Growing up in a rural area is different from growing up in the cities. I was born and raised in a rural village of South Africa (SA), in Nzhelele, where life was a routine, as you saw the same people over and over again. There were two primary schools, one high school and one clinic. Living in a small village wasn’t always easy, though. I felt as though my business was the community’s business – everybody knew each other. We did not have toilets in primary school; we relied on the nearest bushes whenever we wanted to use a toilet. Due to a lack of classrooms, I attended my entire grade 7 under a tree. You might be sitting there, wondering how a 26-year-old woman has experienced this. Frankly, I did not see it as a struggle back then; we used to enjoy it, it was fun. However, this editorial won’t be about me, but about some of the more common struggles young people go through in many rural clinics of my country. Below I will focus on some typical adolescent health troubles in rural areas in SA, including those related to the social determinants of health (eg. sanitation, toilets, … ); SRHR, access to antiretroviral drugs, but also to health systems “software issues” (like lack of trust in nurses).
When I was in primary school, toilet paper was a luxury. Some people used newspapers as a substitute for toilet paper. But we couldn’t always afford to buy a newspaper, so some of us used stones, and sometimes soil. Although things have improved in many villages of my country, toilet paper is still a luxury in quite a few rural areas.
Teenage pregnancies in SA are a threat to achieving the so called “unfinished business of the” MDGs. Teenage pregnancies are mostly reported in the rural areas. When young people start dating back home, their parents are usually not aware of it. In fact, teenagers are not allowed to discuss these things with their parents. Due to this lack of education about safe sex, plenty of teenagers put their health at risk with unsafe sex. If they actually have heard about contraceptives (in school, by coincidence or sheer luck), it’s also not easy for them to go to a clinic to request contraceptives in rural areas because the community is small, and most people fear that some nurses do not know how to be confidential. Also for some people, going to fetch the condoms from the clinics is anything but straightforward as they fear that they might be seen by others who know them and therefore make it public knowledge around the village. In short, most young people engage in unprotected sex.
If they fall pregnant, the health care they receive in this condition not really up to standard, particularly because some people try to hide their pregnancy before it shows due to fear for the community. This means that they take (too much) time before going for their check-ups in the clinics. As most of them are not educated enough about safe sex and safe abortions, they end up having many children that they cannot maintain.
Similarly, some people fear testing for HIV/AIDS because they worry that should they be found positive, the nurses may not be discreet about the outcome of the results and could go around telling other people about it. This also applies to those who are already on treatment and are meant to go to the clinics for ARVs etc. Some people end up not going for ARVs due to fear of being judged. Some of these people worry that their families will see the pills in the homes which could create a lot of discomfort and “not so cool“ moments.
It has also been reported that high school learners are a key population at high risk of HIV acquisition. Even more painful in this situation is that most of these learners are reported to be having sex in the bushes after school hours. There is no entertainment in most rural areas, so when you are dating, you and your partner just meet on the road since parents don’t really allow their children to date. But kids still do it anyway, and when they meet, they can’t really go for movies or anything. And so they end up going to the bushes to sleep under a tree, or to the mountains. In fact, I remember my grandmother telling me that most of the teenage pregnancies were formed in the mountains and bushes, confirming that the learners had found a home in the bushes ..:. This I find very painful because the bushes are not safe and these kids put their health at risk. In addition, many girls have sexual partners who are older than them, sometimes much older, as most of them see it as a way of survival. So called “blessers” and sugar daddies exist everywhere, including in the country side.
Against this rather dire backdrop, it is somewhat encouraging that adolescent health is increasingly a global priority. Better late than never, you might say. WHO and partners launched guidance to help countries improve adolescent health. Other global health stakeholders also focus more and more on adolescent health.
From the above picture, you get a sense why adolescent health in rural areas in LMICs should be a key focus. Adolescents are often neglected in health and social policies, and experience many troubles in accessing health services and information. In addition, many serious diseases in adulthood have their roots in adolescence. For example, drug use, sexually transmitted infections including HIV, poor eating and exercise habits, all lead to illness causing death later in life.
Adolescents in the countryside should not be overlooked, based on a wrong assumption that rural adolescents are more traditional & conservative than their peers in slums & cities. Teenagers are teenagers, anywhere in the world, and are bound to experiment. Governments and donors should really prioritise improving the health of adolescents by creating more platforms for education and after school activities. And yes, like anywhere else in the world, parents also need to be (more) involved.