By Evelyn Lirri
“Over 4,000 teenage pregnancies registered in northern Uganda,” reads one article. “2,300 school girls conceive, 128 married off during lockdown,” reads another. These are just but two examples of stories reported in the media in recent months about the alarming cases of adolescent girls becoming pregnant or being married off during the COVID-19 lockdown.
The COVID-19 pandemic which led to the closure of schools since early March, and therefore left many young girls exposed to sexual abuse in their communities has been blamed for the high numbers of teenage pregnancies and early marriages registered across the country. While there have always been barriers to accessing sexual reproductive health services across the country for all categories of people, COVID-19 put an extra strain on the problem, as most health care services remained inaccessible to a big part of the population.
With high poverty levels, exacerbated by families losing their sources of income during the lockdown, many young girls found themselves engaged in transactional sex in order to meet basic needs such as food and clothing.
Consequently, with no access to sexual reproductive health information and services, including contraceptives, many of these sexual encounters have resulted into unwanted pregnancies.
But even before or without a pandemic such as COVID-19, Uganda has always had a teenage pregnancy problem, one that has remained unaddressed for a long time. What COVID-19 has done is bring to the fore a problem whose symptoms are often addressed instead of the root causes.
To understand the hidden epidemic of teenage pregnancy, let us start by looking at the national statistics. About 25 per cent of girls become pregnant before the age of 19, according to the Uganda Demographic and Health Survey (UDHS), 2016. This makes Uganda one of the countries with the highest teenage pregnancy rates on the African continent.
Furthermore, the age of sex debut, a major contributing factor to teenage pregnancies in the country remains disproportionally low, with the UDHS study showing that 10 per cent of girls and 17 per cent of boys will have already had their first sexual encounter by the time they reach the age of 15.
Most of these encounters are a result of sexual abuse, including rape, defilement and exploitation within homes, families and the communities. For instance, 13,613 cases of defilement were reported to the police in 2019 alone, according to statistics from the annual crime report.
Yet just between January and June this year, another 7,000 cases of defilement were registered with the police directorate of criminal investigations, with cases expected to rise even further by the end of 2020. Despite these alarming numbers, child sexual violence continues to persist. Consequently, more underage girls continue to become pregnant, are married off before the age of 18, or become school dropouts an early age.
Without the government adopting a more comprehensive approach to sexuality education, it remains difficult to address the challenges that teenage pregnancy presents to the country. The problem has been compounded by the lack of comprehensive information on sexual reproductive health and rights (SRHR) for adolescents and young people. This lack of comprehensive information on sexual reproductive health has affected young people’s ability to make informed decisions—which in turn has contributed to the high numbers of underage girls becoming pregnant, according to reproductive health advocates.
“Teenage pregnancies and unsafe abortion are a sign that young people are having sex. Those who deny this should look at the statistics because statistics don’t lie,” Shivan Alinda, a law student at Makerere University and advocate on SRHR told a recent dialogue where experts were examining the impact of COVID-19 restrictions on access to reproductive health services in the country.
At a time when the focus should be geared towards ensuring that adolescents and young people have access to sexual and reproductive health rights information and services, cultural and religious leaders on the other hand have been at the forefront of fighting efforts to expand access to services to young people.
In 2018, the government of Uganda through the Ministry of Education and Sports drafted the National Sexuality Education Framework, to guide the teaching of sexuality education, starting with the primary school level.
However, implementation of the framework has stalled because conservative and religious groups want some amendments made on aspects of the policy that aim to tackle the teaching of sexuality education to school children.
In fact, the controversy on whether to include sexuality education in the school curriculum has been a long running one.
In 2016 for instance, the Ministry of Gender, Labour and Social Development banned comprehensive sexuality education in schools, on grounds that some of the books on sexual reproductive health comprised of what it considered taboo topics, including those about sexual orientation and masturbation. Much of the sex education related teachings conducted in schools often focuses on abstinence and how to prevent HIV and other sexually transmitted diseases.
But activists and reproductive health experts say sexuality education is critical in providing young people with information and knowledge about their sexuality, which in turn enables them to make better choices and increases their chance of preventing sexually transmitted infections, teenage pregnancies and its associated negative consequences, including risk of morbidity and mortality.
This is because a teenage pregnancy is more likely to end up in an unsafe abortion or complications during childbirth. Globally, the World Health Organisation (WHO) says pregnancy and childbirth related complications are the leading cause of death for girls aged 15 to 19, with COVID-19 preventive measures presenting an increased risk for such young mothers because of restricted access to healthcare services.
Between 2015 and 2019, WHO notes that three out of 10–representing 29 per cent of all pregnancies, and six out of 10–representing 61 per cent of all unintended pregnancies worldwide ended in induced abortions, and 45 per cent of them were not safe.
Dr. Charles Kiggundu, a senior consultant gynecologist and member of the Association of Obstetricians and Gynecologists of Uganda (AOGU), explains that service providers are sometimes the barriers to accessing sexual reproductive health services because of the selective way in which they offer these services, especially among young people.
Denis Kibira, the executive director of the Coalition for Health Promotion and Social Development (HEPs)-Uganda, explains that while the COVID-19 pandemic has affected supply chains for reproductive health commodities globally, the issue of choice is one that little attention has been paid to.
“For young people, there was no way of getting to facilities, which put them in more vulnerable positions,” he says.
A recent poll survey by HEPS Uganda that sought to understand how the pandemic has affected access to sexual and reproductive health services found that 33 per cent of respondents said the pandemic had affected their access to all services. Another 33 per cent noted that some services were not available, and only 19 percent said they were able to access services. One of the major challenges given by young people in being unable to access services was the “lack of youth friendly services,” according to the poll survey.
Asked what would be the best way to sustain the provision of quality reproductive health services to young people, 29 per cent of respondents noted that bringing youth friendly services closer to young people could help. Another 24 per cent of respondents said training health workers on how to provide youth-friendly services would make a difference.
