By Patrick Mwesigye
Uganda Youth and Adolescents Health Forum
One 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.
Young 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.
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.
Young 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.