The maternity ward of Pakwach Health Centre IV is a beehive of activity. There are only three pews in the reception room and on the antenatal day, women who cannot fit on the pews sit on mats, on the floor. The majority of the women look teenagers although they claim to have just made 18 years.
Ms Cissy Canpara, the in-charge of the maternity ward and coordinator of reproductive health activities in the district, says of the expectant mothers who attend the antenatal clinic every month, about 30 are aged between 16 and 19 years.
“There are many young mothers here. In fact, some of them are 16 years old and are going to deliver their second babies. Teenage pregnancy is high in Pakwach because of a high school dropout rate. Here, it is normal for a young girl to get pregnant. No one gets concerned. It does not cause alarm like it would in other places,” Ms Canpara says.
Girls having it rough
While Loise, a Primary Six dropout, bears the burden of a seven-month pregnancy, the one responsible is a Senior Four student, waiting to sit his Uganda Certificate of Education examinations. She lives at her parents’ home.
“He (her husband) has not yet paid the bride price. When my father died, my mother could not afford to pay my school fees. She told me to leave school and get married,” Loise says, adding that since her boyfriend cannot support her, she helps her mother, a charcoal burner, in her business.
Before she got pregnant, the 18-year-old girl had never heard of family planning. Now, she wants to have only one child although she has not yet found the courage to discuss it with her husband.
For Prosy, another pregnant teenager, the situation is a bit better. Her husband is a builder in Kampala and even though she is still living with her parents, he sends some money for her upkeep.
“After I dropped out of school, I learnt how to use a sewing machine. The reason I live with my parents in town is that it is easier to get customers,” says the Primary Five dropout.
Like Loise, Prosy did not have much information about safe sex before she got pregnant.
“One time, the senior woman teacher at school told us about condoms. I have agreed with my husband to have only two children, so after I give birth I will come for an injection (injectaplan).”
Ms Canpara also blames teenage pregnancies on the lure of money from selling food by the roadside in Pakwach Town.
“You cannot really know the number of teenage pregnancies because most girls prefer visiting traditional birth attendants. They fear to come to the health centre because the government policy is that a pregnant woman must come with her husband for an antenatal visit. When these girls finally come to us, late in the pregnancy, they get boda boda riders outside the health centre to pose as their husbands. A few come with their fathers,” she adds.
Need to target the youth
Ms Canpara adds that although the district, with the help of village health teams (VHTs), is carrying out sensitisation meetings on reproductive health with stakeholders in the sub-counties, the youth have not been deliberately targeted.
“We are targeting all women of childbearing age from 15 to 49 years. Maybe later, we will plan to target the youth,” she says. The health centre has, on average, 15 abortion cases every month. “Both schoolgirls and women come for treatment after spontaneous or criminal abortion. After treating them, the government policy is that we give them family planning information,” she adds.
By the time Prisca conceived, she was still in Primary Five. At first, the man responsible, a fisherman, denied knowing her.
“He only accepted when my relatives threatened to have him arrested. But now, he is not giving me money for upkeep. After my father’s death, my mother remarried. Now I live with my grandmother,” she says.
To support the family, Prisca provides menial labour in people’s gardens. She is worried about the future of her unborn child because the fisherman is bedridden, suffering from sickle cell disease.
Previously, the area Member of Parliament was donating basins and bars of soap to women who had antenatal visits and delivered at all health facilities in Pakwach.
This was the only reason Awekonimungu has been visiting the health centre. However, the donations have since stopped and she is frustrated because she has not even been given a mosquito net, which she cannot afford to buy.
“I had heard about family planning. I had heard that there are some drugs they can inject you with and you do not get pregnant, but when I met this man I forgot about it,” she says quietly.
Creating safe spaces for youth
On August 12, Uganda joined the rest of the world to celebrate the International Youth Day under the theme: ‘Safe Spaces for Youth’. The day is supposed to provide government and other stakeholders with an opportunity to take stock of the accomplishments made towards youth empowerment.
One of the avenues of youth empowerment is to create safe space for them to know their sexual reproductive health rights and discuss the issues affecting them, their experiences and expectations.
Ms Roselyn Acio, an enrolled midwife at Pakwach Health Centre IV, says although the health centre has a youth corner that was opened in January 2018, few youth come for reproductive health advice.
“The youth corner is open every day, but on average, only one or two youth drop by per day. There is stigma attached to the corner. Until recently, the youth corner was held under a tree and many young people were afraid of being seen by their relatives. People here think that it (sexual reproductive information) is only for married people,” Ms Acio says.
Now, the youth corner is housed in a small room off the maternity ward. The young people mainly come late in the afternoon when the health centre is almost deserted to avoid being seen by their relatives.
“First, they pretend not to be interested and loiter around the compound, but with time they eventually walk into the room. We give them advice on contraceptives and information on safe sex and emergency pills,” Ms Canpara says.
She adds that boxes of condoms are placed around the room and in the antiretroviral treatment (ART) clinic because some youth come with sexually transmitted infections (STIs). By the time the young people leave, the boxes are empty.
Teenage pregnancy impacts development
Mr Richard Mugenyi, the advocacy and communication manager Reproductive Health Uganda, says a rise in the rate of teenage pregnancies affects the attainment of Vision 2040.
“Vision 2040 was revised to reduce the fertility rate of women to two children per woman. If we do not tackle teenage pregnancy effectively, there is no way we can reduce the fertility rate. Moreover, more than 80 per cent of girls who are teenage mothers got pregnant while still at school. Of these, 97 per cent do not return to school. This greatly affects their chances of earning a better livelihood in the future and continues the cycle of poverty,” he says.
Ms Elizabeth Ampairwe, the programme director of Forum for Women in Democracy (FOWODE), argues that a high teenage pregnancy rate is disastrous for national development.
“A teenage mother is likely to get married to a man who has a lot of power over her. She will not be able to negotiate family planning, will have many children beyond her choice, and she will have a big care burden. Most importantly though is the vicious cycle of poverty because the children will not have the basics of education and will probably have stunted growth,” Ms Ampairwe says.
Children from such a home only continue to widen the inequality gap and compromise security. Besides, teenage pregnancies can be linked to the high maternal mortality rates.
“This should worry us as a country because these young girls cannot access quality health care, so they end up going to TBAs. Others use rudimentary methods to induce abortions,” she adds.
In commemoration of the International Youth Day, Uganda should create spaces where youth can share their plight and concerns, Ms Ampairwe says.
Situation in Nebbi district
In neighbouring Nebbi District, the situation is no better. For the month of June, Nyaravur Health Centre III registered 23 antenatal visits for girls aged between 16 and 17 years.
Mr Alexander Vukoni, a clinical officer in-charge of the facility, blames teenage pregnancies on idleness.
“Every Tuesday we have a youth corner. However, most girls dropped out of school. Nyaravur is a town council and video halls operate four times a week. The proprietors do not mind about the age of the girls who enter the halls or how long they spend there,” Mr Vukoni says.
According to Ms Mary Goretti Amonditho, a midwife, in July, the teenage pregnancies were much higher, with the majority coming from Nyaravur Trading Centre.
Who has failed teenagers?
“The national teenage pregnancy rate is now at 25 per cent. This implies that one of every four teenage girls is pregnant. We need to look at how teenagers access sexual reproductive health information. Right now, government is putting in place guidelines for comprehensive sexuality education, but these are targeting the formal systems.
What about the many youths who have dropped out of school? Yes, there are youth-friendly corners at health facilities but these are in the open. Youths are shying away from these places.
On the issue of youth empowerment, FOWODE is carrying out a gender audit of the Youth Livelihood Programme in 14 districts and so far we have discovered that it is retrogressive because of the high administrative costs and corruption. For instance, a driver in the programme is paid a monthly salary of Shs2m, and yet a group of 20 youth is also given the same amount to share as entandikwa. These youths are not given enough skills and yet they are expected to return the money.”
Programme Director, Forum for Women in Democracy (FOWODE)