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Preventing teenage pregnancies and early marriages will keep more girls in school.

15th October 2017

Patrick mwesigye

patsewa@gmail.com

Team Leader – Uganda Youth and Adolescents Health Forum 

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Uganda today is home to nearly 10 million adolescents aged 10-19 years – 24.3% of the country’s total population and majority live in rural areas (2016 National Housing Census Data).

Adolescence characterised by rapid biological, emotional and social development – is a critical life stage during which a person must have the opportunity to develop the capabilities required for realizing their full potential and achieving a productive health and satisfying life.

With the onset of puberty, a child moves into adolescence and their social exposure begins to expand. Various pressures to try new things and to take risks, and various impositions, particularly for girls such as child marriage and non-consensual sex – intensify.

An analysis of data from the Uganda Demographic Health Survey 2016, indicates that more than 1.1 million Ugandan aged 15-19 years are sexually active, – they are either married unmarried and had, had sex in the last three months or they are union (i.e married or leaving together). On average, adolescents who had sex before their age 20, adolescent girls first had sexual intercourse at age 16.1 years and adolescent boys at 16.4 years (UDHS 2016/ Uganda data WHO factsheet).

Today one 1 in every 4 girls aged 15 -19 years is already a mother or pregnant with her first child (UBOS 2016) and (UDHS 2011).

Flavia Najjembe 16 years in the company her colleagues from Kintate Hill School at the Uganda She Decides Open House. Flavia was speaking at the Panel. On the Right is a UYAHF info-graphic on the choices that girls want.  

But for many of these girls, pregnancy has little to do with informed choice. Often times, it is a consequence of discrimination, rights violations (including child marriage, rape, and defilement), inadequate education or sexual coercion, limited access to and contraceptive services among others. The African Reproductive and Sexual Health scorecard released in 2010, showed that Uganda has the highest adolescent fertility rate in East Africa and scores 8th in Africa, with an adolescent fertility rate of 159 births per 1,000 young women.

25% of adolescents aged 15-19 in Uganda have begun childbearing: As expected, the proportion of women age 15-19 who have begun childbearing rises rapidly with age, from 3% among women age 15 to 22% among women age 17 and 54 percent among women age 19.

More than 300,000 teenagers who get pregnant annually also account for the bulk of unwanted pregnancies, which end up in unintended births and unsafe abortions. Actually, 24% of girls aged 15-24 years have had an abortion (Guttmacher institute Report 2013 – Unintended pregnancy and abortions in Uganda). Majority of these are unsafe abortions that end up in maternal mortality and morbidity due to stigma, fear, isolation and criminalization.

The issue of adolescent fertility is important on both health and social grounds. Children born to very young mothers are at increased risk of sickness and death. Teenage mothers are more likely to experience adverse pregnancy outcomes and are more constrained in their ability to pursue educational opportunities than young women who delay childbearing. Adolescent childbearing is more common in rural than in urban areas (27 versus 19 percent, respectively). There is regional variation, with Teso subregion having the highest proportion of adolescents who have begun childbearing and Kigezi subregion having the lowest (31 and 16% respectively).

 

But it’s important to note that, the proportion of teenagers who have started childbearing decreases with increasing level of education: slightly more than one third of teenagers age 15-19 with no education (35%) have begun childbearing compared with 11% of those who have more than secondary education (UDHS 2016)

IMG_1762Sr. Miriam Namugere the adolescent health focal person speaking at the She Decides Opne House panel. 

In 2011, Ministry of Education and Spots reports indicated that about 34% of teenage girls drop out of school due to pregnancy related complications, while in Africa 3 out of 10 girls drop out of school due to pregnancy and child birth related issues (UNICEF 2011 report on the State of the Girl Child)

 

Girls who have dropped out of school lack employable skills. This leads to law productivity which in a long term contributes to poverty. Teenage pregnancy and early and forced marriages also put girls at a high risk to HIV infection. HIV infection is also a big burden among young people in Uganda.

While at a She Decides Open House organized by Uganda Youth and Adolescents Health Forum in partnership with the Uganda Parliamentary Forum on Youth Affairs,  Uganda Women Association for Parliamentarians, RHRN Uganda Platform and National Population Councile on 11th October 2017 at Fair Way Hotel in Kampala, young people people called on the ministry of health to immediately conclude the review process and, pass and adopt the National Policy for the Health of Adolescents and to reinstate, passing of the National Guidelines and Standards for Sexual Reproductive Health and Rights which are designed to focus attention on the service delivery needs of young women and girls aged 15-19.

Dr. Jotham Musinguzi the Executive Director National Population Council, MPs from the Parliamentary Forum on Youth Affairs and the Uganda Women Association for Parliamentarians and the Swedish and Dutch Ambassadors in Uganda speaking at the Open House. 

Ministry of Health has been reported over the media making inaccurate claims that they “had not been consulted” and that the guidelines intend to distribute contraceptives to 10 year olds. But by the virtural of it’s mandate, the ministry of health played a coordination and convening role in the development of the national guidelines and standards for SRHR a process that lasted for over 16 months.

The open house organized as build up for the international Day of the Girl celebrated every 11th October was organized under the theme; “When She decides, the World is Safer, Stronger and Better” 

Young people, CSO partners. community and opinion leaders listening to the panel discussions at the She Decides Open House. 

Inspiring, Visionary and Interactive, the SheDecides Open House was an opportunity to spotlight the SheDecides Movement to the wider circles of policy makers, legislators and the CSO fraternity working around issues of Sexual Reproductive Health and Rights (SRHR) in Uganda, and to show how SRHR issues of women and girls including; access to contraceptives and family planning are central to the SheDecides Agenda.  She Decides is a Global Movement that advances for a World where all women and girls can freely decide what to do with their bodies, their life and their future. Additionally, SheDecides movement promotes, provides, protects and enhances the fundamental rights of very girl and woman including their right to SRHR services.

Hon. Adeke Annah Ebaju the National Female Member of Parliament while speaking at the Open House called on government of Uganda to expand access to quality and age appropriate SRHR information and services for adolescents and invest in policies and programs that protect the rights of women and girls from all forms of sexual and gender based violence. She also called on government to revamp the justice system to address the justice needs of women and girls by bring to book all culprits of defilement, rape and sexual assault “The law must be seen to be active and harshly dealing with with culprits”, noted Hon. Adeke.

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Hon. Adeke Anne Ebajju the National Female Youth MP and Chair of the Parliamentary Forum on Youth Affairs makes her remarks at the She Decides Open House in Support on Expanding access to adolescent and youth SRHR services and information and promotion of the rights of women and girls. 

Despite Uganda’s high teenage pregnancy rates, the country has one of Africa’s highest unmet need for family planning for adolescents ages, 15-19 estimated at 30.4% with total demand of 52.3% and unmet need of 29.3% for young women 20-24 years with a total demand of 63.3%.
Teenage pregnancy continues to contribute greatly to the maternal deaths and injuries in Uganda to about, 24%, with pregnancy and child birth related complication being the major leading cause of deaths among adolescent girls of 15-19 years.

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Youth organizations showcase best practices

Kampala, 8th March 2018

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On 15th February 2018, the Kampala Youth Advocacy and Development Network (KYADNET) members held an engagement with partners at Reproductive Health Uganda (RHU) Learning Center –Kampala. The main aim of the meeting was to share best practices, strategically develop joint ideas to enhance youth participation and foster their sustainability. In addition, members and partners developed the 2018 work plan for youth engagement, the 5 year strategic plan for 2018 – 2022 and discussed approaches for signing new partners to the network.

The engagement attracted over 50 representatives from 20 different youth-led and youth-serving organizations  including; Sensitize Uganda, Uganda Youth and Adolescent Health Forum (UYAHF), Reproductive Health Uganda (RHU), Uganda Youth Network (UYONET), NYSC, SRHR Alliance Uganda, White Ribbon Alliance Uganda, Ignite International, Gals Forum International, Uganda Youth Development Link, Aids Information Center (AIC) , Girl Up Initiative, Kawaala Teenage Centre, HEYFU, Naguru Teenage & information Health Centre, Uganda Youth Forum (UYF), NUDIPU, WWF, and KCCA.

KYADNET as a network show cased their achievements that began with the Ni-YETU Project, an advocacy centered program that focuses interventions on Sexual Reproductive Health and Rights, as well as ending Gender Based Violence, teenage pregnancies, early marriages and unsafe abortions that affect the health and well-being of young people.

In addition, the network engaged in divisional budget advocacy processes that sought to ensure that key issues pertaining young people are considered in the final budget at the divisional and national level. KYADNET also made tremendous strides in relation to integrating climate change into SRHR and FP, environmental management and agriculture. KYADNET registered its full contribution in the global agenda on Climate change that gave birth to the Climate Smart Agriculture Youth Network (CSAYN). Peniel Rwendeire, a program officer at Uganda Youth Network was elected as the national coordinator.

More so, various members of KYADNET organized and hosted key advocacy training and capacity building workshops. An example is the UYAHF capacity building training in budget advocacy held in November 2017, where representatives from several networks participated. To broaden reach of the training, UYONET scaled up the workshop to other networks in Kampala and other districts in Uganda.

Further still, UYAHF a held capacity building workshop on Smart advocacy. The training emphasized the importance and highlighted the different ways of utilizing the ‘Advocating for change for adolescent Tool kit’. Among the key learning points were, smart advocacy work and coordination through having an organized joint voice as youth advocates, meaningful engagement of adolescents and young people in program design, implementation, monitoring and evaluation (M&E), accountability and finally developing an effective advocacy action road map.

Among other successful implementations, UYAHF established a “Youth Hub”, which avails free and safe space for young people to attain business and entrepreneurial skills. The hub further provides a recreational environment for young people, a platform to share correct SRHR information, referrals to service centers and provide psychosocial support for vulnerable and unprivileged youths.

 

As a way forward, the members reflected on tasks assigned that included inputting into place the KYADNET strategic plan 2018-2022 following the five thematic areas i.e. Advocacy, Leadership and governance, Environment sustainability, institutional development, and Youth empowerment. UYAHF was selected and is actively participating on the themes of the advocacy, youth empowerment, Institutional development, leadership and governance to showcase their planned interventions.

 

UYAHF continues mentor and share knowledge, winning tips and best practices with the KYADNET to not only ensure the realization of the network’s goals but also impact other member organizations positively and contribute to their growth. CSO’ continue to emulate the UYAHF approaches on reaching young people with not only SRHR tailored packages but also business and entrepreneurial skills, and recreational services.

Compiled by Hassan Sebugwaawo and Patrick Mwesigye 

 

Adopt and operationalise National Adolescent Health policy and the National Guidelines and Standards for SRHR – CSOs

Kampala, 8th March 2018

28879522_1931292360217173_1674272143_oSRHR CSOs in Uganda meeting at Uganda Youth and Adolescents Health Forum to deliberate the delayed Adolescent Health Policy by Ministry of Health

Uganda’s health ministry on the 21st November 2017 issued an official statement withdrawing the National Guidelines and Standards for Sexual Reproductive Health and Rights, fourth edition August 2017.

“The draft National Guidelines and Standards for Sexual Reproductive Health and Rights, were developed by Ministry of Health and partners. However, processes of consultation and approval were not yet complete by the time of printing in preparation for the launch at the national family planning conference. In addition, there are policy statements in each of the subsections that require approval by Cabinet, read the letter signed by Dr. Henry G. Mwebesa the AG. Director General Health Services.”

 

At a National Adolescent Health Technical Working Group (TWG) meeting held on 15th Feb 2018, Sr. Namugere Miriam the Adolescent Health Focal Point at ministry of health informed participants that the National Health Policy for Adolescents that has been under review could hit a snag like the SRHR guidelines and service standards. This was after the Health Policy Advisory Committee (HPAC) of the health ministry reviewed the draft policy and concluded that there was no need to have the policy and that any key issues for adolescent health could be integrated into the National Guidelines and Standards for SRHR. It should be noted that the guidelines being referred to here were the same withdrawn guidelines as noted above.

HPAC in it’s recommendations also noted that the draft policy, has contentious clauses around adolescent contraception and other SRHR issues like; rights, choice among others.

 

It should be noted that some of the issues considered contentious by HPAC were views and recommendations of young people during the various adolescent and youth consultation meetings held to review the initial draft policy and the second version of the draft. The adolescent and youth consultation held in June and September 2017 by Uganda Youth and Adolescent Health Forum (UYAHF) in partnership with ministry of health were aimed towards ensuring meaningful participation of adolescents and young people in the policy review process. Young people were able to develop a youth position paper with key recommendation which they presented at National Adolescent Health Policy validation meeting convened by MOH with support from UYAHF September 2017. Some of the key recommendation by young people included; lowering ages of consent to SRHR services to 15, expanding access to SRHR for adolescents and young people through making them wide available, affordable, providing a range of services, ensuring privacy and confidentiality, addressing negative health work attitudes, integration, addressing stigma and discrimination and making the policy environment supportive young people’s SRHR as well as protection from all forms of sexual and gender based violence and other harmful cultural and traditional practices.

 

The National Health Policy for Adolescents’ overall goal is to increase availability and accessibility of appropriate, acceptable, affordable and quality information and health services to all adolescents, regardless of gender, socio-economic status, disability and location. Additionally, the policy purposes to guide stakeholders, program officers and service providers on the criteria they will closely follow as they set up or scale up adolescent health services.

 

Analyzing the overall goal of the policy and its purpose, its evidently clear that it’s mandate and scope is not only limited to SRHR but broader adolescent health and wellbeing issues and hence not all these issues can be integrated in the SRHR guidelines which also have since been recalled.

 

For example, the policy is explicit in addressing issues ranging from prevention of adolescent pregnancy and related consequences, Health Promotion in schools, Prevention and management of mental, Neurological, Alcohol and Substance Abuse disorders, Prevention of STIs among adolescent boys and girls including HIV and AIDS and its health effects, Prevention of communicable and non-communicable diseases in adolescence, Prevention of nutrition disorders and effects among adolescents, Prevention of health effects of of all forms of violence among adolescents, Prevention of disability from accidents and injuries among adolescents, mobilizing hard to reach vulnerable adolescents in humanitarian and fragile settings, meaning adolescent and youth participation, Advocacy research, resource mobilization, monitoring and evaluation and Institutional frameworks for policy implementation.

28876420_1931293526883723_856302330_oCSO partners discuss the next plan of action 

But amidst all these developments, the ministry had not officially come out to inform the public and address key stakeholder on it’s next course of action or any planned policy alternatives in absence of the National Health Policy for Adolescents and the National Guidelines and Standards for SRHR.

 

This silence and trends of the shrinking adolescent health and SRHR policy environment has prompted CSOs working around SRHR issues to re-organize and re-strategies on next steps and course of action in holding government accountable to it’s commitments and pledges in expanding access and utilization of SRHR services for it’s population.

 

Uganda Youth and Adolescents Health Forum has played a key role in leading joint CSO engagements on it’s next course of actions. For example on 5th Feb 2018, UYHAF convened a meeting for CSOs to update each other on the status of the National Health Policy for Adolescents and the National Guidelines and Service Standards for SRHR, and lay joint advocacy action for holding ministry of health accountable to the National Adolescent Health Roadmap 2016, the revised PF2020 Commitments among other pledges where ministry of health has committed to finalizing the development and review process of the adolescent health policy and the SRHR guidelines and have them operationalized.

As an outcome of these engagements, CSOs have pledged support to several actions including; persuading ministry of health convene a CSO stakeholder meeting to update CSOs on it’s next plans, petitioning the ministry of health on the delayed approval and operationalization of the policy and service standards, media engagement to build public support, mobilizing and amplifying youth voices to demand, compiling and sharing evidence, lobbying high level decision makers at the ministry and MPs on the health committee of parliament to expedite the policy review and adoption process among others.

 

Various CSO partners including; Reproductive Health Uganda, Mariestoppes, Center for Health Human Rights and Social Development, Uganda Family Planning Consortium, Naguru Teenage Center, SRHR Alliance, Mama’s Club, Pace/ PSI, Planned Parenthood Global, UYAHF among other have embraced the move and committed to support the key recommendations and actions.

By Patrick Mwesigye and Annah Kukundakwe 

 

 

 

 

Youth Advocates train in SMART Advocacy

Kampala – Feb 25th 2018

IMG_7669Workshop participants pause for a group picture on day one.

On Feb 22nd 2018, Uganda Youth and Adolescents Health Forum (UYAHF) held a two day’s capacity building workshop for SRHR Youth Networks at Kolping Hotel Kampala on SMART advocacy and effective Coordination.

 

The capacity building workshop attended by 33 participants from five major SRHR Youth Networks in Uganda aimed at strengthening evidence based SMART advocacy and coordination capacity of youth networks to meaningfully advocate for policy shifts in Adolescents Sexual and Reproductive Health and Rights. The SRHR Youth Networks in attendence included among others; AfriYAN Uganda, Kampala Youth Advocacy Network, Girls Not Brides, Uganda Youth Network among others.

 

More than 3 in 10 people in Uganda are young people age 10 – 23, while nearly 12 million Ugandan are adolescents age 10-19 (34.8%), making Uganda one of the youngest countries in the world, 2014 National Census. Young people are shaping social and economic development, challenging social norms, beliefs and values, and are building the foundation for the country’s future.

But despite evidence that critical investments in Uganda’s young demographic could yield returns in protecting their rights, improve their health and wellbeing, including sexual reproductive health and rights, enhance school enrollment and completion particularly for girls, promote gender gender equality and provide skills and and knowledge to build capabilities and agency, Uganda has not done enough to pay extra attention to it’s young people and invest in their wellbeing.  As a result, many young people still confront obstacles that prevent them from having a safe transition into adulthood.

 

Multiple challenges like; early school drop among teenage girls (22%), pregnancy and child birth related complications (1in 4 girls), early and forced child marriages (1 in 2 girls), HIV infection (570 young women get infected with HIV weekly), sexual and gender based violence (58% for 15-19), unsafe abortions contributing almost 25% to maternal mortality rates youth, unemployment (83%), among others, all deprive young people of opportunities to realize their potential.

 

Majority of the above challenges are as a result of a none supportive policy and legal environment that promotes adolescent and young people’s Sexual Reproductive Health and Rights, gender equality and meaningful youth participation.

Just recently in a space of two years, we have seen government of Uganda, withdraw very critical policy documents including; the National Guidelines and Service Standards on SRHR, the National Standards and Guidelines for reducing maternal mortality and morbidity from unsafe abortion, the National Adolescent Health Policy among others.

 

To enhance meaningful youth participation and promote evidence based advocacy for improved adolescent sexual reproductive health and rights policies and programs, young people were trained on SMART Advocacy, effective coordination as well as improving communication and documentation.

 

The capacity building workshop was delivered using the PMNCH Advocating for Change for Adolescents Tool Kit a Practical Toolkit for Young People to Advocate for Improved Adolescent Health and Well-being.

IMG_7589Workshop participants in one of groups work taking on an excercise.

The toolkit which is joint initiative made possible by a collaboration between the Partnership for Maternal, Newborn & Child Health (the Partnership) and Women Deliver, with the support of several youth partners and contributors was developed to be used by networks of youth-led and youth- serving organizations to change the world! The toolkit guides the design, implementation and monitoring of an effective national advocacy action roadmap to bring about positive policy-specific changes to improve the health and well- being of adolescents.

The toolkit has 5 chapter each of which includes includes examples and exercises that assist young people to influence their country’s national health planning processes.

Interactive group break away sessions as participants delved deep into discussions and excercises of various toolkit chapters 

Chapter by chapter, and in an interactive style of dialogue and learning, youth participants we equipped with information on; Getting ready for action: understanding adolescent health and well-being ie; understanding health issues affect adolescents, adolescents’ rights, barriers that prevent adolescents from achieving health and well-being and understanding advocacy and accountability and why are youth-led advocacy and accountability and partnerships are critical.

Gathering information on national policies, strategies and plans; understanding policies, strategies and plans and what each entails, what makes for an effective adolescent health and well-being policy and why some adolescent health policies ineffective.

Using global commitments to improve adolescent health and well-being; what are global accountability mechanisms and how can they be used, how local and global processes are connected and how global commitments can be used as accountability tools.

Developing an effective advocacy action roadmap ie; understanding what you want to accomplish for adolescents’ health and well-being, who can help you accomplish your goal and objectives, what activities help to accomplish ones’ objectives and how to tell your efforts are successful.

Reviewing, monitoring and action for better results i.e; how do you know your efforts are working and can create a long-term change or whether you need to re-strategize.

Additionally, the workshop equipped youth participants with communication and documentation skills to support their advocacy interventions stressing the importance of accuracy in communication and documentation, developing a communications plan and effective use of the media.

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Main facilitator Patrick Mwesigye facilitating at the two day capacity building workshop.

Integrity was also highlighted a tool for building individual and institutional respect and credibility as well as increasing prospects for funding and sustainability of an organization. Different youth networks shared what they are currently doing in advancing adolescents and youth sexual reproductive and rights.

 

The trained was welcomed by all youth participants and some we quoted noting that there is need for more of such capacity building training organized and facilitated by fellow peers where we don’t only learn how to improved our advocacy, but evidence based SMART advocacy, joint sharing, learning and implementation and most importantly joint reflection, review and monitoring our progress and the impact of our our advocacy work.

 

Youth participants pledged to use evidence in building up cases for their advocacy interventions and ensuring the SMART approach in designing their advocacy strategies while some pledged to develop communication plans/ strategies for their networks.

90% of the participants rated the training highest in attaining the workshop’s intended objectives.

 

By Patrick Mwesigye, Praise Mwesigwa and Hassan Njukyi.

 

I was scared of becoming a young mother and I knew I would drop out of school

By Patrick Mwesigye

Uganda Youth and Adolescents Health Forum

IMG-20170926-WA0042One of the Uganda Youth and Adolescents Health Forum, peer educator pauses with a plac card in support of SheDecides a global movement to promote, provide, protect and enhance the fundamental rights of every girl and woman.

It is when I was 18 that I realized I was pregnant, and I had not planned for this pregnancy. I honestly did not want to get pregnant, though I was sexually active and was not using any form of contraception.
I got to know family planning existed as I watched various adverts on TV and I had herd my friends talk about it, but I was not sure how it worked and even how to go about where to get the services.
I was scared of becoming a young mother and I knew I would drop out of school and thought about aborting though my partner didn’t want. My friends told me abortion is very dangerous for me and I cold die along other way, lose or damage my uterus and never to give birth again.
So I kept my baby, i had to forego school to take care of my pregnancy. At 20 I got married to my partner as my guardian could no longer take care me, since I now had a child. My father had died when I was three and my mum, died when I was nine.
I only got know about family planning after sometime when I was already sexually active, and I was afraid to use family planning as I had herd several myths and misconceptions about it like; family planning causes cancer, if I use it I also stand a chance of not bearing children in the future.
At school they only told us to abstain from sex to prevent HIV and early pregnancy but no one told us what to do in cases we were sexually active.
3 months after giving birth to my first born I was put on family planning by the midwife who assisted me to deliver my baby.
After my first child, I never went back to school till today and I regret having been pregnant. I believe I would have kept in school and completed a degree program If I had not become pregnant by then. May be by now, I would possibly be a doctor since this was my dream as a child.
Today I am pro-family planning as it helps many women and girls in my state to prevent pregnancy. I would actually open up to my doughter as early as 14 to use family planning if they were sexually active to avoid pregnancy and to use condoms to avoid STIs. But of-course I would also encourage them to abstain as the first option. I would also talk to them about the long and short term dangers of early pregnancy and child birth.
This is Shamila’s story now 22 years who is one of the young women that Uganda Youth and Adolescents Health Forum Supported to join over 1000 participant at the National Family Planning Conference held 26 &27th September 2017.

IMG-20170926-WA0052Young people in Uganda, Match across the street of Nsambya during the National Family Planning Conference Pre-Youth event 

The Conference whose overall goal was to position family planning in Uganda as a tool for national development, social transformation and attainment of vision 2040, also aimed at the need to review the progress so far made since the launch of Family Planning Costed Implementation Plan 2015/2020, the FP2020 Commitments and to provide a platform for young people to share experiences and advocate for equitable family planning services, as well as to disseminate research findings, new technologies and best practices in family planning and enhance leadership and dialogue for FP at all national and sub national levels

Uganda’s recently released Demographic Health Survey (UDHS) report has showed some progress in the family planning indicators, though very slow and putting the country behind it’s East African Community counterparts. Uganda’s CPR has improved to 35% with unmet need of 28% (UDHS 2016). Maternal Mortality Rates has also had a slow decline from 438/100,000 live births in 2011 to 336/100,000 live births in 2016. Additionally, there has been tremendous efforts in the country to scale up service delivery by the various players of Family Planning in government, private sector and CSOs including the religious institutions.

In her official opening remarks Hon. Ruth Jane Acheng the Minister for health highlighted government of Uganda’s commitment to widen coverage, access and availability of modern family planning methods and applauded partners that have supported government of Uganda’s efforts in delivering equitable family planning services to all women and girls in need. She echoed that the government of Uganda has revised it’s target to reduce unmet need for family planning to 10% and increase the modern Contraceptive Prevalance rates among all women to 50% by 2020.

She also noted that Family Planning is central for Uganda’s social economic transformation to a middle income economy status and hence called for increased investments. She highlighted government’s support to realzing the FP 2020 commitments particulary, expanding the cadres of skilled workforce to provide quality family planning services including LARCs, allocation of USD 5million for procurement and distribution of reproductive health FP suplies and commodities to the last mile, as well as allocation of 10% of the RMNCAH budget for adolescents friendily family planning services.
The conference also took stalk of the discussions and Uganda’s commitments for Family Planning 2020 announced during the July 2012 and July 2017 Family Planning Summits in London. In 2012, at the London Summit on Family Planning, representatives of more than 20 countries, the research community, privates sector and multi-/bi-lateral organizations, donors came together and forged an agreement to provide modern contraception to an additional 120 million girls and women in 69 of the World’s poorest countries by 2020.
Four years later, important progress has been made, as reported by Family Planning 2020, the partnership established following the London Summit. This includes the 300 million women and girls using modern contraceptives in 2016 across the 69 FP2020 focus countries, more than 30 million were added since 2012.
Regardless, of the above achievement, there still remains a huge gap, especially in relation to meeting the contraceptive needs of adolescents.
The recently concluded July 2017 Family Planning summit, put more focus and attention on the family planning and contraceptive needs of adolescents, recognizing that progress in this group has been slow and inconsistent. This was witness by various countries making new commitments on adolescent health with an overall goal of increasing adolescent’s access to contraceptive services through addressing barriers to access.

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An inforgraphic showing Uganda’s statistics on adolescent sexual debuts and contraceptive use (PMA 2020) while the phot below a UYAHF peer educator demonstrating female condom use. 

This presents us a never before opportunity to address adolescent contraception and it is a timely opportunity as there is enormous numbers of adolescents like Shamila who are currently unable to obtain and use contraceptives. From the level of existing evidence and programmatic experiences, to be able to meet the needs and fulfill the rights of adolescents we must embark of evidence based high impact interventions.
Uganda today has nearly 10 million adolescents aged 10–19 years – 24.3% of the country’s total population. Analysis of data from the Uganda Demographic Health Survey in 2011 showed that more than 1.1 million Ugandans aged 15–19 were sexually active – they were either unmarried and had, had sex in the last three months or they are in a union (i.e. married or living together). On average, among adolescents who had sex before age 20, adolescent girls first had sexual intercourse at age 16.1 years and adolescent boys at 16.4 years (Uganda Data WHO factsheet)
Additionally, Uganda’s 2016 UDHS put teenage pregnancy rates at 25% showing a rise from 24.5% in 2011. The country also has one of Africa’s the highest unmet need for family planning for adolescents 15-19 estimated at 30.4% with total demand of 52.3 and 29.3% for young women 20-24 years with a total demand of 63.3%.
Further more, the countries MMR of 336/100,000 live births in 2016 translates into approximately 16 women dying every day due to complications related to pregnancy and child births. This also translates to over 6000 women dying annually and others suffering from life long complication and disability.
Teenage pregnancy continues to contribute greatly to the maternal deaths and injuries in Uganda to about, 24%, with pregnancy and child birth related complication being the major leading cause of deaths among adolescent girls of 15-19 years. Pregnancy and child birth related complications have life long health and social economic effects on the lives of adolescent girls and their families as well as their children.

IMG-20170926-WA0050Young people participating in a focused group discussion on understanding adolescent and youth sexual reproductive health rights, convened by Uganda Youth and Adolescents Health Forum at the National Family Planning Conference Pre- Youth event. 

Scaling up FP services is one of the most cost-effective interventions to prevent maternal, infant and child deaths in Uganda. Family planning interventions aid in lowering maternal, infant, and child mortality, contributing to the realization of the 2030 Sustainable Development goals.
Through a reduction in the number of unintended pregnancies in Uganda, it is estimated that one quarter to one third of all maternal deaths could be prevented (Uganda CIP 2015/2020). Family planning is linked indirectly as a contributor to positive health outcomes. For example, family planning interventions contribute to reducing poverty, increasing gender equality, preventing the spread of HIV, reducing unwanted teenage pregnancies, and lowering infant deaths. Additionally, for every dollar spent on FP initiatives on average, results in a $ 6 savings on health, housing, water and public services.

Some of UYAHF’s supported Young people at the Pre-youth event.

Uganda Youth and Adolescents Health Forum supported about 10 young people to participate in the National Family Planning Conference. The young people spoke at panels while other made several interventions on the flow.
In her remarks, Flavia 16 years a S.3 student of Kitante Hill School, called on ministry of health and ministry of education to start providing age appropriate, correct and relevant sexuality education at school to aid young people to make informed choices about their health and wellbeing. She also called for training of health service providers to offer quality adolescent friendly SRHR services and to posse positive attitudes and drop the bias towards young people while providing SRHR services. Flavia also called for SRHR services to be affordable, confidential and private and to offer a wide range so young people have options to make a choice. She also noted that communities and the public needs to stop discriminating against and stigmatizing girls who want to use contraceptives.

Young people engaging in constructive discussions at the Zone where their freely shared experiences, dialogued and learnt about their SRHR needs. 

UYAHF featured a SheDecides digital zone in the conference’s main exhibition area and approximately 500 people visited the zone. At the zone we passed on information on SheDecides which is a movement, that advocates for a world where very woman and girl can decide what to do with her body, with her life and with her future without question. Additionally, were able to sign up 300 people as champions for SheDecides who also pledged/ committed to support and advocate for reproductive rights of women and girls.
At the Youth Pre-event that happened on 25th October a day prior to the conference, we held focused group discussions with young people which provided a space for dialogue, sharing and learning about family planning/ contraception and how young people can exercise their sexual reproductive health rights without shame.
We were also able to showcase innovative interventions of our signature Campaign Ensonga which is a menstruation hygiene and management campaign aimed at promoting menstruation with dignity. About 100 of adolescent girls and young women came through to learn about menstruation related issues at the digital zone.

Will the Momentum Set at the 2017 London Family Planning Summit Meet and fulfill the Contraceptive needs and Rights of Adolescents?

By Patrick Mwesigye

Founder/Team Leader: Uganda Youth and Adolescents Health Forum (UYHAF)

 

IMG_2863In the picture, Patrick Mwesigye (UYAHF) conducts a community focused group discussion with adolescent girls from Bwaise Slum a Kampala Suburb on.

2017 marks exactly five years since the 2012 Summit on Family Planning, and just past the halfway to mark 2020, the year the global community promised to have delivered modern contraception to an additional 120 million women and girls who want them but lack access in 69 of the world’s poorest countries by 2020. But delivering on this commitment requires very urgent intensified action to accelerate progress to Family Planning 2020 goals and our shared vision of universal access to sexual and reproductive health as laid out in the 2030 Agenda for Sustainable Development.

Achieving this ambition also requires all women and girls to enjoy fully, their fundamental right to decide freely and for themselves, whether, when, and how many children to have as is central to the vision and goal of FP2020.

On July 11 2017, over 600 policymakers, donors, and advocates from around the world gathered at the Family Planning Summit in London, UK, to discuss efforts to reach our Family Planning 2020 goals and ensure that more women and girls around the world are able to plan their families and their futures.

At the summit policy makers, donors, and advocates collectively announced over $2.5 billion in new funding to deliver rights-based family planning with focus on better serving the largest generation of adolescents in history and the hardest-to-reach women and girls.

The summit also aimed to sharpening our focus on lessons learned and proven solutions, while broadening and deepening our network of partners to bring local action and solutions to scale – particularly for populations that have traditionally been left behind such as adolescents and youth and women and girls in humanitarian situations.

Family planning is a best-buy in global development. When women and girls have access to family planning, they are able to complete their education, create or seize better economic opportunities, and fulfill their full potential—in short, entire families, communities and nations benefit.

The Family Planning Summit co-hosted by, DFID, UNFPA, and the Bill & Melinda Gates Foundation and the FP2020 partnership saw many of the now 41 FP2020 partner countries make renewed commitments to accelerate family planning progress. Over 100 new commitments were made including two thirds of countries making commitments on adolescent health

Alongside the Summit in London, countries took a lead role in demonstrating their commitment to family planning. More than 3000 people gathered at 34 satellite events across Asia, Africa, and the Middle East, demonstrating growing country leadership and support for family planning and untill today, more follow up events are happening at country level.

Financial commitments announced at the Summit are expected to total at least $2.5billion USD by 2020. The majority of the funding – $1.5 billion USD– has been committed by countries in Asia and Africa. Many of FP2020’s 38 partner countries made renewed commitments to accelerate family planning progress, and four new countries are joining the FP2020 partnership. Download the full commitment summary document here

The summit also provided the opportunity for the global community to pause and honor the life and work of Dr. Babatunde Osotimehin. Dr. Osotimehin dedicated his life to the conviction that sexual and reproductive health and rights, and in particular high-quality, accessible family planning for all must be prioritized in the global development agenda.

FP2020 contributes to the goals of Global Strategy for Women’s, Children’s and Adolescents’ Health, and the commitments to FP2020 are in support of Every Woman Every Child movement.

To Realize the FP2020 and Every Woman Every Child goals, we must empower women and girls as actors and decision makers in their own lives, homes and society and ensure that they are able to fully decide what do with their body, their life and their future without question. Increasing access to family planning, harnessing gender equality and empowering of women and girls to realize their rights and potential is critical to achieving peace, prosperity and sustainable development.

IMG_9275Anna Kukundakwe, UYAHF program officer conducting a training session with school girls of Mita college Kawempe a Kampala suburb on prevention of early and unwanted pregancies and prevention of sexual and gender based violence. This was during the International women’s day 2017.

But central to our efforts to realize the FP2020 and Every Woman Every Child goals, lies Populations that have been left behind, such as; adolescents. Despite the commendable progress made over the last four years as reported by Family Planning 2020, there still remains a huge gap especially in relation to meeting the contraceptive needs of adolescents, recognizing that progress in this group has been slow and inconsistent.

This however presents a timely and much needed opportunity to prioritize the rights and needs of adolescents as emphasized by the Global Strategy for Women’s children’s and Adolescents Health. The 2016 Lancent commission report on adolescents and wellbeing also reiterates the triple dividend of investing in adolescent; for adolescents now, for their future adult lives and for their children. Additionally, the recently published WHO country guidance document; “Global accelerated Action for the Health of Adolescents” (AA-HA) notes, clearly that we are at a never before moment for greater global and national attention to increase investments in adolescent health and development.

With the enormous numbers of sexually active adolescents who are currently unable to obtain and use contraceptives but do not want to get pregnant or want to space or delay child birth, the momentum set at the July 11 Family Summit 2017, presents us a never before opportunity to address adolescent contraception.

Our efforts to expand access to quaity contraceptive services for adolescents must be combined with efforts to build their desire and ability to use them and to do so consitently. However, this can only be possible if we get to action and do things differently to meet their needs and fulfill their rights.  Efforts by FP2020 to make adolescent contraception a key priority are timely as witnessed in the prtnerhsip’s midpoint review “Momentum at the Midpoint” which emphasizes accountability, partnership and youth and adolescents as key areas of focus in moving forward.  As recommended by the Midpoint report, to meet the needs of youths and adolescents countries and stakeholders must examine their policies, and programs and develop a process of evaluation that genuinely reflects a youth perspective, and implement evidence based programs that work.

In conclusion, i want to refer you to the words of the former UN Secretary General Ban Ki-moon in his forward to the revised Global Strategy for Women’s, Children’s and Adolescents Health, “The Updated Global Strategy includes adolescents because they are central to everything we want to achieve, and to the overall success of the 2030 Agenda.  By helping adolescents realize their rights to health, wellbeing, education and full and equal participation in society, we are equipping them to attain their full participation as adults”

Adolescents and youth Voices count in the 2030 SDGs Agenda

Patrick Mwesigye

May 18th 2017

Kampala Uganda

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As the world community continues to devise strategies for successful implementation of the SDGs agenda, its paramount that intensive investment is done in  adolescent girls and young women’s health, education, social and economic development as this is key for improving their survival and well-being and critical for the success of the  sustainable development goals agenda.

Meeting the SDGs’s significant commitment of ‘leave no one behind’, will require us as countries to pay attention to the marginalization and challenges that women, children and adolescents face at households and public decision-making and devise strategies to address these challenges as well as meet and address their needs and interests, and ensure that they are better represented in national development plans and programmes.

In the implementation of Agenda 2030, it is time to act and eliminate established power dynamics, structural inequalities and social norms that keep adolescent girls and women, in particular, from realizing their rights and accessing the critical services they need.  There is clear and increasing evidence that meaningful engagement of citizens, including women, girls and adolescents in policy design contributes to improving quality of services and to increasing the uptake of services which in turn leads to improved citizen’s quality of life and wellbeing. Adolescents must participate and be heard in decision making and the development of policies and programmes that affect them. Their needs and rights cannot be overlooked any longer.

With over 200 young people in attendance the Pre – 2017 World Health Assembly, National Adolescents and Youth Symposium on SDGs was held today on 18th May 2017 in Kampala organised by Uganda Youth and Adolescents Health Forum and World Vision Uganda, with growing momentum around citizen-led accountability across the world, to feed into discussions at the May 2017 World Health Assembly.  The symposium sought to share best practices from citizen participation in Agenda 2030 implementation, particularly highlighting the role and contribution of adolescents and young people, and to provide a platform for dialogue between young people and high level policy makers. The symposium feature discussions and dialogue on the multiple obstacles that underpin young people’s opportunities to realize their full potential, ranging from human rights violations, health, social and cultural harmful practices among others.

Young people at the symposium listen in to the discussions and contribute to the discussions.

Additionally, the event highlighted lessons and recommendations coming out of grassroots citizens’ hearings and citizen participation initiatives that we have been conducting with young people across the country as part of a local-to – national/global feedback approach.

Throughout the discussions, young people noted the need to have their unique health needs dominating centre stage of all discussions at the 2017 World Health Assembly discussions on Progress in the implementation of the 2030 Agenda for Sustainable Development and on Global Strategy for Women’s, Children’s and Adolescents’ Health.

Key highlights of the discussions;

  • Health investments need to focus on the fundamental rights of women and girls to decide freely and for themselves about their sexual lives, including whether, when, with whom and how many children they have.
  • Ensure adolescents have access to comprehensive sexuality education so that they are knowledgeable about their own health, develop life skills, and know when and where to obtain health services.
  • Develop/provide a package of information, counselling, diagnostic, treatment and care services that fulfils the needs of all adolescents, through facilities, referral, outreach and other innovative mechanisms
  • Train healthcare providers in technical competencies for adolescent health, and to respect, protect, and fulfil adolescent’s rights to information, privacy, confidentiality, non-discrimination, respect and choice.
  • Invest in health facilities to ensure a clean, welcoming, private and confidential environment with the right equipment, medicines, supplies and technology.
  • Ensure that adolescents can access a full range of contraceptive methods by ensuring that providers have been trained, commodities are available, and demand generation activities address myths and misconceptions around certain methods.
  • Eliminate legal, legislative, financial, and third-party consent barriers to adolescents receiving information, counselling and services, irrespective of age, marital status, parity etc.
  • Engage adolescents in the planning, monitoring and evaluation of programmes, and in certain aspects of health information and service provision.
  • Collect and analyze new and existing data on adolescent health, disaggregating by sex, age (10-14,15-19), marital and rural/peri-urban/urban location.
  • Map and evaluate existing adolescent SRHR programmes, assessing their coverage, costs and effectiveness.
  • Use data to inform adolescent SRHR policy and programming, and to ensure that information and services are reaching the most marginalized and vulnerable adolescents.
  • Invest in strategies beyond health that protect and empower adolescents, such as keeping girls in school particularly into and through secondary, ensure adolescents have the necessary life skills and social support to make safe, voluntary transitions to adulthood and help bring an end to harmful practices such as child marriage and FGM.
  • Build support for adolescent SRHR among parents, community members, community organizations, religious leaders, and teachers; and challenge social norms and beliefs that undermine both girls’ and boys’ SRHR.