A 12 year review of routine data for deliveries by teenaged women in public sector health care facilities in the Western Cape Province, South Africa, from 2000 – 2012
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Background: The factors that underlie teenage pregnancies are complex and multifactorial. The prevailing perception is that teenage pregnancies are increasing in South Africa. However, the empirical extent and trends in teenage births in the Western Cape Province are not well understood. A systematic analysis of routine health information for the data element.Delivery in facility to women under 18 years for the period 1 April 2000 to 31 March 2012 is presented in order to contribute to documenting and understanding how this problem manifests in the Western Cape Province.Objectives:The objectives of the study were to describe the trends in the number of deliveries for women under the age of 18 years in the Western Cape Province for the period 1 April 2000 until 31 March 2012, and to compare the trends within and between districts. A secondary aim was to explore the quality and usefulness of Routine Health Information in the Western Cape Province focusing on the dataset for deliveries for women under the age of 18 years.Methods:The data for the Province extracted from the Sinjani system (the data repository for health information management in the Western Cape Department of Health) was subjected to a trend analysis at the Provincial, District and Sub-District level. The absolute numbers of all deliveries, and deliveries for women under the age of 18 years as well as proportions of deliveries for women under the age of 18 years were compared across districts, years and seasons. Results were discussed with senior managers in the Department of Health as compared to performance indicators presented in workshop settings to triangulate and help interpret findings.Findings The key finding is that both the absolute number of deliveries for women under the age of 18 years and the deliveries for women under the age of 18 years relative to all deliveries have declined steadily since 2007, while 8 absolute numbers of deliveries in 2012 were only slightly higher than in 2000-2001, despite an increase of 19.4% in the total population of the Province between 2002 and 2011. Despite the decline in the number of deliveries for women under the age of 18 years, the number of deliveries remains high. Seasonal increases in numbers of deliveries coincide with school holidays in most districts. The data analysis also revealed challenges with the quality of the data, and that it is not possible to determine the age distribution of deliveries across women under 18 years from the provincial data set. Routinely collected data do not permit analysis or comparison of births at the ward level where significant socio-economic variations are likely to influence fertility.Conclusions and Recommendations:The data did not support widespread perceptions of rapidly increasing teen births. The declining birth rates and relatively stable proportion of under 18 births relative to all births suggest that adding new indicators throughout the entire routine information system is not justified on public health or economic grounds. However, more detailed and disaggregated evidence is needed to inform locally tailored interventions and could be obtained from alternate sources of information such as point prevalence surveys, annual surveys, or data collection at sentinel sites. While teenage birth rates are not increasing, they remain high. It is recommended that additional service delivery models be explored to ensure that sexual reproductive health services are strengthened and delivered in a manner that would be acceptable to young people. Further, it is recommended that programmatic interventions that target the sexual reproductive health choices made by young people be scaled up in partnership with intersectoral partners and communities in order to mitigate against seasonal increases in the number of deliveries for women under 18 years of age.