Asking midwives to report young mothers is not wise
On August 30, the media reported that state minister for Youth and Children Affairs, Florence Nakiwala Kiyingi, urged health workers, particularly midwives to take a lead in the fight against teenage pregnancies.
The minister told midwives that they risk imprisonment if in addition to providing antenatal care to teenage mothers, they did not report to police so that those responsible for teenage pregnancies can be prosecuted.
Teenage pregnancy is a public health challenge not only in Uganda, but also, in most developing countries. Not only are teenage mothers more likely to die or suffer from pregnancy and delivery-related complications, but children born to teenage mothers are more likely to die in the first year of life.
Teenage pregnancy is not new in Uganda.
According to the Uganda Demographic and Health Survey 2016, 31 per cent of girls aged 15 to 19 years, had either already given birth or had their first pregnancy in 2000.
This proportion reduced markedly to 25 per cent in 2006 and has remained constant since. Available statistics indicate that the years of 16 and 17 present a golden opportunity to intervene if we are to make a meaningful impact on reducing teenage pregnancies. The report shows that only 3 per cent of girls have either had a child or are pregnant with a first child by 15 years.
However, this figure rapidly increases to 22 per cent by 17 years and 54 per cent by 19 years. These figures are made more believable by the statistic that show that pre-marital sex is highly prevalent in the country. It is estimated that most girls have their first sexual encounter aged nearly 17 years and are married off aged nearly 19 years.
However, the figures for girls with no education from poor families and those in rural areas are significantly lower. Perhaps the most annoying statistic is that, a whopping 43 per cent of women in Uganda are married off before 18 years, meaning that a great proportion of teenage mothers are married or in union with someone known.
Requiring midwives to report teenage mothers might cause unintended consequences. Already, the country has registered substantial gains in increasing provision of antenatal care by skilled providers and health facility births.
Nearly 100 per cent of mothers in Uganda access antenatal care from a skilled provider and 73 per cent deliver in health facilities.
However, access to these services is lower for women, who are most likely to become teenage mothers; women with no education, poor and from rural areas. Anything most likely to prevent teenage mothers from accessing these services will worsen an already bad situation.
The Ministry of Health is striving to improve the quality of services provided to pregnant women for the best possible pregnancy experience and outcomes. High quality antenatal care includes assessing both the pregnant mother and her fetus for nutritional problems, common physiological symptoms that portend a likelihood of unfavourable pregnancy experience and outcomes, provision of preventive measures such as iron and folic supplementation, prophylaxis for malaria, etc.
Previously, the media had been awash with incidents of purported Ill treatment of pregnant women by midwives, and this has been blamed for poor antenatal attendance and births from health facilities.
The concept of “respectful maternity care” is slowly, but, steadily gaining prominence in Uganda.
This entails considering a pregnant woman as an active participant in her health, with rights and values that must be respected. All health workers, including midwives, are duty-bound to ensure privacy and confidentiality during the provision of services. This aspect of care is not just a crucial component of respectful maternity care, but it is deeply entrenched in ethics that guide provision of healthcare.
Therefore, requiring midwives to report teenage mothers to police, might affect quality of maternity care, and an additional burdensome addition to their already busy work schedule.
