregnancies in girls below 20 are considered adolescents.

From 2010 to 2020, there were 80,430 births, and the share of women giving birth under the age of 19 was 3,193, which makes up around four percent of the total number. 

As the number of births in the last ten years decreased by about 900 per year, from 7,820 in 2010 to 6,919 in 2020, the number of births among adolescents also reduced. That figure has dropped by more than 100 births per year, from about 370 in 2010 to 252 in 2020.

Health institutions keep records of early childbearing, so in the most significant health institution in the country - the Clinical Center of Montenegro (CCM) - 48 cases were recorded in the last five years. "The youngest minor was 14 years old," CCM stated in the response.

However, the hospital in Berane recorded the most significant number of teenage pregnancies. In the last five years, 103 minors have given birth; the youngest mother was 15.

The director of the General Hospital "Blažo Orlandić" in Bar, Igor Karišik, told CIN-CG that in the same period, they had 15 teenage pregnancies, of which two women were 14 at the time of labor, two were 15, four were 16, and seven 17 years old. The number of teenage pregnancies in Bar has increased in the last two years.

At the General Hospital in Nikšić, there were 19 teenage pregnancies in the last five years, and the hospital told CIN-CG that the youngest among them was 15, while most were 17-year-old girls. The General Hospital in Bijelo Polje reported eleven teenage pregnancies in the last five years; the youngest mother was 16.

The head nurse of the General Hospital in Kotor, Dijana Kukuličić, told CIN-CG that they usually give birth to one or two minors yearly and that the youngest among them was 16 years old. The youngest woman giving birth at the "Danilo I" General Hospital in Cetinje was the same age, Anđelka Lopičić, head nurse of gynecology and obstetrics, told CIN-CG. In that hospital, in the last five years, there were three teenage pregnancies.

Since 2017, General Hospital in Pljevlja recorded 14 minor births; the youngest patient was 16.

Teenage pregnancies are reported to centers for social work and the police

The director of the hospital in Bar, Igor Karišik, said that in the case of teenage pregnancies, the practice is to inform the police and the local Center for Social Work. The director of the Center for Social Work, Biljana Pajović, told CIN-CG that there had been three reported teenage pregnancies in Bar and one more in Ulcinj in the last five years. She clarified that they are usually informed about the childbirth of a minor by the hospital's gynecology department.

"The specialist workers for children and young people then go to the gynecology department, where they talk to the underage mother. It is necessary to determine where and with whom the minor lives and whether she is ready, with the help of the family, to take care of the baby adequately. It is also common to contact family members - parents, emotional partners - to confirm that the woman in labor will be provided with support and necessary assistance", Pajović said.

She added that, if necessary, family monitoring is carried out for a certain period so that a plan of support services is drawn up for the user and the family, counseling sessions are held at the Center, and psychosocial or material support is provided.

As representatives of several centers for social work explained in an interview with CIN-CG, most reports are submitted by the General Hospital - maternity ward, or the information is offered by educational institutions or parents.

Depending on the situation and the parental acceptance or non-acceptance of the minor, the Center for Social Work can react in the following ways: if the family accepts the minor with the child, then they monitor the family situation and, through monitoring, perform advisory work and refer family members to relevant institutions. Also, the Center provides various types of material assistance and counseling. In cases where the family does not accept a minor with a child, the Center finds an acceptable form of protection for the mother and child, usually family accommodation, until the child reaches the age of three.

In the last five years, this has happened once, said Marija Nikčević, head of the Department for Children and Youth at the Nikšić Center for Social Work. "In the meantime, we are working on empowering and making the user independent, so they can take care of the child when the service ends. Family accommodation is provided by persons who have undergone licensed training", she explained.

The director of the Center for Social Work in Berane, Petar Pajković, said that the hospital reported three teenage pregnancies in the last five years. "It is also important to emphasize that the hospitals usually report cases to the Center when family’s relationships are unsettled, and the parents are dissatisfied with the situation in which the minor found herself," he explained.

In many cases, the data of the centers for social work and health institutions on teenage pregnancies do not match.

Community barriers to contraception

Jovana Knežević, a Center for Roma Initiatives (CRI) psychologist, told CIN-CG that "it can be said with certainty that the issue of teenage pregnancies is widespread when in RE community, considering that child arrangement marriage is closely connected with early pregnancy."

Knežević believes that in the last ten years, there have been more teenage pregnancies, childbirths, and abortions.

When asked by CIN-CG how awareness can be raised about the dangers of teenage pregnancies and childbirths, Knežević said that since 2011, CRI had been intensively dealing with the suppression of child arranged marriages. As part of its work, it continuously points out the risks of teenage pregnancy and the consequences girls face during childbirth.

"Considering that the community of Roma and Egyptians still follow strict patriarchal norms, one of the main problems is that the community generally does not allow young people, especially girls, to learn more about reproductive health, especially regarding contraceptives," Knežević explains. 

MICS survey shows that only 4.1 percent of the respondents who were married or in a union at that time said they were using a contraceptive.

The executive director of CRI, Fana Delija, said that there is a high percentage of teenage pregnancies, especially between the ages of 16 and 18.

"Even more worrying is that cases of teenage pregnancies before the age of 16 have also been registered, which points to the problem of the legislative framework in cases of preventing illegal child marriage. When preventing child marriages, it mostly happens that 'when returning girls to their biological parents as the best interest of the child, the arranged marriage becomes a 'public secret,' which results in teenage pregnancy and children giving birth to children", she said. 

"All our victims' confessions confirm that the girls became mothers before adulthood. This does not exclude the possibility that they do not decide whether to become mothers in the early stages and during the marriage. Unfortunately, they are often victims of marital rape," Delija says.

When it comes to health care, it is available. However, Delija points out that we have to keep in mind that a certain number of victims from the Roma community do not have documents, so automatically, they do not have health insurance cards, and thus, the right to health education is denied.

The European Commission pointed out in the last annual report on Montenegro that all health services are not available for people without regulated legal status, including members of the RE population.

Love marriage, in addition to her own, she takes care of three other children

Although girls are often married against their will, the case of Andrijana Kajtazaj is quite different.

She told CIN-CG that she fell in love with her husband while still in school and decided to get married because she was in love.

"I wanted to marry him since we were dating. My parents didn't want me to get married. But now I'm happily married, and we have seven children. I gave birth to my first child when I was 14, to my second when I was 16... and so on," said this 37-year-old in an interview with CIN-CG.

Almost all childbirths are performed in health institutions. The MICS survey also showed that 85.7 percent of the respondents had at least one examination during the last pregnancy, and 63.5 percent had at least four. This is the percentage of pregnant women in the two years preceding the survey. Of them, only 77.1 percent said that their blood pressure was measured and that they gave a urine and blood sample during their last pregnancy.

The CIN-CG interlocutor said that she had a positive healthcare experience during her seven childbirths and that her health was still excellent.

After her cousin passed away, Kajtazaj decided to take care of her other three children.

"They wanted to place the boys in children's home and to take the girl. The Social Center was not in favor of that. I said - I will adopt them; why not. I will raise them the same I raised my children. I'm happy. We don't have any problems", said the CIN-CG interlocutor.

Montenegro has the highest rate of early marriage

Regarding the prevalence of child marriages, data from MICS research from the region's countries show that they are the most common in the Montenegrin Roma community.

Thus, in Montenegro, the highest percentage of Roma women married before age 15 is 18.2, while in the general population, that percentage is 0.5. In the group up to 18 years of age, that percentage is as high as 56.4 percent among Roma women and 6.2 percent in the general population. In this second group, only Serbia has a slightly higher degree - 57 percent of Roma women get married by the age of 18.

This research included Bosnia and Herzegovina, Kosovo, and North Macedonia.

Young Romani men and women from poorer families are at greater risk of getting married before the age of 15 compared to their peers living in wealthier families, research shows. As many as 27 percent of the poorest families marry before age 15, and 16 percent of the richest.

Young unmarried people from Roma settlements are literate in 57 percent of cases. Among those who married before 18, slightly more than half (54 percent) are literate. On the other hand, the MICS research showed that of those who married before the age of 15, only two out of five were literate (42 percent). Among young Roma who are illiterate, 45 percent are not married, one-third (32 percent) got married between the ages of 15 and 18, and almost two-quarters (23 percent) before age 15. Of those who do not attend school, more than half (55 percent) are not married, nearly one-third (31 percent) got married between the ages of 15 and 18, and 14 percent before the age of 15.

Miloš RUDOVIĆ