thesis

TABLE OF CONTENTS
i. Acknowledgments ………………………………………………. 4 ii. Preface ………………………………………………. 5 iii. Abstract ………………………………………………. 6
1. Chapter 1 – Teenage Pregnancy …………………….………… 7
Problem Statement
1.1 Teenage Pregnancy
1.2 Why teenage pregnancy is considered problematic
1.3 Teenagers and issues relating to sexuality
1.4 Teenage pregnancy among minority communities in the Netherlands

Relevance and Justification
1.5 General Objectives of the research
1.6 Research Question
1.7 Sub questions
1.8 Scope and Limitations

2. Chapter 2 - Framework and Methodology for Analyzing the occurrence of Teenage Pregnancy ……………………………….…………. 13
2.1 Concepts and Framework
2.1.1 Teenage Pregnancy and Rights based Approach
2.1.2 The three aspects of teenage pregnancy
2.1.3 Framework
Unwanted / Unintended Pregnancies
Wanted Pregnancies
Motherhood and Childbearing
2.2 Methodology
2.2.1 Approach and sources of data
2.2.2 Review of findings from research by Van Berlo, Wijsen and Vanwesenbeeck

2.3 Methods
Questionnaires
Interviews and Group Discussions
Data from other sources
Interview Questions
2.4 Standpoint and Approach to the Research Question

3. Chapter 3 – Teenage Pregnancy in the Ghanaian community in Amsterdam ..……………………………….………….. 21
3.1 Demographics of Ghanaians in Amsterdam, focusing on children and the youth
3.2 The Ghanaian community in Amsterdam
3.3 Influence of Ghanaian culture, traditional and religious beliefs on the community 3.4 The Ghanaian community and child rights issues
3.5 Role of community organizations and local services in shaping the views and perspectives of the community

4. Chapter 4 – Views and Perspectives on Teenage Pregnancy ………. 25
4.1 Review of findings on Ghanaian teenage pregnancy in research by Van Berlo, Wijsen and Vanwesenbeeck and from other sources
4.2 Ghanaian Teenagers General Perspectives on Teenage Pregnancy
4.3 Ghanaian Views and Perspectives on Unwanted/Unintended Pregnancies
4.4 Ghanaian Views and Perspectives on Wanted Pregnancies
4.5 Ghanaian Views and Perspectives on Motherhood and Child-bearing
4.6 Analysis and reflection by Researcher

5. Chapter 5 - Teenage Pregnancy: Policies and Interventions ……….. 35
5.1 National Policies and services
5.2 Local Policies and services

6. Chapter 6 – Conclusions ………………………………………. 40
6.1 Summary of findings
6.2 Conclusions
6.3 Recommendations

7. References ………………………………………. 43

8. Annexes ………………………………………. 47

ACKNOWLEDGMENTS
I wish to thank God for the opportunity he provided me to study at such a great institution as ISS. It had been my desire for a long time as I had heard very good things about it. And rightly so! I am proud to have studied here.

I wish to also thank my husband Bernard for the support he provided to me through my studies and above all for his encouragement, commitment and understanding for the demands of my course. I also wish to thank deeply Drs Loes Keysers and Prof. Dr Ben White for their comments and contributions, my supervisors who guided me and without whom this paper could not have been put together. Finally let me thank the teenagers that shared their stories and experiences with me. Without them all this wouldn’t have been possible.

Now permit me to share my findings on the views and perspectives of Ghanaian teenagers in Amsterdam’s on teenage pregnancy.

Love PREFACE
I grew up in Amsterdam and as teenagers we all knew one school mate, friend or relative who had a child while we were all in school. Many a times our view of our peers who got pregnant was negative, often because of the fact that the girl was young and it would end her schooling, since she had to take care of the child. In a few cases the child upon delivery was taken up and taken care of by the mother of the girl and she would come back to school.

As a social worker I have been working with children and the youth from migrant communities and with both governmental and non-governmental organizations which provide support to teenage girls, including those from minorities, who would find themselves pregnant.

My curiosity was further aroused when I learnt from a research undertaken by Van Berlo, Wijsen and Vanwesenbeeck that teenagers from migrant communities in Amsterdam, namely Antilleans, Surinamese and Ghanaians have a higher rate of teenage pregnancy than among their native Dutch counterparts. Knowing what exists in terms of the interventions provided by agencies which offer support when I was challenged to come up with a research topic I had no hesitation in applying the research methods we were taught to this subject which interested me so much.

ABSTRACT

Teenage pregnancy is an occurrence which can be found in almost all societies worldwide as teenagers by their nature are adventurous. Thus when they are confronted with their sexuality and become sexually active without being firstly prepared for the consequences that these may bring, often resulting in adverse consequences.

While research has shown that the incidence of teenage pregnancy is higher in developing as opposed to developed countries, there exist some pockets of the developed world where the incidence of such pregnancy may be considered significant and therefore has an adverse effect on the youth. Of particular interest are migrant communities from developing countries who reside in developed countries. Many are caught between the two environments and cultures and are often unable to cope with the pressures that their sexual awakening brings, resulting in some cases in pregnancies.

This is the situation that Ghanaian teenagers in Amsterdam find themselves. As the community’s size does not qualify it for the recognition required for them to be granted a “minority” status, they end up being lumped up with the other migrant communities whose numbers are greater, such as the Antilleans, Surinamese and Moroccans and included in interventions designed to meet the needs of these communities without any recognition being given to the distinction between such groups. Furthermore no cognizance is given to their views on issues that concern them, including the perspectives that the youth have on teenage pregnancy.

This paper explored the situation of the Ghanaian teenagers in Amsterdam with regards to the incidence of teenage pregnancy and seeks to ascertain and analyze their views and perspectives on the subject with the view to providing recommendations on how best the welfare and situation of these youth may be enhanced. CHAPTER 1 – TEENAGE PREGNANCY

Problem Statement
1.1 Teenage Pregnancy
Teenage pregnancy poses a problem for Ghanaian teenagers in Amsterdam as it prevents them from completing school and affects their health and future development. Teenagers from the Ghanaian community in Amsterdam find themselves pregnant for many reasons.

Teenage births are today seen as a problem and a burden for the child, for society in general, and for taxpayers in particular. It has been found to increase the likelihood of poverty and to reinforce inequalities (Daguerre et al 2006). Adolescent pregnancy, the disproportionate number of births to unmarried adolescents, the potential disadvantages for both mothers and their children, and the commensurate costs to society has received the attention of researchers in a variety of disciplines (Corcoran 1999).

The prevalence of teenage pregnancy in industrial and developing countries are distinctly different. In developed regions, such as North America and Western Europe, teen parents tend to be unmarried and adolescent pregnancy is seen as a social issue. By contrast, teenage parents in developing countries may be married and their pregnancy welcomed by family and society. However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems. The majority of young parents struggle and it is hardly surprising that many teenage parents seem barely able to look after themselves, let alone their children .

It would have been expected that as a developed economy the occurrence of teenage pregnancy in the Netherlands and its consequent effects on teen aged mothers would be minimal. Also one would have expected with a low birth rate among the native Dutch it would be considered something positive.

In a time when issues related to the welfare of children and the youth receive high priority from governments, particularly those who are signatories to the Convention on the Rights of the Child, teenage pregnancy has become one of the issues affecting a significant number of the youth considering that it is considered detrimental to their growth and development. Given that the Netherlands is a developed economy and a signatory to the above-mentioned Convention, makes the subject of teenage pregnancy among Ghanaian teenagers in Amsterdam worth researching.

It is quite interesting and worth noting the views that Ghanaian teenager themselves have on the subject and on what they consider the relevant systems which need to be in place to provide support to their peers who find themselves pregnant. This paper will present, analyse and reflect on the findings in this regard.

1.2 Why teenage pregnancy is considered problematic
Teenage pregnancy is considered a problem by the Ghanaian families in Amsterdam mainly because of the impact it has on the teenagers’ future since most teenagers who find themselves in this situation have to drop out of school to support the new born children. Invariably the families of these teenagers have to provide support to the teenager and the new born child and these strains the already heavy financial burden that they face. The issue is also considered a problem by the Ghanaian society as a whole as they consider it as an occurrence which is contrary to its tradition and culture. Although teenagers in rural Ghana do marry early these are currently considered detrimental to their welfare and not encouraged these days. However in cases where they do get pregnant, they are expected to get married before having the child. This is the case of the Ghanaian community in Amsterdam which consists more of first generation migrants.

While there have been several interventions designed to address the problem of a higher incidence of teenage pregnancy among teenagers from migrant communities in Amsterdam none have been found to deliberately include the perspectives of the teenagers themselves.

Childbearing during adolescent years is problematic on many scores, and is problematised and addressed by various categories of people and institutions in different ways. To ascertain that it is indeed perceived as being “problematic” by the Ghanaian teenagers in Amsterdam this researcher found it necessary to review the medical/health, social and legal aspects of adolescent childbearing in the Netherlands.

It is also relevant to consider teenage pregnancies in relation to the practice of early marriage. The imposition of a marriage partner upon a child means that a girl or boy's childhood is cut short and their fundamental rights compromised. While much of the impact remains hidden and undocumented, it is absolutely clear that millions of children and young people - particularly girls - suffer negative consequences, one of them being early childbearing .

Young people often reach sexual maturity before psychosocial maturity. The average age for one’s first sexual relations is now 15 years old, three to four years earlier than the preceding generation (Bourque 2002). Since teenagers are now beginning their sexual lives earlier, they are not necessarily properly equipped – cognitively, emotionally, or socially – to deal with the difficulties and manage the risks associated with sexuality (Daguerre et al 2006).

The greatest risks associated with teenage pregnancy are health related. Sir Professor Dugald Baird (in Morris 1981:796) in his research “The Biological Advantages and Social Disadvantages of Teenage Pregnancy” is of the view that women under 20 years of age may be mature physically and have easy labours but they neither have the educational background nor the emotional strength to face the responsibility of marriage, motherhood, and life in modern society. He observes that “the disadvantage is certainly outweighed by the social advantages of having more responsible and better educated mothers".

A UNICEF report by the Institute for Social and Economic Research at the University of Essex in Colchester, United Kingdom, suggests that giving birth as a teenager is strongly associated with disadvantages in later life. Teenage mothers are twice as likely to live in poverty and be without a partner in their 30s, and three times more likely to be in a home where neither they nor a partner is working . Associated problems include the increased likelihood of deleterious consequences for both adolescent mothers and their children . This supports the notion of teenagers who have children experience severe hardships and a general inability to cope with their situation. Indeed this is the popular notion that most people have of Ghanaian teenagers in Amsterdam who have children and this research seeks to confirm or dispel this notion.

Giving birth as a teenager is also believed to be bad for the young mother because statistics suggest that she is more likely to drop out of school, to have no or low qualifications, to be unemployed or low-paid, to live in poor housing conditions, to suffer from depression, and to live on welfare. Similarly, the child of a teenage mother is more likely to live in poverty, to grow up without a father, to become a victim of neglect or abuse, to do less well at school, to become involved in crime, to abuse drugs and alcohol, and eventually to become a teenage parent and begin the cycle all over again. They are also seen as a burden for the society as they place an additional strain on its resources. This is however inconsistent with the widely accepted view that children are the future of each society. If indeed they are it is the responsibility of society to make the resources required for their welfare available.

Figure 1: Teenage births by ethnic background and generation, 2004

Teenage pregnancy is also an ongoing issue in the policy and academic discourse mainly because of the adverse effects it has on the mothers. Since one in every ten births worldwide is to a teenage mother and 15 million adolescents aged 15 - 19 years give birth each year, accounting for up to one-fifth of all births worldwide, the issue is of concern, not only qualitatively but also in terms of numbers.

The incidence of teenage pregnancy is wide-spread and therefore warrants the constant attention of policy-makers and deliverers of social services to children and the youth. In this paper I will propose the view that the case of Ghanaian teenagers in Amsterdam is a good case in point and strongly recommend that to address the issue stakeholders need to establish and include the view and perspectives of teenagers themselves.

1.3 Teenagers and issues relating to sexuality
It is widely agreed worldwide that teenage years are from the ages of 13 to 19 and also that sexuality refers to how people experience the erotic and express themselves as sexual beings. It may thus be deduced that teenage sexuality refers to the way people from the ages of 13 to 19 years experience the erotic and express themselves as sexual beings.

Adolescence which coincides with one’s teenage period is a transitional stage of physical and mental human development that occurs between childhood and adulthood. Adolescence is also considered to be a transitional period of development between youth and maturity. Adolescence is also usually accompanied by an increased independence allowed by the parents or legal guardians and less supervision, contrary to the preadolescence stage. This transition involves biological (i.e. pubertal), social, and psychological changes; the biological and physiological being the ones easiest to measure objectively.

1.4 Teenage pregnancy among minority communities in the Netherlands and a Review of findings from research by Van Berlo, Wijsen and Vanwesenbeeck and information collected from other sources
Research shows a high incidence of teenage pregnancy among minorities in the Netherlands. The findings of the article “Births and abortions among Amsterdam teenagers according to ethnicity: 1996 - 1998” by Stuart, van der Wal established that in Amsterdam unwanted pregnancies were most frequent in Surinamese, Antillean and Ghanaian teenage girls. Girls from these countries and aged 14-16 years and 17-19 years were found to have a higher abortion rate compared with Dutch girls of the same age.

The findings of the supplementary research paper by Willy van Berlo , Cecile Wijsen , Ine Vanwesenbeeck, in their book “Gebrek aan regie / “Lack of direction : een kwalitatief onderzoek naar de achtergronden van tienerzwangerschappen”, a qualitative research on the background of teenage pregnancy ” also confirms this.

The birth-rate among teenagers has been increasing yearly since the mid nineties (Garssen 2004). The birth-rate of Antillean and 'other' non-Western immigrant girls, that is not Suriname, the Antilles, Turkey or Morocco were also found to be high, around 43 per 1,000 girls aged 15-19 years. The figures of the national abortion registry 2001-2002 (Wijsen & Rademakers, 2003; Wijsen, 2004) shows that 10 of every 1000 teenage girls to abort a pregnancy. The increase in the number abortion among teenagers is higher than the increase among women of all ages. The group from 'other' countries of origin is a very large group of abortion within the population. Unfortunately it is not known from which country of origin, these women come and so it is not possible for them to calculate an abortion rate. The size of their share of the population abortion, we can deduce that their abortion rate will be high.

By the early 2000s however it was on record that the birth rate among 19-year-old girls had reduced by 7 percent, among 17 and 18-year-olds by 10 percent and among 15 and 16-year-olds by 17 percent. The probability of teenage motherhood among foreign girls has declined since 2001. The decline among native Dutch girls started one year later. In 2001 the probability of teenage motherhood was more than 6 times as high for non-western foreign girls as for native Dutch teenagers, than against 4.5 times in 2004. This may be partly responsible for the high incidence of teenage pregnancy recorded among minorities including Ghanaians.

The probability of teenage motherhood is only marginally higher for second-generation Turkish and Moroccan girls than for native Dutch girls. This is also true for second generation girls in the category ‘other non-western’.

This reinforces the view that teenage pregnancies are more common among immigrant girls, and that cultural influences are important. In the study the differences between native and immigrant girls in terms of motherhood-by- choice, unplanned and unintended pregnancies were highlighted. Among girls who have had an abortion, the native girls were in the majority, and the situation with teenage mothers is the same. Immigrant girls were found to have fewer future aspirations (van Berlo et al 2005).

Despite the fact that both the above-mentioned researches were undertaken several years ago, from a current assessment of the situation of such teenagers in Amsterdam and from my own observations having grown up in Amsterdam around the same time the research was conducted there is a strong case for the notion that the issue continues to pose a setback to some Ghanaian teenagers. This is known to both the local government and social welfare authorities as well as the community welfare organisations as it is deemed one of the issues which inhibit the prospects of the affected teenagers and their children having better economic opportunities in the future. Interestingly though the investigation undertaken by this research for this paper indicates that at no time have the views and perceptions of the teenagers themselves been sought and hence the objective of this paper to ascertain the views and perspectives that they have on all the different facets of the issue.

Relevance and Justification
Childbearing during adolescent years is considered problematic on many scores. Teenage pregnancies are strongly associated with a range of disadvantages for the mother and social disadvantage and is therefore of relevance to any student of child and youth studies in the context of development studies .

In the Netherlands most often policies and interventions addressing problems facing migrants only consider the situation and perspectives of the more dominant migrant communities in Amsterdam, namely the Antilleans and Surinamese, subsuming the interests of Ghanaians in those of these groups. This is not only because they are more dominant in terms of their greater numbers but also due to the fact that these communities have been in the Netherlands for a longer period. Even though the Ghanaian community which is estimated around 20,000 in the Netherlands falls short of that needed for the Dutch government to recognise it as a minority, there is still the need for support to provide support to teenage mothers.

However with the numbers of Ghanaian migrants having steadily gone up over the last ten years it is most important that the group’s interests are isolated and directly addressed as this will impact positively on the community. In the case of Ghanaian teenagers it is important that their views, perspectives and concerns are considered when planning policies and interventions for migrants in Amsterdam.

1.5 General Objectives of the research
This research paper seeks to bring out the ”voices” and perspectives that Ghanaian teenagers have on the issue of teenage pregnancy with the view to informing policy makers to enable them factor such considerations in their planning and interventions. This will enable the specific needs of the various identifiable teenage groups within the migrant community in Amsterdam to be better addressed and the impact of such interventions maximised.

1.6 Research Question
How is teenage pregnancy perceived by Ghanaian teenagers in Amsterdam, the Netherlands and how can this be understood in the context of the views of the various stakeholders namely the teenagers themselves, the families, Ghanaian community organisations, local authorities and the social services?

1.7 Sub-questions to each category of the identified stakeholders
The sub questions included;
• Perspectives of Ghanaian teenagers who get pregnant

• Is support available to such teenagers considered adequate?

These questions were asked of Ghanaian teenagers, local authorities, social services, families of teenage mothers and Ghanaian community organisations. Other questions were also asked of the local authorities and social services, including the GGD. The sub-questions were to establish the view and perspectives of the various stakeholders on teenage pregnancy.

1.8 Scope and Limitations
The scope of my research was limited in several ways. There was not enough time to do the research with a large sample size which could be said to be representative of all Ghanaian teenage mothers in Amsterdam. For this reason a sample size of ten (10) teenagers who were familiar with the issue were provided with questionnaires and later interviewed on the issue. The researcher also held a focus group discussion with 19 Ghanaian teenagers to further deliberate on the subject.

Among other limitations encountered in the research was the reluctance of the target group to take part in the research. Given the stigma attributed by the Ghanaian community to having children out of wedlock. This accounts for the rather small sample size and may explain any incorrect and inaccurate information which was provided. It would also explain any biased responses provided, since Ghanaian culture, tradition and religious beliefs frown on having children out of wedlock. CHAPTER 2 - FRAMEWORK AND METHODOLOGY FOR ANALYSING THE OCCURENCE OF TEENAGE PREGNANCY

This chapter outlines the analytical framework and methodology used in the preparation of this research paper. It begins with an explanation of the framework and the key analytical concepts and outlines the considerations that were made in selecting the respondents and administering the questionnaires.

2. 1 Concept and Framework
An explanation of human behaviour has been developed by Bronfenbrenner (1979) in his ecological model of human development which conceptualizes ecological space as operating on different levels of systems, each of which is incorporated within the next" (Corcoran 1999). At the most basic interactional level is the microsystem, which is the pattern of activities, roles, and interpersonal relations experienced by the individual in a given setting. And the mesosystem, which is the next level, involves interactions among settings. The third level, the exosystem, includes settings that affect the individual but with which the individual does not interact directly. There are many other variables that have a more direct impact on adolescents. The macrosystem includes the cultural variables that influence the individual.

Bronfenbrenner's conceptualization of ecological systems has been used in theoretical formulations, as well as employed in empirical research. The model may be seen as a way to organize factors associated with complex social problems so that knowledge building can occur and intervention can be implemented at the appropriate system level.

The ecological model has been criticized as being difficult to test since variables have often been chosen to represent system levels depending on the social phenomenon under study, making it difficult to "test" (Corcoran, 1999).

2.1.1 Teenage pregnancy and the Rights based Approach
While there are no specific provisions in the Convention on the Rights of the Child relating specifically to teenage pregnancy there are provisions that are relevant to the issue. Article 3 states that “In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration”.

The Convention charges States Parties to ensure the child such protection and care as is necessary for his or her well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures. States Parties are also to ensure that the institutions, services and facilities responsible for the care or protection of children shall conform to the standards established by competent authorities, particularly in the areas of safety, health, in the number and suitability of their staff, as well as competent supervision.

The United Nations Convention on the Rights of the Child (UNCRC) provides the legal and conceptual framework and emphasizes children's rights as citizens. It recognizes their capabilities to enact and change in their own lives. The UNCRC has resulted in a profound shift in the legal treatment of children (Save the Children, 2009). It has brought issues relating to children worldwide onto the international agenda and has encouraged action by bodies like the UN Security Council. The Monitoring and Reporting Mechanism (MRM) which was created by the Council in 2005, deals with six grave violations of children's rights in situations of conflict, including rape, abduction, killing and maiming. The Convention has also led to two important global studies commissioned by the UN General Assembly on the impact of armed conflict on children and violence against children.

The Convention has also pushed regional initiatives. A good example is the African Charter on the Rights and Welfare of the Child (1999) which is mandated to consider individual cases and investigations and the European Commission (EC)’s first children’s rights strategy. At country and regional levels it has helped to improve the lives of many children and encouraged politicians to listen to children’s views, and pushed children’s rights onto the political agenda. There have also been a number of legal cases as a result of the Convention which have had a real impact on children around the world. However while every country in the world, except the USA and Somalia , has ratified the Convention many do not follow its tenants in practice.

As a result the Convention has come to entrench of the concept of child rights, particularly when issues relating to child welfare and development are raised. This researcher learnt from a social worker in Amsterdam in the course of preparing this paper that in the Netherlands none of a teenagers parents can force their child, should she become pregnant, to have an abortion nor any medical procedure which may be life-threatening when done. What they can do is to make the teenager feel guilty and as a result of this want to have an abortion but in the case where the teenager is adamant that she does not want an abortion the parent cannot physically force her to.

2.1.2 The Three aspects of Teenage Pregnancy
Three distinct sides of the “problem” of teenage pregnancy emerged after the researcher had completed collecting and processing the identified data and information. These relate to planned and unplanned pregnancies and the choices that teenagers have to make between keeping or terminating the pregnancy. These refer to teenage pregnancies which are “unwanted” or “unintended” and those that are “wanted” or “intended”. The third aspect involves issues relating to teenage child-birth and motherhood.

2.1.3 Framework
a) Unwanted” or “unintended” Pregnancy
Unwanted or unintended pregnancies are used in this research paper to refer to those pregnancies that are unplanned. Unintended pregnancy is an important concept for understanding the fertility of populations and the need for contraception (Santelli 2003). While women of all ages may have unintended pregnancies teens are at a higher risk . The US Department of Health and Human Services’ Centers for Disease Control and Prevention states that unwanted pregnancy is a core concept in understanding the fertility of populations and the unmet need for contraception. It describes unintended pregnancy as a “pregnancy that is either mistimed or unwanted at the time of conception”. Unintended pregnancy, it states, is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy that are associated with adverse effects. The example of such women delaying prenatal care, which may affect the health of the infant, is cited in support of this contention. In the United States efforts to decrease unintended pregnancy include finding better forms of contraception, and increasing contraceptive use and adherence (United States Centers for Disease Control and Prevention).

Unintended pregnancy is difficult to measure as nearly all pregnancies ending in abortion are unintended. It is assumed that the estimated unintended pregnancy rate is low due to inconsistencies in the reporting of miscarriage and abortion (Colorado Department of Public Health and Environment; Unintended Pregnancy, Why it Matters).

According to a news release by Rebecca Wind in the media centre of the Guttmacher Institute in an article entitled “Abortion Worldwide: A Decade of Uneven Progress”, global contraceptive use have contributed to a decrease in the number of unintended pregnancies. Worldwide, the unintended pregnancy rate declined from 69 per 1,000 women aged 15 - 44 in 1995 to 55 per 1,000 in 2008.

As a student of development studies I was interested in exploring, as part of this research, any linkages which may exist between unintended pregnancies among Ghanaian teenagers in Amsterdam and the results of these findings.

b) Wanted or intended Pregnancy
Conversely wanted or intended pregnancies refer to those that are planned. Other researchers also refer to them as the percentage of births where mothers report that the pregnancy was intended .

I was also interested in ascertaining to what extent Ghanaian teenagers in Amsterdam planned having children.

c) Motherhood and Childbirth
Motherhood and childbirth refer to the issues surrounding having a child and taking care of the child subsequently. In 1930 the League of Nations Health Section noted concerns about maternal mortality. In the 1970s and 80s the issue caught the attention of the international community as it became a global tragedy, even though it affected more, women in the developing world.

International commitment to reducing maternal mortality was reaffirmed in 2000 when United Nations member’s states committed themselves to Millennium Development Goal 5, Target 5.B. This goal seeks to achieve, by 2015, universal access to reproductive health. Reproductive health here refers to a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes .

The concept of safe motherhood has been widely touted in recent times. Safe motherhood is a model used to primarily ensure that women receive the care they need to be safe and healthy throughout pregnancy and childbirth (Netherlands School of Public and Occupational Health; 2006). The first international conference on Safe Motherhood was held in 1987 and it led to the formation of an Inter-Agency Group (IAG) for Safe Motherhood. In 1989 there was a Safe Motherhood conference in Niamey to assist country teams to develop effective action plans for national and local implementation.

The main difference in the Netherlands between people of foreign origin and indigenous people in terms of care concerning childbirth is the higher prenatal mortality and death of mothers among the former. While global epidemiological research shows few significant discrepancies in access to care specific research, however, shows big differences in accessibility to care (Uiters 2001). Often people of foreign origin do not get the right care tailored to their needs. This applies to many specialities. In areas with a high concentration, such as Amsterdam Southeast, health care problems often are multiple and complex. Compared to the ethnic Dutch, minorities participate less in both specialized and general practitioner health (AMC de Meren EU Conference on access to care in the Netherlands, 24-27 June 2008) and services (Stronks 2001).

The experience of Dutch women exhibits a broadening range of different partnership and living arrangement pathways to first birth (Matsuo H., 2003). In the Netherlands, single mothers run a high risk of becoming poor, even though this country has a well-developed welfare system (Ypeij A. 2009).

2.2 Methodology
2.2.1 Approach and Sources of data
In view of the research question and its sub questions, the research draws upon the research conducted by van Berlo which is referred to above. To complement this information was also sourced from the other publications and related material. These were used to determine and support the context within which teenage pregnancies occur in the Netherlands. This paper also reviews other available literature on the subject. Online sources are also used to collect secondary data on the demographics of the Ghanaian community in the Netherlands and its constituents.

In order to determine the situation of Ghanaian teenage mothers in Amsterdam the researcher collected data directly from teenagers from the Ghanaian community in Amsterdam, focusing on the Bijlmer area where the Ghanaian community is mostly concentrated. A total of ten (10) one on one interviews were conducted by this researcher with Ghanaian teenagers from the Bijlmer. She also had deliberations with a group of nineteen (19) Ghanaian teenagers on the subject.

Among the ten (10) with whom one-on-one interviews were held, six are aged between 13 to 17 years with 4 between 18 to 21 years. Out of this seven (7) are students. One of them lives with a partner, being married. Six of the ten respondents indicated that they did not have a child as against the remaining four who said that they had had their children between the ages of 17 – 19 years.

In view of the constraints of time besides the above teenagers, another core group of nineteen (19) teenagers who are familiar and also have some experience with the subject and its related issues were focused on and further interviews and discussions held with them. Those selected had either had children while in their teens or were close to someone who had had such an experience.

For the perspectives of the Ghanaian community organisations and to find out what interventions they were undertaking which relate to the subject of this paper the researcher sought through questionnaires, interviews and discussions the views of five senior officials of five well-known community organisations, two of which are regions organisations. The religious organisations are the Christian Baptist Church in Amsterdam and Grace Baptist Church in Rotterdam. The other organisations were Stichting Sikaman, Stichting Recogin and AFAPAC. Pastor John Justice Serebour of Christian Baptist Church and Pastor Francis of Grace Baptist Church were interviewed. Mr Joe Lamptey of Stichting Sikaman and two officials of RECOGIN and AFAPAC who want to remain anonymous, were also interviewed.

This paper also includes my own personal observations as a teenager growing up in Amsterdam well as those recorded in the course of putting together this research paper.

2.2.2 Review of findings from research by Van Berlo, Wijsen and Vanwesenbeeck
As indicated earlier a source for this paper is the study undertaken by Van Berlo, Wijsen and Vanwesenbeeck, in 2005 in their research paper “Gebrek aan regie: een kwalitatief onderzoek naar de achtergronden van tienerzwangerschappen ,”, particularly its supplementary report on the backgrounds of pregnancies among Dutch teenagers, both “native” and “ethnic” .

Critics of Van Berlo, Wijsen and Vanwesenbeeck warn of the dangers of the sexualisation of women and girls and the self-objectification connected to it. They also guard against showing the negative impact of sexualisation on girls' self-esteem; sexual autonomy; cognitive abilities; emotional well-being and psychological health; and sports, school, and professional achievements and ambitions. Criticizing sexualisation without also looking at the sexual health and rights of women and girls is a step backward for women and girls, as well as for feminism (Reist et al 2009). Feminists are aware that sexuality provides danger, as well as pleasure, for women and likewise, sexualisation is associated with risks, as well as with rights.

2.3 Methods: Questionnaires, Interviews and Focus Group Discussions
For the purposes of gathering information for this research paper the researcher used questionnaires as a guide and asked the questions directly to the interviewees. She then rerecorded the answers they provided. This was because those I spoke with were more comfortable in Dutch, however the research required that the answers be provided in English.

Questionnaires were chosen over other forms of data collection and survey because of the advantages they have. They do not require as much effort from the questioner as verbal surveys, and often have standardized answers that make it simple to compile the data they generate.

In using questionnaires however the researcher was well aware of their limitations in terms of the frustration standardized answers may cause to informants and the fact that the informants must be able to read and understand the questions to be able to respond to them. As a type of survey, questionnaires also have many problems relating to question construction and wording.

These in themselves however do not explain why questionnaires were not used as the sole source for this paper. The researcher chose not to rely solely on questionnaires as the information that was needed from the respondents was not clear-cut and straightforward and the researcher didn’t want the information to all be in a standardised format but rather in a story form. Moreover the informants weren’t comfortable with just filling in a questionnaire but wanted to tell their stories. As already mentioned the method adopted was for the researcher, in administering the questionnaire, to ask the questions verbally and then based on the response fill in the responses. This turned the process into a sort of “questionnaire based interview” although the questionnaire by itself looks to all intents and purposes similar to any self-completed questionnaire.

The questions raised in the questionnaires were verbal and open. The researcher spoke with some informants on the phone and others in person. The expected responses were in the form of a word, a phrase or extended comments. This produced useful information but posed a challenge during the analysis of the information. It did have the advantage though of giving the informants a chance to also provide their own views.

The main research technique employed by the researcher in this paper though is the interview. One-to-one interviews and focus group discussions were used to collect the greater part of the information. The one-to-one interviews were held with all the informants and with some on more than one occasion when one session was not sufficient to complete the questionnaire. The one-to-one approach was used primarily with the older informants such as the community and local authorities and also with some of the older teenagers. Some of the interview techniques used were structured, semi-structured and depth or unstructured interviews. The interviews and questionnaires sought to establish the perspectives and” voices” of Ghanaian teenage mothers firstly on the on-going debate on teenage parenthood and secondly to establish what support is available to them; how accessible this support is and what they believe may be undertaken to improve the situation of teenagers who find themselves in this situation to enable them transition safely through parenthood and subsequently enable them resume their “interrupted” lives. Through the focus group discussions the researcher had the opportunity to meet up with a group of teenagers who were willing to share their experiences and have their stories told. For seeking the views of the organizations and the institutions the researcher distributed questionnaires and also undertook interviews.

The informants selected for this paper were identified through a network of family and friends also with the assistance of the two churches whose leaders were interviewed. Out of the ten teenagers two (2) were male and eight (8) female. Three were of the informants were teenage mothers while the remainder were close to persons who had undergone such experiences.

With most of the teenagers the interview was conducted in the Dutch language, this made it easier for the informants to express themselves during the interview. This was time consuming because though the researcher recorded some of the interviews there was the need to write down what she had observed during the interview and as the observations were made in Dutch it was necessary to translate them into English. This was time consuming particularly as the researcher had not anticipated this issue.

When the researcher decided on the topic of her research she was well aware that she would be working with the Ghanaian teenagers in Amsterdam. She knew that the group is not a homogenous group and has varied cultural and educational backgrounds. This was realised as an issue that would engage a lot of the time of the researcher and impose the pressure of time on her. After careful reflection the best approach settled upon was to record the stories and concerns discussed during the interviews and the focus group discussions. Another issue which came up during the course of conducting the interviews and discussions was the fact that teenage mothers tend to have very limited extra time to offer. This posed difficulties for the researcher to get all informants together for the discussion segment of the research and involved a careful scheduling of the interviews. This was considered necessary to provide the researcher a more in-depth knowledge and a firsthand view of the situation.

From the general objective of this research paper and considering the purpose of this research paper, it was realised early in its formulation that there would not been enough time, given the allotted time, to have a big sample size that would be representative of all Ghanaian teenagers in Amsterdam. It was thus considered more practical to select a core group from the Ghanaian teenagers whose perspectives could be said to be indicative of the views and perceptions of the group.

2.4 Standpoint and Approach to the Research Question
While growing up in Amsterdam my peers and I viewed teenagers who became pregnant as those who sought a gateway for marriage and who wanted to become mothers before their time! They were considered as those who were looking for love and affection. The community was unanimous in considering unwanted pregnancies as a problem. This is compounded as in most of such situations the teenage mothers do not have a partner to support them during the pregnancy and child raising.

We were brought up to accept that abstinence was the best way to avoid getting pregnant, that one needed to get married before having sex. However it was no secret that the easiest way of getting rid of an unwanted pregnancy is to have an abortion, especially in the Netherlands since these facilities, unlike in Ghana, are available legally.

Most of the teenage mothers I know have children outside marriage with no support from their families; their friends stopped hanging out with them once they became pregnant. This isolated them and they were forced to grow up very fast. While some continued their schooling at the beginning of the pregnancy many stopped once the pregnancy began having an effect on their health.

Few have their mothers taking care of the baby to enable them go back to school. Teenage is the time to think of life and to explore life opportunities. Being pregnant at this stage to me is like jumping a life stage over.

My regard for the Ghanaian community organisations in Amsterdam is quite high for the reason that they do provide an important service to the community. As one who has worked with a few of them professionally I realise the limitations they face including limited funding from the Dutch authorities and the lackadaisical attitude of the community. Often times there have been stories of such institutions diverting resources and funds meant for the community for their own personal gains. However it must be said that there has never been any evidence to support this. For the purposes of this paper it must be pointed out that there is the perception in the community that they concern themselves mostly with issues that they know they can get funding and other resources easily from the authorities for such as HIV/AIDS, religious and spiritual organisations and activities for the youth. These institutions cannot therefore be said to be on top of the challenges and problems faced by the community as an entity.

Having worked with social welfare organisations in Amsterdam over the past six years my impression of the local authorities and social services is that they do not have any room to address issues which relate to a particular section of the migrant community unless it is an issue that is considered or becomes evidently problematic. In this regard many of the services which fall within the competence of these agencies, such as counselling for teenage mothers and providing support for them are currently undertaken by individuals and other ethnic and social entities. CHAPTER 3 - TEENAGE PREGNANCY IN THE GHANAIAN COMMUNITY IN AMSTERDAM

Teenagers from migrant communities in the Netherlands are confronted with a myriad of problems in the course of their integration into the Dutch society. Some of these include the cultural differences they are confronted within their families and immediate communities as opposed to what they are exposed to within the larger environment where they find themselves and coping with learning the Dutch language and educational system since most often their parents do not have the level of understanding of the language to support and assist them.

3.1 Demographics of Ghanaian children and the youth in Amsterdam
Figures provided by Statistics Netherlands in 2009 put the total number of Ghanaian inhabitants in the registered population of The Netherlands as at 1 January 2009 at 19,733. Out of this number those with a first generation background are stated as being 12 159 while those with a second generation background amount to 7,574.

These figures suggest that there are older Ghanaians living in the Netherlands than there are children and youth since those in the latter group refer to those who were born in the Netherlands. Interestingly those defined as Ghanaians in these figures are those with characteristics showing close association with the country, either through their own birth or that of their parents. The figures also suggest that there is an incidence of negative migration recorded in the Ghanaian community in recent times

According to the Gemeente Amsterdam website there are 10233 persons of Ghanaian origin currently living in Amsterdam, up from 10207 last year (Gemeente Amsterdam 2009).

3.2 The influence of Ghanaian culture, traditional and religious beliefs on the Ghanaian community in Amsterdam
The Ghanaian community in Amsterdam, like Ghanaians worldwide have strong views about teenagers having children out of wedlock. This is mainly based on Ghanaian culture, traditional and religious beliefs. Ghanaian culture demands that a bride price be paid for a woman before she bears children and when this is not done both the mother and the child are often stigmatised, and in some cases even ostracised, by the community. Ghanaian teenagers in Bijlmer are thus brought up in families which expect that they get married before having children.

Most Ghanaians in Amsterdam are first and second generation meaning that either they themselves or their parents migrated from Ghana to the Netherlands. This suggests a community which has close links with their origins in terms of their culture, traditional and religious beliefs. This is true of the Ghanaian community as often norms and practices undertaken in Ghana are practiced and upheld by the community. The main guardians of Ghanaian culture and tradition in the Netherlands, as is the case in Ghana, are the chiefs and traditional rulers who are recognised and highly regarded by the community in Amsterdam. Another issue which has a great effect on the lives of the community is religion and for this reason religious leaders play an important role and have significant influence within the community.

The silence around issues of sexuality in most cultures imply that young people are poorly informed about how to protect their sexual health, it also prevent them from accessing information on contraceptives. As a result many young girls (married or unmarried) suffer from health risks associated with early pregnancy like haemorrhage, anaemia, and malnutrition, delayed and obstructed labour and low birth weight for the child. In addition young girls who become pregnant out of wedlock face social stigmas, family conflicts, school problems and the potential needs for unsafe abortion.

All major studies on the subject show that the health of people of foreign origin in the Netherlands lags behind compared with that of the indigenous people (AMC de Meren EU Conference on access to care in the Netherlands, 24 -27 June 2008). The main differences are in terms of mortality-risk. Migrants die at a younger age than indigenous people, spend more years in (seriously) bad health, and often suffer from psychic illnesses, especially fear and mood disorders (Nationaal Kompas Volksgezondheid of the RIVM, 2006).

Ghanaian community organisations do not engage in any significant activities to lend support to teenagers from the community who get pregnant and go on to have the children. Other social issues such as funerals, religious events, care for newborns and HIV/AIDS are instead given more priority within the community.

3.3 The Ghanaian community and child rights issues
Under Ghanaian tradition and culture children’s rights are mainly limited to that of being provided a name and catered for by their parents, particularly by the father. Until recently most Ghanaian children could only be “seen but not heard”. Of late though with the establishment of the concept of the rights of the child and the strong promotion of children’s rights in the Netherlands most Ghanaians have come to recognize and accept that children have civil liberties which are protected. Even though children were not given any rights they were strictly taught to obey and respond positively to laid down rules and regulations and to respect their parents and adults. Any deviation from this was severely punished.

Children were also denied any opportunity to freely express their opinions and make inputs. Among the Ghanaian community in Amsterdam the youth had very little representation in the community, although it is a fact that some of the community organizations collected subsidies under the pretext of undertaking activities in support of the children in the community.

Corporal punishment was also until recently very common with Ghanaians, including those in Amsterdam. However the fear of being reported to the authorities was often enough to deter guardians from using these means to correct their children. Currently many have thus come to adopt corrective methods such as verbal advice and reprimands which encourage and motivate children for a more positive change.

3.4 Role of community organizations and local services in shaping the views and perspectives of the community
A wide range of Ghanaian community organizations operate out of Amsterdam with support from the local authorities. These organizations provide a wide range of services to the community including providing information to the community on developments that affect the community. In practice few undertake these mandates effectively.

Through the performance of this role these organisations are able to wield significant influence over the views and perspectives and life of the Ghanaian community in Amsterdam, especially when most of them have direct access to the local electronic media.

Stichting Sikaman was established within the framework of the Dutch government’s guidelines for the welfare of minorities in June 1988. It is a non-profit institution which aims providing support to Ghanaians in Amsterdam by providing assistance with social welfare, politics, education and employment

The objectives of Sikaman include integrating Ghanaians and improving their position in the Netherlands and providing them with a wide range of information. Sikaman also promotes Ghanaian culture for the younger generation of Ghanaians and for Dutch society so as to provide a better understanding and seeks methods to improve the Ghanaian image and counteract all forms of injustice which Ghanaians in Amsterdam will be faced with.

These objectives Sikaman achieves through co-ordination, support and advice. It also directs Ghanaians to organizations and institutions, which can provide more specialised support in some cases.

The organisation disseminates information though the publishing of its periodic newsletter which is called Okyeame and the distribution of information materials on behalf of Dutch and Ghanaian institutions.
The AFAPAC Foundation undertakes HIV/AIDS prevention and care initiative for Africans living in the Netherlands. The Dutch language, method of HIV/AIDS education and the cultural differences are considered the main challenges faced by the Foundation in its work. Officially about 15.000 people are said to have been infected with HIV/AIDS in The Netherlands. Out of this figure about 157 are said to be Africans.
With the financial support of the Dutch AIDS fund, AFAPAC Foundation has developed a culturally appropriate method for HIV/AIDS information dissemination to Africans living in The Netherlands. These include family chain and family arbitration methods. AFAPAC provides training for nurses, general practitioners, psychologists and AIDS consultants at various Dutch health institutions. AFAPAC undertakes a wide range of activities in the promotion of its objectives including radio broadcasting, information giving in churches and at meetings of socio-cultural organisations, youth community health promotion (YCHP). These are the strategies used in reaching the target group. AFAPAC also works together with Dutch institutions in formulation of policies for migrant communities.
The Representative Council of Ghanaian Organizations in the Netherlands (RECOGIN) is an umbrella organization embracing about thirty six (36) organizations and churches. RECOGIN was inaugurated in 1993 and owns the Ghanaian Community Foundation, which is the administrative arm of the RECOGIN council. The main source of income for the organization is the District Council of Amsterdam Southeast. It also sources funding from charity organizations and sponsors through the implementation of projects and incidental activities. This has enabled RECOGIN make significant progress in the fields of organization, representation and networking. Associations that are affiliated to RECOGIN operate independently.
The organization has committees on culture, health and education. The Legal Committee has worked on cases entailing immigration, nationality, resident permit, verification and legalization of documents. Through its Media Committee, Radio RECOGIN broadcasts programs that are educative, informative and entertaining for 24 hours each week. The station is very popular and the majority of Ghanaians listen to it.
The other two organisations contacted for the purposes of this paper were Ghanaian religious organisations namely Stichting Christian Baptist Church in Amsterdam and Stichting Grace Baptist Church in Rotterdam.

These are five of the major Ghanaian community organisations in Amsterdam and between them they represent the greatest part of all available social and political support provided to the community.

One other organisation which provides support to pregnant teenagers with which the researcher became familiar with in the course of her research is Mi Oso Es Mi Kas an organization in the Bijlmer where pregnant teenagers and mothers can go and engage themselves in different activities and learn more about parenthood, responsibilities and reintegrating into the society with a focus on making something out of one’s life. The management of this organisation made it a point to draw this researchers attention, several times, to the fact that like other similar organisations it faced some challenges among which are a cut in the support received from the local government and this places a limit on the services that it could render to the teenagers who visit their shelter. CHAPTER 4 –VIEWS AND PERSPECTIVES ON TEENAGE PREGNANCY In this chapter I will present the views and perspectives of Ghanaian teenagers, Ghanaian community organisations and the local authorities on unwanted/unintended and wanted pregnancies and the issue of child-bearing and teenage motherhood as provided for in the questionnaires and during the ensuing discussions. These are subsequently analysed against the background of the reality of the issue in Amsterdam.
4.1 Review of findings on Ghanaian teenager who get pregnant from research by Van Berlo, Wijsen and Vanwesenbeeck and other sources
Research by Van Berlo, Wijsen and Vanwesenbeeck (van Berlo et al 2005) shows teenage pregnancies are being more common among immigrant girls and that cultural influences are important in this regard. In the study the differences between native and immigrant girls in terms of conscious motherhood, unplanned and unintended pregnancies are highlighted. Among girls who have had an abortion, the native girls were in the majority, and the situation with teenage mothers was also found to be the same. Immigrant girls were also found to have fewer ambitions and are therefore less motivated to continue their education (van Berlo et al 2005).

This researcher also reviewed “Kind Van Twee Werelden, Een kwalitatief onderzoek naar de achtergronden van zwangerschappen bij allochtone tieners (Wijsen C. et al 2006)” which is a research into the background of teenage pregnancies in ethnic groups in the Netherlands. It is a qualitative study among 50 teenage mothers originating from Surinam, the Dutch Antilles, sub-Sahara Africa and China and describes a wide range of culturally specific backgrounds of teenage pregnancies. These include Ghanaians. The research is a supplement to the one undertaken by Gebrek aan regie, Van Berlo, Wijsen en Vanwesenbeeck in 2005 and which reports on the backgrounds of pregnancies among predominantly native Dutch teenagers.

Among the topics that covered in the study are educational climate and attitudes towards sex in the family, sex education, attitude towards contraceptives and sexuality and its cultural background. Others include relationships with partner(s), significance of motherhood, intentions and personal efficacy of contraceptive-use in sexual contacts, considerations concerning the choice between motherhood and abortion, support and future expectations.

According to the findings of this study ethnic teenagers run a higher risk to become pregnant than native Dutch teenagers. It deals with the period from the child’s earliest childhood until the first months of pregnancy and gathers information from teenage mothers and from experts from the aforementioned different cultural backgrounds.

Also according to the research’s findings ethnic teenage mothers’ lives are much more complex than those of their native Dutch peers. The home situation in which they were raised is often unstable, and they lack significant support from their families. The greater numbers of these girls live in inhospitable family environments. Most experience rapid sexual development which is hardly supervised by their parents. Consequently this situation has a negative influence on their use of contraceptives, since they are not able to develop the right psychological and cognitive abilities and become self-reliant in the area of sexuality.

Ethnic teenagers’ cultural backgrounds in the Netherlands differ from the society they grow up in, specifically in the sphere of sexuality and relationships. This can be attributed mostly to them having to deal with two, often conflicting, cultures even though none of those interviewed in the study admitted this. The study found that girls who insufficiently master the Dutch language are badly equipped to prevent a pregnancy or deal with teenage motherhood. Mastering the Dutch language means better access to services and counseling.

In these girls’ sexual relations boys play a dominant role. Generally girls become emotionally and sexually dependent on boys and being lower educated with lower expectations in terms of their future expectations at school and work attitude. Since the girls often are lower educated and therefore have low future expectations with regard to school and work they become more concerned and content with playing “mother” and having a relationship and children subsequently become more important. As a result of this they often adopt an evasive and passive attitude (Wijsen C. et al 2006).

The study also found out that the attitude of teenagers from the four studied communities towards motherhood also plays a vital part in the issue of teenage pregnancy. Motherhood for them implies some element of status and is an essential part of the female identity. Teenagers observe that mothers in their families are held in great esteem. This is a result of the prominence given by the Ghanaian society to the advent of a girl’s sexuality and in some cultural backgrounds various traditions and ceremonies are performed in this regard. This serves as a strong factor when they are confronted with making a choice to prevent pregnancy or get an abortion when pregnant less a matter of course since they are of two minds. It asserts that this means these teenagers become happy with their pregnancies later although they do not initially plan them. Fatherhood also has a positive meaning which strongly influences the girls in their use of contraceptives and determination whether to keep a child or not.

While all girls receive sex education at school it is limited to the more technical aspects of sexuality and does not take into account the teenager’s original culture or phase of sexual development. Other pressures they face include peer pressure, temptations, insecurities and risks at school and both inside and outside their homes. 4.2 Ghanaian Teenagers General Perspectives on Teenage Pregnancy
In administering the questionnaire to the Ghanaian teenagers when the researcher asked the informants what percentage of Ghanaian teenagers they considered sexually active 4 out of the ten informants indicated that between 85 to 100 % of the teenagers were active with 3 settling for between 70 – 80 % and the rest indicating that the occurrence was below 45%. One individual said, ‘It’s time our parents deal with the fact that we have sex, when they become open about that we will also be open and then we can dialogue.’ When asked of their perception on how many of these sexual encounters end in pregnancy respondents were divided with an equal number indicating that the occurrence was low, average and high (i.e. between 3- 5%, 25 – 30 %, 50%, 65% and 94% respectively). All the informants agreed that such pregnancies were not always carried to term with eight (8) of the informants indicating that these pregnancies end up in abortion. Other reasons for the pregnancies not being carried to term cited by the informants include the need for an emergency operation, complications to the mother’s health and isolation because of shame. All informants agree that sexual activity does not result in pregnancy. Another person who had an abortion said, ‘If only I “had been told how to deal with sexual desires and puberty challenges, I would have acted differently when the situation occurred”. The best method to avoid getting pregnant, according to the majority of group, is abstinence followed by contraceptives.

Seven of the informants state that they know a Ghanaian teenager who has had a child with two stating that those they know had their child when they were 13 years old. Others had their child when they were between 17 to 19 years old. All those who the respondents knew had had the children outside marriage. Seven (7) of the informants state that having a child in ones teens had affected either they or their child’s life since it had either forced the family to move, compelled the mothers to “ grow up”, resulted in the mothers dropping out of school or becoming disrespectful and bitter. Others claimed this made them more focussed and responsible. For those whose lives had not been affected by having children respondents cited arrangements for child care, going back to school, having their parents/grandparents adopt the child and “ moving on” as reasons for this.

The major effects that getting pregnant has on the schooling of teenage mothers as cited by the informants were having to drop out of school and delaying their education; having to endure the shame of their peers and the community, and health problems.

Other teenage informants recorded mixed feelings in terms of any type of teenage pregnancy being a good but challenging situation which presented a choice to the mothers to either keep or abort the child. For some it signified a “rush” to behave older while other thought it presented an opportunity to have a better relationship with the other parent of the child.

In terms of the support received from local authorities during/after pregnancy a significant number of the informants stated that they had been provided with counselling and advice which had however ended rather abruptly later. An equal number indicted that they had also received financial assistance and support from the community organisations especially the church. The majority of informants however disagreed stating that they were neglected and did not receive any support at all.

In terms of the type of support received from social services during/after pregnancy many of the informants indicated that these were available only if the mother decided to keep the child and varied. In this case they would be provided with access to counseling services, housing/youth shelter and antenatal care. It is worth noting that a significant minority indicated that they were unaware of the type of support available.

The majority of informants stated that teenage mothers had received some form of support from their family during/after pregnancy, mostly from the mothers of these teenagers. The rest received no support and some even reported being kicked out of the house. With regards to such support from school during /after pregnancy these came in the form of Flexibility with regards to time, receiving a postcard and encouragement to further their education.

The majority of the informants when asked to grade the assistance received by teenage mothers from social services and local authorities in raising their children pegged this between fair and good for the social services and no services and no knowledge of the services provided by the latter.

Similarly when asked for their assessment of the assistance teenage mothers receive from local authorities and social services to assist them go back to school after delivery, those who responded indicated that the assistance provided by the social services was between fair and good and the same number stating that they did not know of any services being provided. The majority of the respondents stated that nothing was provided or if it was they did not know of them.

Informants were divided as to how helpful the assistance provided teenage mothers have been. Those who agree that assistance has been helpful cite financial; assistance, mental support while those who disagree say that there could have been more support, the family eventually ends up taking care of the child and ending back on the street after the initial support runs out. Half of the informants (five) rate the assistance received as being “poor” while four (4) indicated that it was between fair and good. The majority indicated that it was insufficient and that the assistance provided did not contribute to what is required to take care of the child.

When asked what additional services/structures/facilities they would like to see in place and why, most indicated that being accepted by their family, friends and community was most important to them. This was followed jointly by support from families, doctors, GGD and friends and then daycare facilities which will allow the mother to continue her schooling and then more support from the social services in this order. This they believed would enable such persons go back to finish their schooling.

Asked whether they felt that the local authorities/social services address the issues facing teenage mothers adequately, eight (8) said no since they don’t talk much about such issues, especially the church and also because they do positively impact the lives of these mothers and essentially abandon them. Among the role ascribed by respondents to the services provided by these institutions to teenage mothers include child support and welfare benefits and advice and counseling services.

Informants indicated that the provision of more support and counseling and being more open about the issue of teenage motherhood would enable local authorities and social services to improve their service delivery to teenage mothers.

The respondent’s concept of “ideal” teenage life is viewed in terms of education, employment, having a car, access to finance, being responsible and “good” family support.

Their thoughts on teenage pregnancy among Ghanaian teenagers in Amsterdam range from it being a “hard life”, “easily irritating those affected” and a “very bad situation”. Others are of the opinion that it is not common among the Ghana in community and certainly not the end of the world.

Among the root causes of unwanted teenage pregnancies cited by the teenage respondents are financial problems, unsafe sex, experimentation, peer pressure, influence of the media, broken families and lack of love and commitment. Most of the respondents indicated unsafe sex and experimentation as the leading causes of unwanted teenage pregnancies. This is followed by peer pressure and lack of love and commitment with equal ratings then financial problems and media influence and coming from a broken home, in that order.

Seven of the teenage informants feel that such teenage pregnancies become problematic as they result in the child not being properly catered for due to the lack of money. It then poses as a burden to the parents. The absence of a partner's support and the fact that it disorganises the life of the teenage mothers and puts them behind in their education are also cited as reasons why teenage pregnancy is a problem as it often left its victims with no education and no future. It also poses health problems for them and is detrimental to the growth and development of teenagers.

All respondents agree that it is possible to prevent an unexpected/unwanted child being born through abortion. One of the teenagers indicated that this depended on the age of the foetus.

On how the pregnancy was received by their families the greater number of the informants (five) stated that they were disappointed with another two (2) stating that it was “shocking” for them. Three (3) indicated that it was well received since the family was against abortion. A small minority stated that it was not an issue as their mothers had also had a child as a teenager while for the others it was because their parents did not know.

The teenagers perceptions of being a teenage parent of an unwanted child ranged from being “very bad” since it often resulted in being kicked out of the house and being forced to raise a child while a teenager which signified the end of one’s life.

When this researcher asked the Ghanaian community organisations who were interviewed for this research for their views and perspectives and how they see teenagers who become pregnant unintentionally, they all agreed that it is not a good thing because of the adverse affect it has on the teenagers themselves and the burden it has on the society. To them it was most important that the impact having children could have on the children themselves as many do not have the opportunity to grow with their fathers around them. Other challenges faced by such mothers include the lack of housing and the children not getting the stable environment they require to grow into responsible adults.

They are of the opinion that the approach adopted in the Netherlands to deal with unwanted or unintended pregnancies is based on the acknowledgement that kids will have sex anyway thus they should be provided access to anti-conceptive measures to prevent them from getting pregnant and/or prevent them from contracting Sexually Transmitted Infections (STI’s). Regrettably this has resulted in the lives of the youth of the community becoming commercialized as a result of the numerous advertisements for contraceptives on the market.

For the officials of Sikaman and Recogin, whose work principally touches upon social and welfare issues affecting the Ghanaian community in Amsterdam, the issue of teenagers who have unwanted children was of great concern. This is because they support the high ambitions that parents have for their children. When teenage daughters become pregnant it is therefore considered a setback because it gives both the teenagers and the parents a sense of failure. Such teenagers have less of a chance in the job market since it is most likely that they will drop out of school to support the newborn child.

Furthermore being a foreigner in The Netherlands comes with a lot of challenges and by the nature of the work they do, Ghanaian parents are on the lowest rungs among the migrant communities in Amsterdam when it comes to earning income. Once a teenager becomes pregnant she becomes a burden to the family and of course to the society.

The officials of the two churches who were interviewed are of the view that the use of contraceptives is not the remedy for teenage pregnancy although they can be of great help. The effect of the policy adopted by the authorities towards contraception was highlighted by all those interviewed. To make a teenager believe that pills will prevent the problem and that they can do whatever they chose with whomever and whenever will certainly lead to problems.

When asked about the use of contraceptives and the best way to prevent teenage pregnancy the following views were noted. The churches consider it most important that emphasis is put on abstinence as a means of preventing such pregnancies. For this reason they also place a lot of emphasis on helping the youth overcome youthful lust and related challenges as this will help their self-esteem and their confidence and enable them develop a sense of self-control. They prefer that teenagers abstain till marriage but do admit that that is not the reality. Curiosity is part of being a teenager and the Dutch system and way of doing things do not help either. They consider it good to encourage teenagers to explore and try new things.

Under their faith religious community organisations consider abortion a very sensitive issue because for a woman or a girl to have to make this decision she must have gone through some serious trauma and dilemma. They consider abortion as not being good for anyone to go through for whatever reason but do not oppose it if then mother’s life is in danger.

Another view which I came across was that unintended pregnancies were an indication of the failure of the society, in this case the Ghanaian community, to uphold Ghanaian culture and morals and was not just an issue for the teenagers who find themselves in this situation. They further supported this view by stating that as it was in Ghana where the whole community or village raises a child by enforcing the applicable culture and norms, so should the Ghanaians in the Netherlands have been able to uphold this. Consequently the Ghanaian teenagers are influenced by other ways of life. Other ethnic groups in the Netherlands are on record as supporting, sometimes rather violently, their communities with in terms of socio-cultural issues such as early marriages, the wearing of religious dresses and accessories and teaching of their language and culture and observing religious practices.

One of the best ways, suggested by Mr Lamptey the official of Sikaman who was interviewed, to prevent teenagers having unwanted pregnancies was for the Ghanaian community in Amsterdam to set higher standards for these girls. In his opinion this is “because to whom much is given much is expected”.
The view of the local authorities and social services is that any teenager who chooses not to have a child should be provided with the relevant support to terminate the pregnancy. For they cite the counselling and access to abortion that is provided to these girls.

My interview with one of the teenage mothers was most interesting. This girl who is 19 years old narrated her experience on teenage pregnancy for me. For the purpose of this paper she preferred being referred to as Abena.

Abena was living with her parents and her two younger female siblings of the age 8 years and 11 years in Amsterdam, Bijlmer. She got pregnant at the age of 16 years when she was in her final year in high school. Abena’s mother found out that she was pregnant and was in great distress because she could be blamed for this. Abena’s father had threatened his children that whoever becomes pregnant in his house would be kicked out and probably send back to Ghana. To cover up the shame Abena’s mother was considering getting an abortion for her daughter to prevent other calamity since the pregnancy would make people especially the church question her parenting skills, after all she was the leader of the women’s fellowship and she would not stand a chance of being re-elected next year. Also this would jeopardise her marriage. When Abena’s father found out he kicked Abena out. He figured if she was old enough to have sex, she was old enough to take care of herself.

Abena could not go to the one she was pregnant with because he did not have a stabile life here in the Netherlands and moreover he was undocumented and much older. Abena could not even get a hold of him since he was afraid Abena’s parents would call the police on him so he was not in the picture.

Abena went to stay with her friend that weekend whose parents had travelled but had to go when they returned. She went to the Salvation Army and they gave her a place to stay and at that time she was almost 5 months pregnant. Through the Salvation Army she went for a check up for the first time. She could not go to school because of the exams that was going on and besides she did not study so could not participate. She decided to work because in order for her to stay at the shelter she either has to be in school or working and having a job seemed more practical in her situation. She got a job at the nearest grocery shop but stopped because of her health situation.

In the seventh month of her pregnancy she gave birth to boy and because it was a premature baby, he was kept in the hospital. Life at the shelter was very difficult for Abena after she gave birth because she had to work or go back to school so she left the shelter whiles her baby was still in the hospital. Soon after her baby was well fit to go home and Abena took her baby and went to stay with her male friend who was willing to take them home. Abena started dating this friend and became pregnant again at the age 17 years. Now she knew what to do and went to see her GP as soon as she realized she was pregnant.

Her doctor sends her after the check up to an organization called Mi Oso Es Mi Kas. This was an organization in the Bijlmer where pregnant teenagers and mothers could go and engage themselves in different activities and learn more about parenthood, responsibilities and reintegrating into the society with a focus to make something out of your life. She joined this group and was going there every day for the activities.

She could not rely on the church because with her first pregnancy she had to stop all the activities she was engaged with and stay at the back of the church. This was to set an example to others so that they will learn and not follow Abena’s footstep. She could not bear the embarrassment stopped going to the church.

After Abena had given birth to her second child, this time it was a full term baby. She was much stronger and had a job in another grocery shop. She arranged through Mi Oso Es Mi Kas a babysitter and could afford this because the day-care had a very long list and it was not yet her turn. After breaking up with the father of her second child she rented an apartment and shared this place with another teenage mother that had become her friend in the course of all this. They shared the rent and it became affordable for Abena.

Now Abena is 19 years old and she is in school doing nursery course and working at the grocery shop. She is on the waiting list for her own apartment and hope she soon gets one. Looking back at her life she said to me, “teenage pregnancy is a problem when the teenager hasn’t got a partner supporting her through her pregnancy and child raising”. She also believes that her father’s intention of making life really difficult for her really worked. She says if maybe her parents had forgiving her for the first pregnancy and accepted her child she wouldn’t have had another baby so soon after her first one. And yes, her friends stopped hanging out with her. She got isolated and was forced to grow up very fast.

Abena’s life story is typical of many of the other Ghanaian girls in Amsterdam who are faced with the challenges that come with the issue of teenage pregnancy. Although a lot of emphasis has been placed on teenage pregnancy, as her story illustrates, Ghanaian teenagers become sexually active at a very young age. Many enter into the world of sex totally unprepared and only armed with the views and perspectives that they have managed to piece together themselves through what they hear and learn on TV and from their friends. Often times they know little of what they are getting themselves into.

In Abena’s story the kind of sexual education she got from her parents was very little, scanty and limited. Unfortunately parents and the local authorities have not been able to create an environment which will get these teenagers talking publicly on the issue but instead place emphasis on individual risk factors. Parents focus on the negative consequences of early sex for individual health as well as to protect their own reputations and/or positions in the society.

Abena’s story depicts in the Ghanaian community in Amsterdam a teenager who becomes pregnant is faced with a community which questions her character and that of the youth in general, instead of the social context that fails to provide them with the needed opportunities to understand the issues arising out of sex and prepare for them once a teenager becomes active. Silencing discussions about sex or pretending the youth do not engage in it, and threatening the youth through actions such as forcing them out of the house or sending them to Ghana rather makes sex topical, controversial, enchanting and exciting and actually compels them to delve deeper armed with only their ignorance of the issue. The sad news is that those who end up in Ghana often become infected with STIs, end up having unsafe abortions and even children with several different men.

As we have seen from Abena’s story Ghanaian teenagers find it difficult to approach the available social services for support. When they do they feel they do not fit in and end up not benefiting from these services. They eventually then give up and drop off.

4.4 Ghanaian Views and Perspectives on Wanted Pregnancies
Teenage respondents who indicated that they do not consider teenage pregnancy as being a problem had the perspective that such pregnancies were wanted and issues relating to the “problem” mainly concerned catering for the child and maintaining the mother. To them teenage pregnancies became a problem only when the affected is “stagnant” . In their view teenage mothers are considered a problem by society. Where assistance and support is available to the mother from either the parents of the teenager or any of the organisations which provide such assistance, it ceases to become a problem. They thus consider the provision of assistance as a “right” due to teenage mothers. In their experience the issue of teenage motherhood only became a problem only when such persons were denied this “right”.

For the Ghanaian community organisations the issue of teenagers wanting to have children was wrong as by the virtue of their age they are not physically or mentally mature to have children. They however agreed, in all cases most reluctantly, that in a situation where the teenagers were physically capable and showed maturity they would support them having children as long as they got married before and had the means to support them. The religious organisations are particularly supportive in this respect as they stressed that it was a better option to the teenagers having sex outside marriage.

4.5 Ghanaian Views and Perspectives on Motherhood and Child-bearing
All the Ghanaian teenagers interviewed agreed that they had at one time of the other adored motherhood. They did not however agree on whether to have a child when married or not. They did however recognise that to have a child when not prepared for it would have a negative impact on both the mothers and the new born children. In cases however where two teenagers had the means to support them and wanted have children this would be fine although they felt that it would limit their lives.

On the issue of teenage motherhood the religious community organisations are of the view that regardless of whether the child is wanted or unwanted once someone who is considered a child also has a child then it is an indication that there is something wrong somewhere. Parents they opined, need to nurture their children and not let their up bring take a “natural” course. Another reason for this view which was stated was that teenage mothers are not stable because they are too young to be mothers.

They acknowledge that teenagers are social beings and as such sex is a part of their lives. However they need to be made to consider their choices and handle their sexual impulse. As humans they must be taught to be stronger than their emotions. They also need to be taught to think of the consequences of their actions before they act.

The view of the officials from organisations dealing with social issues was interesting. To them there was a direct linkage between the issue of wanted and unwanted pregnancies and the issue of motherhood and as such views on the subject could not be discussed under these separate headings. They state that many a time when a girl from the community became pregnant the issue of it being unwanted lay with the parents, family and larger Ghanaian society. Also for most girls it is a very frightening experience and this also adds to the child being considered “unwanted”. However at the same time these girls are very excited about becoming a mother and playing the parent. Sometimes if one spoke with these girls one would realize that motherhood is something they had been planning for a very long time.

4.6 Analysis and reflection by Researcher
Despite the fact that the researches referred to at the beginning of this chapter were both undertaken several years ago, my assessment of the situation of such teenagers in Amsterdam and from my own observations gained from growing up in the same, I am strongly convinced that teenage pregnancy has been and continues to remain a problem. Despite the situation being known to the community organisations, the local government and social welfare authorities no specific interventions are in place to mitigate the effect that teenage pregnancy has in terms of limiting the prospects of these girls to having better economic opportunities in the future. This may be because either the issue is not seen as a problem by these stakeholders or that whatever polices have been undertaken have not been effective.

The unfavourable development, during the past decade of both the teenage abortion rate and the teen birth rate in the Netherlands makes the question relevant to the backgrounds of teenage pregnancies. These are both planned and unplanned pregnancies and the choice that teenagers have in this respect. It is therefore important to investigate the backgrounds of teenage pregnancy to acknowledge the cultural diversity of the teenage girls living in the Netherlands and the implications this has for policies and interventions. CHAPTER 5 – TEENAGE PREGNANCY: POLICIES AND INTERVENTIONS

Several policies were identified, in the course of reviewing the literature for this paper, as having been implemented to address the issue of teenage pregnancy in the Netherlands. These may be distinguished in terms of those ones aiming at reducing the incidence of teenage pregnancies; those targeting abortion and those directed towards teenage mothers and their children, in cases where such teenage pregnancies are carried to term.

Among these are interventions to;
• promote safe and healthy sexual behaviour among young people
• provide front-line services such as developmental support for teenagers, psychosocial counselling and crisis intervention
• provide support and information to help teenage girls and their partners make informed decisions regarding the outcome of pregnancy
• preserve a teenage mother’s physical and psychological integrity
• prevent and reduce social adjustment difficulties and developmental delays in children born to such mothers
• reduce intergenerational transmission of health problems and social problems such as abuse, neglect, and violence towards children born to such mothers
• providing support in making a decision concerning whether to abort or to carry the pregnancy to term;
Research shows the potential of two approaches to address determinants of teenage pregnancy relating to disaffection and low expectations. These are school-ethos interventions (Fletcher A. et al, 2008).

5.1 National Policies and services
In the Amsterdam municipality the minimum age at which one can marry is (18) eighteen years. Both parties must have no other registered partnership. A (16) sixteen year old can marry if the girl is pregnant or has already given birth and provided that both parties are at least between 16 or 17 years old. This however is subject an exemption which the Minister of Justice has to grant. .
For teenagers who become pregnant and do not wish to keep the child they have the option to abort the child. In the Netherlands, abortion is legal since 1981 to limit the viability (22 weeks gestation), provided one adheres to certain rules (Mouthaan I. et al 1998). For a teenager below the age of 16 years the consent of her parents is required before an abortion is done. For those who are expected to remain virgins and thus cannot discuss it with their parents there exists the possibility of discussing it with a Counsellor at the abortion clinic. The counsellor can then work with the girl to find a solution.

Abortion clinics provide confidentiality, especially for unmarried women who are not supposed to engage in premarital sexual relations and women residing illegally in the Netherlands. They also offer interventions to prevent teenage pregnancy and education activities on sexuality, STI and blood-borne infection prevention, and counselling on family planning. Youth clinic services are established in close collaboration with the school network and local organizations.

The costs of abortions are charged to the Exceptional Medical Expenses Act (AWBZ), as long as a woman can prove that she lives in the Netherlands. In the case of undocumented women the reverse is the case. The abortion clinic will discuss the issue with the woman to reach a solution. Should there be a requirement for the woman to pay for the abortion it ranges between four to eight hundred guilders.

Support is also available to teenagers who wish to keep their pregnancies. Since January 2005 the new Childcare Law came in force (Gezond Amsterdam Kinderopvang, 24 November 2009). This law regulates the conditions and child care must meet the health authorities to designate as supervisor. One of the interventions provided by the GGD is the “Precaution in first pregnancy” programme. This is a programme for women up to 25 years who are pregnant with their first child and feel very insecure about what to expect. This programme offered by Youth health, starting as early in pregnancy and continues until the child is two years old. It is provided by specially trained nurses JGZ GGD, which can provide support during pregnancy and then in the upbringing of the child during the first two years.
As part of the support provided to new mothers the local authorities provide home visits. The support of the nurse is provided in the form of a large number of home visits. During these visits, the nurses work with young mothers on six topics namely the health of the mother; the health and safety of the child; the personal development of the mother; the role of mother as a parent to her child; the relationship of the mother with family and friends and the use of general facilities, such as information for prospective parents. Free care is offered to mothers who need support during and after their pregnancies (Gezond Amsterdam Voorzorg bij eerste zwangerschap, 24 November 2009).
Most of the teenagers interviewed knew little of the services and facilities available for pregnant women and nothing about anything for pregnant teenagers. The few who had some idea about what is available had little faith in it making any significant impact in terms of the support it provided to these teenagers. One interviewee remarked that the day care facilities which would enable these mothers return to school after giving birth were so expensive and no arrangements were made for teenage mothers who had no permanent sources of income.

Another issue was the language. Few, if any, Ghanaian households in Amsterdam speak Dutch as their first language. This is because many of the Ghanaian parents do not understand the Dutch language or have a very limited understanding of it. This issue is reflected in the homework that the children from migrant communities take home since few are able to get the support of their parents or families for their school work. This issue also translates into the issue of the provision of services for the teenage mothers. Another dimension to this is whether the few who do seek out these facilities are able to communicate their needs effectively and in turn carry out or understand fully what they are requested to do.

For the Ghanaian community organisations the facilities and services available to Ghanaian teenage mothers is very limited and definitely insufficient. Like the other segments of the community none of those organisations interviewed had any comprehensive knowledge of the facilities and services that are available. One cannot help but wonder how they expect then to be able to advice such teenagers who may approach them for assistance.

As far as the local authorities are concerned the facilities available for pregnant women, including teenage mothers, are adequate although the official interviewed admitted that a lot more needed to be done to be able to specifically cater for the needs of teenage mothers from migrant communities. To them the needs of this community can be included in the existing structures and the official interviewed was of the view that there was no need to institute any special arrangements for this target group.

5.2 Local Policies and services
The researcher gathered that the support provided by the Ghanaian community organisations to teenage mothers where available, did not distinguish between whether the mother wanted the pregnancy or not, largely because culturally Ghanaians are against abortion. Many of the interventions therefore focused on prevention and once the teenagers became pregnant on motherhood.

When asked about what interventions their organisations have for teen mothers the religious organisations interviewed indicated that they did not have any document or formal approach to what they provide to “help our children in a foreign land” as Pastor Francis stated. “All we have is the bible and the word of God. He stated that they were not equipped enough to provide counsel to teenage mothers and for that matter to provide any adequate social intervention. His support, he stated, was in the form of praying against any demonic powers working against children and teenagers and also by providing them with the word of God. “We let them understand that having a baby is not the end of your life but rather the beginning of a new chapter in their lives”.

The religious community organisations thus provide support to youth who get pregnant primarily through counselling. This is based on the view of these organisations that such teenagers do not need money from the church but acceptance and our love. Most of the time those provided such support tends to deal with motherhood quite well and go back to school to earn a qualification to be able to have a better life.
Stichting Sikaman indicated that in the previous years they had been very active in passing through the radio information to teen mothers as well as the general public. They got positive result from both parents and teenagers who would share their challenges in their social lives. The organisation also networked and directed the Ghanaian community to professionals. They had also undertaken a lot of prevention programmes in which they would invite staff from the health authorities to provide advice and/or answer questions that were bothering these girls and the larger community on health and social issues.
One of the limitations to the support that the community organisations could make to address the issue was the fact that for official recognition of the Ghanaian community by the local government authorities as a minority the regulations stated that the community needed to be forty thousand (40,000). Officially however there are only about twenty thousand (20,000). This means that Ghanaians do not qualify to structural support from the central government in The Hague! What is currently provided by the local and central government authorities is minimal and they need no wait until the situation gets out of hand before something is done. The organisations themselves also felt that there is a need for something more to be done and that interventions could reverse the occurrence of these cases.

The officials of the social welfare organisations find the attitude of the Dutch authorities rather surprising given that many foreigners reside in the Netherlands and thus one would have expected that they would have learnt from lessons in other minority. The official from RECOGIN remarked sarcastically that perhaps the community needed to encourage its teenagers to have more children to increase the numbers and thus gain officials recognition!

The researcher learnt that recognising the need for collaboration across the organisations themselves they had come together under one umbrella institution, the Africa Social Activation Platform the (ASAP). This consists of Sikaman, Recogin, churches and other Ghanaian professionals, communities and groups. The objective of the ASAP is to put Ghanaian issues on the agenda of the Dutch government, both central and local.

When the researcher sought their views on whether the existing interventions for Ghanaian teenage mothers are adequate enough to support them, all those interviewed from the Ghanaian community organisations in Amsterdam agreed that more could be done for their welfare, wellbeing and positive development of all Ghanaian youth in the Netherlands, including teenage mothers. Two said the discussion had prompted them to think about teaming up with social workers and local authorities to provide some form of intervention in this regard.

Some of them expressed the view that although the support provided by the organisations was limited the community was doing very well, given the situation. This was because being in a foreign country with limited resources posed as challenge as did the fact that Ghanaians did not always understand the Dutch system. They remarked that “with God all things are possible” and emphasised that despite trying to understand the Dutch and their way of doings their efforts always end up being one-sided.

Both the Ghanaian religious organisations in Amsterdam who were interviewed agreed that the best way to prevent teenagers getting pregnant was for all stakeholders, including parents and guardians, to work together to help the children. They cite the bible’s teaching on this .

The other organisations also stressed the importance of the home in the up bring of children as it forms their opinions and approach to life. One of those interviewed stated that “charity begins at home”. Another view held was that parents need to work hard to give their teenagers a life that they didn’t have and the best parents they could therefore do to prevent their teenage daughters from getting pregnant was to talk to them….” because what else can you do?” Mr Lamptey concluded.

All those from the Ghanaian organisations who were interviewed reinforced the fact that the issue of teenage pregnancy is an issue in the community and teenagers who fell victim to this needed to be provided extra support. There were differences among them as to what should be done for such persons and the researcher was quick to note that this is primarily due to the specific mandates that they all have. The welfare organisations focus on providing information, raising awareness and sensitizing the youth to the issues around their sexuality. It was also noticed that the religious organisations focus more on counselling.

Regrettably though all the organisations complained that the recent cuts in the funds they receive from the local authorities had had an adverse effect on their ability to carry out their work with teenagers. The situation is slightly different for the religious organisations however it must be noted that they unlike the other organisations depend solely on those teenagers who attend or join their churches, limiting the scope of the support they provide in this regard.

CHAPTER 6 - CONCLUSIONS

6.1 Summary of Findings
From my research I learnt that many Ghanaians in Amsterdam consider teenage pregnancy an adverse consequence of youth sexual activity. This among Ghanaians in Amsterdam is an issue primarily for the affected individual as the decision to keep the child or terminate it is ultimately hers. This is mainly based on whether the child is wanted or unplanned and the teenager’s views and perceptions of childbirth, motherhood and fatherhood. The society that these teenagers find themselves in also have everything to do with the decision they make in this regard.

The Ghanaian societies by its ethnic groupings each have their cultural norms and traditions which shun having children when the woman’s bride-price has not been paid for. While it is not the norm for young girls to marry there are no strong objections to it especially when it is by the choice of the girl with the support of her family and provided it does not impair her development in terms of her schooling and physical well-being. Few, and in fact almost negligible, local policies, strategies and interventions exist to cushion teenagers from the community who find themselves in this situation resulting in they having to struggle through taking care of the child and eking a living. Eventually this constrains their futures, limiting many to casual and other menial vocations and to a world in which they are unable to break out of their moulds and provide a different life for their children.

Among the factors attributable to the occurrence of the phenomenon in the Ghanaian community are parents’ lack of frankness and acceptance of the sexuality of their children, the absence of sex education, culturally determined prejudices regarding contraceptive use, teenagers understanding of motherhood and fatherhood, and unequal relations between men and women.

In Amsterdam it was found that there is a large lack of knowledge regarding the health of and the care for people of foreign origin (AMC de Meren, EU Conference on access to care in the Netherlands, 24 -27 June 2008). The GGD and other authorities responsible for ensuring that the youth are provided with health care, need to ensure that there are enough health workers who are knowledgeable of the background of youth from multicultural environments and who can even preferably communicate in the local dialects which these children and their families speak. This is supported by the finding (Uiters, 2001) that health care education in first language encounters decreases the isolation of immigrants and increases participation in society. This should be tied to a general policy directed at increasing the competence of social workers with regards to their dealings with teenagers. To be able to do this effectively there is the need to start with a research into a good intercultural policy in health care.

Oftentimes the providers of care aim at the organisation of the care and do not attach much importance to the perspectives of the receivers of the care particularly the youth. Both the requesters of care, suppliers of care and financiers of care need to co-operate to tackle the bottlenecks identified in its delivery starting with those highlighted in this paper.
This research found that the factor with the strongest influence preventing teenage pregnancy is educational opportunity as it is well-educated women who tend to delay childbearing. Consequently to make the greatest impact in reducing unplanned pregnancies, and sexually transmitted infections, there is the need to increase the time spent in education by young women worldwide. This is supported by the evidence that where school is the main source of information about sexual matters it is less likely that there will be early and unprotected sexual intercourse as compared with other sources such as friends and the media (Wellings K. et al 1995).
Despite the exigencies of the situation there is an extent to which sexual education may be used to alleviate the incidence of teenage pregnancy among Ghanaian teenagers. There is therefore the need to balance the extent of interventions particularly those which involve parents as many are uncomfortable with their children taking part in sex education classes will tolerate such activities. The incidence of abortion in the community, it was found, is closely related to that of unintended pregnancy.
Many researchers of the subject have called for a shift in the research and policy agenda regarding teenage pregnancy. In addition to interventions that aim to address proximal, individual factors, such as sexual health-related knowledge, there should be a more complementary focus on socio-environmental as well as targeted individual-focused interventions aiming to address the wider social determinants of teenage pregnancy (Fletcher A. et al, 2008).

This researcher’s interaction with the Ghanaian teenagers in the course of this research reinforced the findings (Fletcher A. et al, 2008) that teenage mothers from migrant communities are unable to communicate effectively in Dutch, resulting in serious consequences since they are unable to acquire and understand the necessary information about sexuality and the prevention of STIs and pregnancy (Wijsen C. et al, 2006).

6.2 Conclusions
Ghanaian teenagers in Amsterdam are faced with challenges in coming to terms with their sexuality as a result the environments they find themselves. In the meantime however they grow indulging in sex and are faced with related decisions which because they are not adequately equipped to deal with affect their future. While it is accepted that these teenagers are sexually active the community acts as if the youth have the capacity to deal with them. Ironically when they do become pregnant the same community condemns and shuns them, treating them like outcasts.

Being improperly equipped these teenagers find themselves thrust into parenthood with only some initial support from their families, the local and social welfare authorities. This consigns them to dropping out of school to be able to take care of their children and the consequent forfeiture of any meaningful future.

Unfortunately their situation is compounded by the fact that very few of the teenagers have any in-depth knowledge of the limited facilities and services that are provided by the community organisations and the local and social welfare authorities. They do know that these services are severely constrained and do not meet any substantial need that the girls who find themselves in this situation require. These services are also limited in terms of their relevance since the teenagers themselves are not provided any opportunity to make an input into their formulation or delivery. Social scientists have suggested that lower rates of adverse sexual health outcomes are related to more positive attitudes toward sexuality in Western European nations (American Public Health Association 33rd Annual Meeting and Exposition December 10-14, 2005 Philadelphia, PA).

6.3 Recommendations
Teenagers from migrant communities in Amsterdam need to be provided with an expanded access to modern contraceptives and improved family planning services to reduce the incidence. Social services must be made to provide high-quality maternal health services to all teenage girls during pregnancy, childbirth, and during the postpartum period (Netherlands School of Public and Occupational Health; 2006). Among these are improved family planning services which will enable girls plan their pregnancies and prevent unwanted pregnancies, health education and services for adolescents. It includes education for parents and families on the need to be more open on this issue. For this they need to be innovative in the execution of their organisations’ policies. Also community organisations and the local and social welfare authorities must put in place monitoring and evaluation mechanisms to track the progress of any support they provide to ensure that it is making the desired impact.

Most importantly the community organisations and the local and social welfare authorities need to provide leadership along with any support they may offer. Ghanaian youth must be recognised as a distinguishable group among the community and treated as such.

While there have been several interventions designed to address the issue of teenage pregnancy among teenagers from migrant communities in Amsterdam, none have been found to include the perspective of the teenagers themselves.

Research needs to focus on providing a better understanding of the intentions behind pregnancy and how these may be measured. Clarifying issues of meaning and measurement is required to develop a more complete understanding of pregnancy intentions, which will in turn help improve public health and clinical prevention programs aimed at preventing unintended pregnancy for as one study suggests, “A better understanding of the multiple dimensions of unintended pregnancy also may lead to a better understanding of the consequences of these pregnancies” (Santelli 2003). Based on the outcomes of these research national and local targets may be set. The authorities in the Netherlands may take a cue from the United States which has set a national goal of decreasing unintended pregnancies to 30% by 2010.

The results of the study give rise to developing interventions and policies that are directed towards teenage mothers, and also towards boys and parents. One researcher is of the opinion that an individual approach “made to measure” will be more effective than interventions aimed at groups with the same cultural backgrounds (Wijsen C., et al, 2006). Children and the youth need to be involved in the implementation and enforcement of initiatives and interventions which protect their rights as this is critical to ensuring their effectiveness and to securing the protection and care necessary for the well-being of these teenagers.

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Annex 1

QUESTIONNAIRE FOR TEENAGERS

1. What is your age range?  13 years - 17 years  18 years - 21 years

2. What is your status?  Student  Living together  Married  None of the above

3. What in your opinion are the root causes of teenage pregnancy?

4. Do you consider teenage pregnancy as being a “problem”?  Yes  No

o If Yes in what way?

o If No why not?

5. Taking a wild guess what would you say is the percentage of Ghanaian teenagers who are sexually active? _______________________

6. How many of these result in pregnancy?(%) __________________________
6/7 Are all teenage pregnancies carried to term? If not: what happens, what is done?
7, Do you believe that all sexual activity results in pregnancy?

 Yes  No o If Yes in what way?

8. How best can one prevent pregnancy? _____________________________

8/9 How can one prevent unwanted child to be born/OR: is it possible to terminate an unwanted pregnancy (if so, how)
9. Do you have a child(ren)?  Yes  No

10. If Yes how old were you when you had your first child? ________________

11. If No do you know any Ghanaian who has had a child(ren) while a teenager?  Yes  No 12. If Yes how old were they when they had their first child? ______________

13. Was the child born within a marriage/partnership or outside?  Within marriage/partnership  Outside marriage

14. Has having a child affected your/their life?  Yes  No o If Yes in what way?

o If No how have you/they been able to maintain your/their ‘ideal’ life?

15. How did the pregnancy affect your/their school?

16. How was the pregnancy received by the family?

17. What does having a child(ren) while a teenager mean to you/them?

18. What kind of support did you/they receive from the local authorities during and after the pregnancy?

19. What kind of support did you/they receive from social services during and after the pregnancy?

20. What kind of support did you/they receive from your/their family during and after the pregnancy?

21. What kind of support did you/they receive from your/their school during and after the pregnancy?

22. What assistance, if any, have you or do you receive from the local authorities and/or social services in raising your child? Social Services? (Like: GGD?)

Local authorities? (church? Others?)

23. What assistance, if any, have you or did you receive from the local authorities and/or social services to go back to school?

Social Services?
Local authorities?

24. Has any of the assistance received been helpful?
 Yes  No

o If yes in what ways? (Kindly prioritize)

o If no please explain why?

25. Rate the type of assistance received;  Poor  Fair  Good  Excellent

26. Has the assistance received been sufficient? Please elaborate.

27. How much did or does the assistance provided contribute to what is required to take care of the child(ren)?

28. Which additional services, structures and/or facilities to support the up bring of the child(ren) would you want and why?

29. Do you feel local authorities and social services address the issues facing teenage mothers adequately?  Yes  No o If Yes in what way? o If No why?

30. What do you consider as being the role of local authorities and social services in providing support to teenage mothers?
Social services?

Local authorities?

31. What can local authorities and/or social services do better?

Social services?

Local authorities?

32. What is your idea of an “ideal” teenage life?

33. Write down your thoughts on these two questions: o What are the roots causes of teen pregnancy among Ghanaian teenagers?

o What can be done about this?

34. Any other comments _________________________________________

Annex 2

SUMMARY OF RESPONSES FROM QUESTIONNARIES DISTRIBUTED TO
GHANAIAN TEENAGERS IN AMSTERDAM

Q# QUESTION RESPONSES # RESPONDENTS Q1. Age of respondent 13 – 17 6 18 – 21 4
Q2.

Marital status

Student 7 Living together 0 Married 1 None of the above 3
Q3

Root causes of TP

money problem 3 unsafe sex 7 Experiments 6 peer pressure 4 Media 2 broken family 2 love & commitment 4
Q4.
Do you consider TP a problem? Yes 7 No 3
4a

if yes

lack of money to cater for child 1 poses as a difficulty for parents 3 absence of partner's support 1 disorganizes the girls life 3 gets behind in school 2 with no education no future 1 health problems 1
4b

if No

it's a problem when you are stagnant 2 society makes a problem out of it 2 lots of organizations render help 1 parents assist 1 with enough money it should be fine 1
Q5.

Perception of sexually active Ghanaian Teenagers

0 - 20% 1 21 - 40% 1 41 -60% 1 61 - 80% 3 81 - 100% 4
Q6.

Result in pregnancy 0 - 20% 2 21 - 40% 2 41 -60% 2 61 - 80% 2 81 - 100% 2
Q7.

All carried to term yes 0 no 10 if yes 0 if No

Abortion 8 Isolation because of shame 1 emergency operation 2 health problems 2
Q8.

Does sexual activity result in pregnancy? yes 0 no 10 no 10
Q9.

Best method of pregnancy prevention Abstinence 5 Contraceptives 8 no 0 if yes how? depends on age of fetus 3 Abortion 6
Q11.

Do you have children yes 4 no 6
Q12.
if yes how old when first had a child 17 years 2 18 years 1 19 years 1
Q13.

if No do you know any Ghanaian teenager who has had a child yes 7 no 0
Q14.

How old were they 13 years 2 16 years 1 17 years 2 18 years 1
Q15.
Was child born within or outside marriage? Outside 10 Within 0
Q16.

Has having a child affected your/their life? yes 8 no 2 if yes in what way?

forced to grow up 4 dropped out of school 4 she became disrespectful 1 I'm now focused and responsible 2 she became bitter 1 If no how have they been able to maintain “ideal" life? arranged child care 2 went back to school 3 I just moved on 1
Q17.

How did pregnancy affect your/their school?

dropped out 6 no day care for child 2 shame of peers 1 shame of community 2 school was delayed 4 health problems 2 I was still going to school 1
Q18.

How was pregnancy received by family

Received well - against abortion 4 Disappointment 7 Shocking 3 girl mother was also a teen mom 1 parents did not know 1
Q19.

What does having a child while teenager mean to you/them

rushing to behave elderly 1 mixed feelings: good =challenging 4 It will not happen to me 2 with right support should be good 3 kicked out of the house 1 a choice either abort it or keep it 1 to have a better relationship with your boyfriend 2 end of your life 1 child raising up a child= end of life 1 Very bad 4
Q20.

Support received from local authorities during/after pregnancy

initially provide counseling and advice which stops later 4 Neglected 4 none at all 4 financial 2 especially from church 1
Q21.

Type of support received from social services during/after pregnancy

Don’t know 2 counseling only if she decide to keep the baby 1 housing 3 antenatal care 2 none at all 2 depend on the situation 1 youth shelter 1
Q22.

Support received from family during/after pregnancy Strong support 3 support from mother 5 None 2 kicked out of house 2
Q23.

Support received from school during /after pregnancy

flexibility with regards to time 3 encouraged to get diploma 1 sent a postcard 2 Don't know 4 nothing 1
Q.24. Assistance received from local authorities and social services in raising child
24a

Social Services

Good 4 Fair 3 Excellent 0 Don't know / none 3
24b

Local authorities

Good 3 Fair 2 Excellent 0 Don't know / none 3 nothing 2
Q25. Assistance received from local authorities and social services to go back to school
25a

Social Services

Good 3 Fair 1 Excellent 0 Don't know / none 4
25b

Local authorities

Good 2 Fair 0 Excellent 0 Is important 1 Don't know / none 4 nothing 2
Q26.
Has assistance been helpful? yes 4 no 3
26a

if yes in what ways?

support 3 money 4 Mental 1 knowledge on biological make up 1
26b

if no explain why? they could have done more 1 grandparents takes care of the baby 1 after 18 years I was back on the street 1
Q27.

Rate the type of assistance received:

Poor 5 Fair 2 Good 2 Excellent 0
Q28.

Has assistance received been sufficient? Reasonable 1 health wise she did not recovered 3 not at all 4
Q29.

How much did the assistance provided contribute to what is required to take care of a child Contributed a lot 0 Contributed somewhat 3 Did not assist 6
Q30.

What additional services/structures/facilities would you want and why more support from families, doctors, GGD & friends 6 acceptance 7 More social workers 2 daycare for child then mother can go to school 6
Q31.
Do you feel local authorities/social services address the issues facing teenage mothers adequately yes 1 no 8
31a if yes in what way? sex education in school 1
31b

if no why?

Don’t talk much about such issues especially the church 6 her life did not improve 2 the child and mum get abandoned 3 we have sex! they should deal with it 2
Q32.

What do you consider the role of local authorities/social services in providing support to Teenage mothers Social Services

More education 7 Child support 4 welfare benefits 2 need to listen 3 Local authorities More education 4 More counseling 5
Q33.

What can local authorities/ social services do better? Social Services More support 6 More counseling 5 Local authorities Should be more open about issue of teenage mothers 7
Q34.

What is your idea of "ideal" teenage life

Education 7 Employment 4 Vehicle 1 Money 1 Being responsible 4 one who has parents to talk to 1 good family support 2
Q35.

Thoughts on pregnancy among Ghanaian teenagers in Amsterdam

"Hard life" 5 Easily irritated 2 Not common in Ghanaian community 2 very bad situation 2 not the end of the old 2