Extra credit: In Ghana, a project to get girls back to school also lowers teen pregnancy

When Celestine Ankara joined a program for girls in Ghana who had never been to school or had dropped out, she wasn't sure what to expect. She was delighted when the vocational training component helped her to set up her own small beadwork business, which now helps her support her family in Nkyene-Nkyene Amanfro, southeastern Ghana. And she was grateful the life skills component helped teach her how to look after her children, including what ailments she could treat at home and which ones would require a trip to the hospital.

But it was the sexual and reproductive health (SRH) classes that made some of the most profound improvements in Ankara's life and the lives of the other young women in the Strategic Approaches to Girls' Education (STAGE) program. Those classes taught the girls how to take control over when and how many times they got pregnant, Ankara said. "I have given myself four years before maybe having another child – I didn't know anything about how to do that before," said Ankara, 20, who has two daughters, aged 2 and 4. "Out of all my colleagues in the program, no one is having another child. We know how to protect ourselves."

Despite recent progress, Ghana, like many sub-Saharan African countries, struggles with a relatively high adolescent pregnancy rate, with 76 out of every 1,000 births in the country born by mothers between the ages of 15 and 19 years old. The global average is 49 per 1,000 births. The link between adolescent pregnancy and school dropout rates is well documented, and in Ghana, up to a third of girls who leave school early report the decision is due to pregnancy. National policies and initiatives designed to address these issues – such as the Guidelines for Prevention of Pregnancy among School Girls and Facilitation of Re-entry into School after Childbirth introduced in 2018 – have had limited effect due to a range of obstacles, including staffing deficits, inadequate funding, and a focus on teaching abstinence over contraception, not to mention the disruptions caused by the COVID-19 pandemic.

But local-level initiatives like the STAGE project, which build on the success of similar programs around the world, are making progress on both parts of the problem: they are getting adolescent and teenage girls, including young mothers, back into formal and informal education while also lowering adolescent pregnancy rates.

Over the course of five years, 17,000 girls in Ghana went through the STAGE program, which ended in February 2023. Implemented by World Education, a division of the health consulting firm JSI, and funded by the U.K.'s Foreign, Commonwealth and Development Office, STAGE was born out of evidence that World Education and its partners had collected while running earlier complementary education programs for out-of-school children in Ghana that underscored the major challenges and barriers preventing many girls and young women from accessing education, said Willem van de Waal, senior technical advisor at World Education. STAGE participants came from groups that the organization had identified as particularly vulnerable, including teenage mothers, child brides, girls with disabilities, girls living in extreme poverty or in remote areas, and those involved in modern slavery.

Using community mapping and sensitization activities, World Education found girls who were eligible and worked with communities, local services, and government to enroll them in STAGE.

Just under half of the girls who took a nine-month accelerated learning program focusing on functional literacy, numeracy, and life skills, including SRH practices, were aged 10 to 14. The program supported them in their transition to formal education with uniforms, learning materials, and bicycles for those living far from their closest school. The rest of the girls, aged 15 to 19, also went through the accelerated learning program, but they then received vocational training from master craftspeople in their communities to learn trades such as breadmaking, soap making, event decor, and beading.

Once girls left the one-year program and re-entered school, World Education and local NGOs followed up with them regularly, in collaboration with the Ghana Education Services, the Ministry of Education, and the Ministry of Local Government. "STAGE continued to monitor their attendance [in school] through established Community Oversight Committees that addressed any barriers and discussed with parents and caregivers or husbands how they could support the girls," said Van de Waal. "It’s important to explain what the benefit of educated girls is towards the community as a whole."

When the program started in 2018, around 40% of the first cohort were teenage mothers, according to Van de Waal. Follow- up research showed that around 90% of the initial group of 10-to-14-year-olds were still in school two years after they had transitioned into the education system. Studies show that girls who stay in school longer are more likely to learn about and use contraceptives and other birth control methods. That makes them more likely to delay starting a family, which increases and broadens their opportunities to participate in society, including the labor force. It allows them to better protect themselves against sexually transmitted infections (STIs), reduces the chances they might seek an unsafe abortion, and greatly lowers their risk of maternal mortality: complications relating to pregnancy and childbirth are the leading cause of death for girls aged 15-19 globally.

For both the groups of younger and older girls, SRH courses were a core component of the life skills training, said Joyce Larnyoh, country director at the International Child Development Program (ICDP), which ran the STAGE project in collaboration with municipal health bodies in several regions of eastern Ghana. "We established awareness-creation campaigns for issues (such as) STIs and how to regulate pregnancies through family planning. Some did not even know when they were pregnant," Larnyoh said.

"The project absolutely improved the health of these young mothers. They learned about managing their sexual lives, deciding when to get pregnant and when not. They were empowered. It's working," she said.

To see how to replicate these results on a nationwide scale, Ghana could look to Jamaica, where the Programme for Adolescent Mothers has become a model for reducing teen pregnancy by focusing on getting young mothers back into education. Since it was launched by the Women's Center of Jamaica Foundation in 1978, the program has supported nearly 55,000 adolescent mothers through a combination of core curriculum lessons, vocational training, and counseling in personal development and SRH issues. Each year for the past three years, the foundation has also offered bursaries to cover the school expenses of 40 girls who go back to secondary school after going through the program and scholarships to a small group of young mothers to continue their tertiary education.

In the years since the program launched, teen pregnancy in Jamaica has fallen from 134 births per 1,000 women aged 15 to 19 to 33 births per 1,000 women in that age range. For girls in the program, repeat pregnancy has stayed under 2%.

"Our data shows that among girls who access the program...[many] don't have another child until they are settled in a job." said Beverly Martin-Berry, the Foundation's acting executive director. "That allows them to take care of themselves and their children and even their extended family."