Eva Paulo wanted to be a tailor when she grew up. When I meet her, she is dressed in a floor-length pink gown—the kind of dress teenagers wear to prom, with a ruffle that trails behind her in the dust. She made it herself; it acts as a silky reminder of what she has lost. Like many young women in rural areas of Tanzania, the 17 year old's greatest ambition is now survival.
Married at 14, de facto divorced three years later, Paulo is a single mother to a three-month-old baby. Her husband rejected her, so she now relies on an uncle for food and shelter. She has achieved a lot since then, not least surviving childbirth, the leading global cause of death for young women aged 15 to 19. She's lucky to live near to Uteshu, where Africa's leading health charity Amref Health Africa have overhauled the facilities to ensure women have access to life-saving cesareans, antenatal care and HIV clinics.
Paulo is the only woman I meet during a week travelling across the Shinyanga region of Tanzania who cries while telling me her story. The unfairness of her abandonment is too much for her. "Don't cry, don't cry, " says our translator. I don't hush her; she seems glad of the permission to talk. "It's not that I want my husband to come back," she explains, "I don't. But it is difficult to be on your own. Raising a baby in this environment, in these conditions, is tough for anyone."
Though practices are changing, it's common for Tanzanian children to be married before 18. "We were too young to make marriage work," Paulo tells me. Tanzanian women start having children age 19. Access to contraception is made difficult by long walks to health centers and a lack of local dispensary facilities. Many husbands and fathers-in-law have the final say about young women's reproductive futures, and they often say no to family planning.
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At Uteshu I meet three 15 year olds, each recovering from an emergency cesarean necessitated by pelvises damaged by malnutrition. Their voices sound like elementary school children when I play my dictaphone back. Salome George tells me she likes being a mother, despite the pain from the scar across her belly. But she wants a gap between her children and knows she is likely to be back here next year.
In Mbiki village, Zena Bakari tells me that she had her first baby at 19, and says that there is occasionally still reluctance to move away from traditional birthing practices. Recently a local witch doctor told her pregnant acquaintance, "You and your baby will die if you have a C-section."
When the woman went through obstructed labour, doctors and nurses tried to convince her to have a cesarean. She refused. Instead, she walked home and went to church. "Everyone prayed for her," says Bakari. "During the night the pains started again and she went back to the hospital. She refused the cesarean again and both she and the baby died."
Access to education is seen as key to making progress on reproductive and child health. Children are now legally required to attend school from age seven to 15, though 15 to 20 percent do not. Many families still see a financial advantage in marrying girls young. Some young women are worth a financial premium; younger girls with the lightest skin and firmest breasts can earn their families up to 40 cows. These cattle can be exchanged for maize flour if the family's own crops fail, and can be used to pay dowries for their sons.
Eva has her sights set on more for her child. "I try not to have dreams for myself but I think of my daughter. What I want most is for her to grow up and finish school. So I've named her 'Schola'—Scholastica."
Projects like Amref Health Africa that focus on sexual health, reproductive education, and men's participation in women's health initiatives, are beginning to make Eva's dreams more of a reality. Technology may well play its part too, with texts being used to deliver health messages to remote communities. Despite not having access to running water or mains electricity, 20-year-old Mary Isaka is able to take a photo of me with her mobile and send it to her friends. She's HIV positive and waiting until she stops breastfeeding to find out if her baby is too. Thanks to new medical protocols and her proximity to a hospital, her child has a 95 percent of being clear of HIV.
When I see lines of teenagers pass my house on the way back from school each day I now think of Schola, Clara, Maryam: the baby girls I met last month. In 15 years, they will hopefully be in their own schoolyards with their future in their own hands, motherhood safely awaiting them if and when they are ready.