Wednesday, October 11, 2017

Contraceptives for teens? Immoral but they are having sex!

By Esther Nakkazi

On the International Day of the Girl Child, Uganda is struggling with what to do with her girl child. At the tender age of sixteen or less, the average Ugandan girl is having sex. But do they need contraceptives?

According to studies, Uganda has one of the highest teenage pregnancy rates in sub-Saharan Africa. By ages 15-19, one in four Ugandan women is already a mother or is pregnant and later in life from age 15 - 24 years - the burden of HIV is high - Uganda has the second highest rate of HIV infection among women.

To wisely address this issue Uganda revised its fourth, 2015, policy, National Guidelines and Service Standards for Sexual and Reproductive Health and Rights.

After 18 months of adequately engaging all stakeholders including district leaders, service providers, religious and cultural leaders, with Uganda's Ministry of Health, particularly its reproductive health department, spearheading the review process, the Guidelines were ready to be launched.

They were, duly, signed by Uganda's Ministry of Health acting director general of health services, Prof. Anthony Mbonye who is also a member of the faculty of public health at London's Royal College of Physicians meaning his ministry endorsed them. As well the assistant commissioner of health services, Dr. Bladinah Nakiganda appended her signature.

Strategically, the revised Guidelines were to be launched on the final day of the Uganda National Family Planning Conference, held from 26th to 27th September 2017 in Kampala.

When they were presented to the state minister for primary health care, Joyce Moriku, there was hesitation and she announced that the speaker of Parliament, Rebbeca Kadaga, was not consulted so she could not launch them.

Ultimately, she refused to launch them saying, Ministry of Health officials had not been consulted and that the Guidelines intended to distribute contraceptives to 10-year-olds.

Birth control is a preventive health care strategy.

In the same breath when the Minister of health, Dr. Jane Ruth Aceng, appeared before parliament she confirmed that her ministry does not own the Guidelines and ‘acting staff’ in this case a high-level well-trained official, who is part of her team, endorsed the guidelines.

The Permanent Secretary at the Ministry of health, Dr. Diana Atwine has also told reporters that they do not agree with the guidelines and they will stick to ‘moral principles’.

Now, besides showing a lame, uncoordinated leadership at Uganda’s Ministry of health this whole fracas shows two other things. While for HIV, the leadership is worried that the money injected into prevention is not yielding matching results and will defend every coin the story is different when it comes to family planning.

This year, the Uganda teen pregnancy rate shot up by 1%. For over 10 years, the Uganda teenage pregnancy levels have stagnated, at least 25 percent of Uganda teenagers become pregnant by 19 years and face four times the risk of maternal death according to the Ministry of Health.

On the other hand, there is increased funding, even domestically, the family planning budget has grown by 40% from $3.3 million $5 million after President Museveni attended the 2012 London Family planning summit. 

But the leaders at the Ministry seem to be comfortable with having more funds and maintaining the miserable reproductive health stats.

Secondly, in February this year, I attended the first international symposium on community health workers held in Kampala. 

The Executive Director for African Centre for Global Health and Social Transformation (ACHEST) Prof. Francis Omaswa, a much-celebrated officer at the Ministry of Health advised that; ‘the best way to manage a system is not to blame an individual. I guess, in this instance, that should be advised to the ministry of health leadership.

This morning civil society had a press conference and confessed to a dangerous trend of Ministry of Health creating a ‘leadership vacuum’ and refusing to provide evidence-based policy and technical guidance on issues that relate to sex and sexuality in Uganda.

They also blamed the ministry for creating a ‘policy desert’ especially for health workers who are faced with challenges of young girls asking for contraceptives.

Apparently, the revised Guidelines are an essential technical tool to equip policymakers and health workers with the framework to provide SRHR services to Ugandans, including adolescent girls and young women.

"We have to address the reality the girls are facing. We need access to services based on science and evidence. Ministry of health should be ashamed," said Moses Mulumba, the team leader at CEHURD.

“Our babies are having babies and it is a reality that young girls are having sex,” said Justine Balya, the Human Rights Awareness and Promotion Forum (HRAPF) Legal Consultant at the civil society press conference.

Civil Society also cited governance issues, saying it is a "failure of leadership on the part of the Ministry of Health," for the launch and later withdrawal of not only these SRHR policy guidelines but also the ‘Standards and Guidelines for reducing Morbidity and Mortality due to unsafe abortion in Uganda’ which were withdrawn in 2016.

For the National Guidelines and Service Standards for Sexual and Reproductive Health and Rights civil society which funded them said all they are interested in is providing age-appropriate family planning information to young girls and that is spelt out in the Guidelines.

Now, no one is interested in giving teens contraceptives. They are too young. But if they become teen mothers their own teen children will also have babies and the cycle will continue.  The best we can do is have an 'open and honest' conversation not mute it. With the right information, they will make the right call! Don't we get it!


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