Health boss clears birth control for 15-year-olds

The government has announced that it is allowing girls as young as 15 years to access contraceptive services, a policy reversal that proponents argue will reduce early pregnancies.

The development comes months after Uganda in May signed a compact with the United Nations Fund for Population Activities (UNFPA), renamed United Nations Population Fund, to promote birth control among young people.

Dr Charles Olaro, the director for curative services at the Health ministry, who made the announcement last week told this newspaper that their priority will be out-of-school teenagers and young adults.

“Ensuring access to reproductive health information and services to all individuals, including young people, is not just a matter of choice; it is a matter of fundamental rights and public health,” he said.

He added: “It is essential that we foster an environment where youth can access information on sexual and reproductive health and contraceptives for those in need without stigma, discrimination, or judgment.”

Religious leaders, among them Inter-Religious Council of Uganda (IRCU) Secretary General Joshua Kitakule, described the shift as “unfortunate” and argued that the move will breed promiscuity among youths who should be abstaining from sex.

Sheikh Ali Waiswa, the deputy mufti of Uganda and a member of the executive board of IRCU, said the government should promote contraceptives among couples.

“Ideally, religious leaders advocate for restraining the activity of sexual relationships at an early age,” he said,  adding: “Contraceptives can help in a couple, but for people who are not married, that would be promoting promiscuity and fornication.”

Although the trends may have changed over the past decade, the 2014 National Housing and Population Census showed that 98 percent of Ugandans professed a faith – 84 percent Christians and 14 percent Muslims – sketching a wider horizon of influence for clerics. 

The Catholic Church has globally consistently opposed use of contraceptives, including condoms, suggesting that majority Ugandans who subscribe to the faith, according to the 2014 data, may more likely subscribe to the church’s teaching.

Uganda’s long-standing policy sexual and reproductive health policy in preventing HIV spread has been Abstaining, Being faithful and using Condoms --- otherwise, called ABC.

They also argued that sex is ordained by God and must be enjoyed in marriage, branding sex among the unmarried a sin.

However, Health ministry’s Dr Olaro and others argued that things have changed and that youngsters in schools would be provided age-appropriate information about sexual and reproductive health.

“But when [young] people are out of school, they become vulnerable. That is why we are targeting them [by providing access to contraceptives],” he added.

The director also explained that they are looking at those who have already experienced sexual and gender-based violence, child mothers, and those who have had an abortion “which is usually unsafe.”

“We have seen that 10 percent of maternal mortalities are due to unsafe abortion. So, we need to protect them from becoming pregnant again. Some of them have been raped and so they have to access emergency contraceptive pills to prevent pregnancy,” he added.

Proponents such as Mr Jackson Chekweko, the executive director of Reproductive Health Uganda, said the epidemic of early pregnancies among teenagers during the Covid-induced lockdown demonstrated the need to change course.

Opponents and parents, he noted, should know things are not as they were “in the past” and uptake of contraceptives among young people is increasing.

“Right now, the demographics structure of the country [shows that] over 78 percent of the population are below 30 years. At 24 years, almost more than half of women are either pregnant or have had a child,” he said.

Citing the Uganda Democratic and Health Survey (UDHS) report released on September 7 in which one in every 4 of 19-year-olds were found either pregnant or to have given birth, Mr Chekweko said “Covid caught us flat-footed, teenage pregnancies brought us to our knees”.

“These are not good for the country and our future generations,” he said, adding: “But we could have prevented this [if young girls were using contraceptives].”

The government and the United Nations Population Fund estimated that up to 32,000 teenagers eloped every month during Covid-19 pandemic, sometimes with relatives, after schools closed.

This saw the United Nations Population Division to rank Uganda as the 10th country with the highest teenage pregnancy globally, but that trend is now slightly on the decline.

Report

A 2023 report shows that pregnancy rates stands at 24 percent, a marginal one percentage point drop from 2016, despite the Covid-19 challenges.

Commenting on the feat, Health ministry’s Dr Olaro said: “I am sure that if we had not had Covid-19 [outbreak which caused closure of schools), we could have registered a better outlook.”

Mr Chekweko noted that prevention of early pregnancy involves empowering young people with information and allowing them to access services.

“The young people should know that when you enter into a relationship and you enter into sex, you become pregnant. If they know that, then they know how to handle their relationship while mindful that they don’t want to cross the line,” he said.

The introduction of the contraceptives for teenagers, according to defenders, is to help individuals such as a 15-year-old known by the pseudonym Sarah from Lira district, who conceived and was delivered in 2021 by a caesarian section, not to get pregnant in the first place.

“She had labour complications in the lower public health facility where we took her and the midwife did not appear bothered about her,” her elder sister, who preferred to speak on condition of anonymity to express herself freely, told our reporter last week.

She added: “But later, when we raised our concern, she was referred to Lira Regional Referral Hospital where they performed the caesarian section and she had a baby who is healthy and growing well.”

Ms Martha Mugabe, an advocate for sexual reproductive health services in the country, challenged those opposing the grant of rights to teenagers to use contraception.

“Contraception are different devices that people can use to prevent pregnancy. We have products like intrauterine devices (IUDs), implants, injectables, and pills. The young people have a right to privacy, to make a choice and to have sex, to access services and information,” she argued.

Dr Jotham Musinguzi, the director general of the National Population Council, while defending the government’s move, said in an interview that the issue of promoting contraceptives among young people is a development matter that cannot be ignored.

“The government is making sure young people are empowered, not only to get educated and jobs, but if they don’t use family planning and they are sexually active, they are going to become pregnant. Then all these things will be interfered with – the ability to continue with education, get skills and employment,” he said.

However, the celebrations might be premature. A highly-placed source in comments, later separately confirmed by the Ministry of Health Spokesman Emmanuel Ainebyoona, said the government has not yet formally approved the policy to permit birth control measures for teenagers.

However, this publication understands the ministry is relying on global commitments by the government of Uganda to promote access to family planning options among adolescents and young adults.

Our investigations reveal that the leapfrog by Dr Olaro and others to grant 15-year-olds access to contraceptives reflects years of attempts from as early as July 2012 when Uganda committed during the London Summit on Family Planning to attain universal access to Family Planning.

Contention about the proposal meant the 2020/21-2024/25National Family Planning Costed Implementation Plan(FP-CIP II) unveiled in 2021, suggesting access to contraceptives for adolescents and young people, remained a draft.

2017 commitment

In 2017, the government committed to extend family planning services to “cover adolescents and young people as a commitment to the present and future mothers and children,” and its National Sexual and Reproductive Health and Rights (SRHR) Policy of that year was not approved.

The draft SRHR pointed to myriad human rights instruments, including covenants, treaties, charters and commitments under various regional and global initiatives, which Uganda ratified to underline the country’s obligation to “respect, protect and fulfil reproductive health as a right to health.”

According to the 2020/21-2024/25National Family Planning Costed Implementation Plan (FP-CIP II), the draft SRHR policy details and itemises national documents (policies, guidelines, standards, etc.) that speak to the issue of teenage pregnancy.

It focused on the need to delay sex debut alongside providing information and services to sexually active adolescents and youth.

In Uganda, the age of consent is 18 years and critics questioned whether a proposed blueprint to get teenagers access birth control was an implicit approval of sex for individuals below the consent age.

Mr Mondo Kyateka, the assistant commissioner for youth and children at the Ministry of Gender, Labour and Social Development, said there is an urgent need to employ strategies that are effective in scaling back early pregnancies.

“Around Covid-19 time, 1,000 children were getting pregnant every day. We need to tackle this evil because this affects human capital development in the country. Child marriage stands at 20 percent, these are unacceptable,” he said.

On social media, some commentators said the proposal to permit use of contraceptives for 15-year-olds and younger adults risked exposing them to HIV.

Seven in every 10 of the 30,000 new HIV infections among Ugandan women in 2022 were among those aged 15-25, according to Uganda Aids Commission. 

“This will increase HIV cases among these teenagers since most of them fear getting pregnant than contracting HIV,” noted X (formerly twitter) user who identified himself as Stephen Nsubuga.

A one Moses Turyahabwe, again on X, questioned the long-term effects on the girls of early exposure to contraceptives. “I think the best method would be abstinence,” he noted.

According to the Ministry of Gender, Labour and Social Development, “one out of five women in Uganda engage in sexual activity before age 15 [while] 64 percent have sex before age 18”.

The statistics further shows that three out of every 10 women currently aged 25-49 got married before the age of 18 and 7.3 percent married much earlier, before they were even 15-years-old.

Dr Allan Kasoozi, a senior medical officer in the Division of Adolescent and School Health of the Ministry of Health, said preliminary findings from a new UDHS report indicate that modern contraceptive use among young people and the general population is improving.

“This is in line with our family planning commitment towards achieving a modern contraceptive rate of 50 percent by 2030. Recent data from Uganda Bureau of Statistics (Ubos) shows that the modern contraceptive prevalence rate for the age group 15 to 19 years, is at 20 percent. But that is twice as much when it comes to the unmarried youths. That shows there is still some work to do there,” he said.

 Statistics

Ms Esther Makula, the communications officer at Naguru Teenage Information and Health Centre (NTIHC), said that through their 32 supported facilities, they provided sexual reproductive health and rights (SRHR) services to 419,069 adolescents and young people in 2021/2022 Financial Year.

This is nearly double the 217,162 adolescents covered the previous year.

“As a teenage centre, we are seeing very many young people getting pregnant. Most of the time, it is because they lack access to contraception. What we have been doing over the last 30 years is to increase access to SRHR services which includes contraceptives,” she said.

She added: “We know there are many abortions that result from teenage pregnancy. And because these pregnancies are unplanned, you realise that this is going to be a problem for the country. We have been supporting the establishment of youth corners in different facilities along with the Ministry of Health.”

Mr Chekweko said: “After that, we need to empower the young people who are either in stable relationships or are having sex so that those who cross the line can protect themselves from getting pregnant. We need to make sure young people access contraceptives, both males and females.”

According to Ms Bridget Amutwongire, the communications and media officer at the Aids Health Foundation (AHF) Uganda Cares, the government should address the negative attitude of health workers, parents, and religious and cultural leaders towards contraceptives for young people.

“Adolescent girls and young women find it hard to access sexual and reproductive health services. The attitude of some health workers towards access to the services is not good. Most health workers tend to discriminate [against] the adolescent girls and young women,” she said.

“For example, we all know that you might find a young girl who is 16-years-old and is sexually active, and has gone to the facility to have a vaginal ring or contraceptive and the health worker will refuse to offer the service to them. The health worker tells the young person “you are still young, you don’t need these services”,” she added.