Contraceptives for teenagers divides opinion

In January 2020, Uganda’s teenage pregnancy rate stood at 25 percent, according to statistical data provided by the Uganda Demographic and Health Survey 2016. This meant that in every 100 adolescent girls, at least 25 or one-in-four were pregnant or had given birth.

 Today, that figure is much higher. In October 2020, six months after schools were closed to prevent the spread of Covid-19, journalists working with the Daily Monitor carried out a desk research in district health, education, probation and social welfare departments. 

 In the findings, over 2,372 teenagers were pregnant in the districts of Ngora, Luweero, Rakai, Kayunga, Ntungamo, Kitgum, Ngora, Kyegegwa, Kasese and Lyantonde. The six districts in the Acholi sub-region recorded 4,062 teenage pregnancies, while the West Nile region recorded over 1,779 teenage pregnancies. 

Doris Ahebwa’s* 16-year-old daughter is one of these statistics. In September 2020, just before finalists were scheduled to return to school, Ahebwa procured an abortion for her daughter. 

“It was against my religion. I feared I would burn in hell…I have never talked to my daughter about sex. I did not know she had a boyfriend,” she says. 

In our conservative society, a number of parents and guardians still find it shameful to discuss sexual reproductive health (SRH) with their adolescent children.   

“After the abortion, the doctor told me the girl needs to start using contraceptives. He wanted to have a private talk with her about her sexuality, but I did not allow it. How can a 16-year-old girl use contraceptives? Isn’t that opening the way for her to begin having sex with many men? I have advised her to concentrate on her studies. She will have sex when she gets married,” Ahebwa says. 

The abortion and post-abortion care cost the family Shs800,000. Without contraceptives, there is a chance that a sexually active girl, like Ahebwa’s daughter, mY fall pregnant again.

How big is the problem?

Abortion in Uganda is illegal, unless a licensed medical doctor deems the life of the woman to be at risk. In 2006, the Ministry of Health proposed an update to the Comprehensive Abortion Care Services section of the National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights. 

The update would have widened the legal circumstances in which abortion can be permitted, to include, fetal abnormalities, rape, defilement and incest, cervical cancer, and HIV. The proposal failed to pass. 

In April 2015, the ministry proposed another set of guidelines intended to reduce deaths and injuries caused by abortion-related complications. However, the government withdrew the guidelines after objections from religious and cultural leaders. 

With a restrictive policy environment surrounding termination of pregnancy, many abortions done in health facilities are poorly documented, or undocumented, for fear of litigation. 

Ms Dorothy Amuron, a sexual reproductive health rights (SRHR) advocate with Centre for Health, Human Rights and Development (CEHURD), says few gynecologists have the skill to conduct safe abortions.

 “Due to the scarcity of skills, clinical abortions and post-abortion care are expensive and are only accessible to the well-connected.” 

Dr Kenneth Buyinza, the clinical services manager at Reproductive Health Uganda, gives a grim picture from the organisation’s 2020 statistics. 

“During the lockdown, we noticed a 45 percent decline in condom distribution, compared to 2019. We also noticed 215 percent incident of people reporting with sexually-transmitted diseases. That is in excess of 115 percent compared to the numbers we had in 2019,” he says.

Statistics from Marie Stopes Uganda, a reproductive health organization, which provides contraception, family planning and SRH services to women and sexually active youths, show that in 2018, through their services, the organisation helped avert 663,000 unintended pregnancies and 262,000 unsafe abortions. 

Teenagers like Gloria Namono* have benefited from these services. The 17-year-old Senior Three student has been sexually active for two years. Recently, when a neighbour’s daughter got pregnant, Namono’s mother got a wake-up call. 

“My mother took me to the health centre and talked to the nurse in private. It was the nurse who asked if I had started having sex. She then told me that I could get pregnant and I needed contraceptives. My mother and the nurse decided to put me on injectaplan,” she says. 

Unknown to her mother, Namono had an abortion last year. “I was in a boarding school. When I got pregnant, a friend – a day scholar – bought for me a pill and antibiotics at a pharmacy. I swallowed the pill and the fetus came out at night and we buried it in a hole we had dug behind the pit latrine,” she says. 

Many parents entrust the sexual education of their children to senior woman teachers in the school setting. However, with the closure of schools, this avenue of information was cut off.

Outsourcing sensitive stage of the upbringing of a child to outsiders, whose personal values and culture may vary, is a teething problem for modern-day parents who struggle to balance work-family life.

 Doreen Lillian Olaa, a registered midwife, who owns St Bakhita Medical Clinic, a private health facility in Laroo Division in Gulu City, says denying sexually-active adolescents information pushes them into getting unwanted pregnancies.

 “For the last two years, I have been providing free SRH services to women and girls who need them. I have seen adolescents who need contraceptives being turned away from private facilities because they do not have money,” she says. 

Dr Buyinza says while giving sexually active adolescents contraceptives is a possible solution to teenage abortions, the government should first invest in health education for the youths. 

“People cannot use services (contraceptives) they do not know about. Health education means providing age-appropriate, unbiased SRH information to young people. This information will enable them to understand their reproductive systems to make decisions that keep them from falling into the trap of undesired pregnancies, even without swallowing a contraceptive pill,” Dr Buyinza says. 

In October 2016, the government banned sexuality education in schools until a regulatory policy is formulated. At the time, the Gender minister said sexuality education was leading to a decline in the national values. 

To date, given that the National School Health Policy has been in draft form for the last 18 years, there is still no policy to govern sexuality education. In 2018, after consultations with stakeholders, the government passed a National Sexuality Education Framework to guide childhood development and reproductive health and hygiene to save young people from early sex and its associated problems. 

However, the Framework was later rescinded after religious leaders opposed it. Religious Orders run a number of schools across the country, through which the Framework would have been implemented.

“Every time we talk about contraception, people think we are promoting something anti-religious. They want us to emphasise abstinence. But, in today’s setting, abstinence can be best achieved through health education,” Dr Buyinza says. 

What other countries are doing

Uganda is not alone in its emphasis of abstinence. In 2013, the Kenyan government signed a declaration where it committed to scaling up comprehensive rights-based sexuality education beginning in primary school. 

However, a study by the African Population and Health Research Centre (APHRC) and the Guttmacher Institute found that while sexuality education is indeed being carried out in schools, most teachers focus on abstinence as the best or only method to prevent pregnancy and sexually transmitted infections. 

The study found that almost a quarter of the students interviewed – most of them aged between 15 – 17 years – were sexually active, and so needed the information and skills to do so safely. 

In Tanzania, sexuality education in school is mainstreamed in other subjects, such as science, biology, and social studies. However, it is not clear how much sexuality education is covered in these subjects. 

In 2017, Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children directed all primary and secondary schools across the country to establish help desks dedicated to preventing early pregnancy. 

The help desks provide counseling, reproductive health information, and referrals to clinics. 

However, information on contraceptive use is not easily available to young students due to the social stigma of using contraception before marriage.

 Way forward

With government failing to take the lead on catering for the sexuality needs of adolescents and youths, non-governmental organisations and community based organisations are filling the gap. 

However, government needs to come to a compromise with religious leaders so that the National Sexuality Education Framework can be passed. This way, policy makers will be comfortable separating their religious beliefs from the offices they hold. 

“As society evolves, so does each generation’s behaviours and needs. Policy makers need to adjust the policies that govern sexuality education accordingly,” Dr Buyinza says.  

*Names have been changed to protect the privacy of the sources.