Friday, June 28, 2019

Uganda’s National Sexuality Education Framework Lies Dormant

By Esther Nakkazi

Uganda is experiencing significant sexual and reproductive health challenges like high teenage pregnancy, early marriages, HIV and gender-based violence in schools.

The National Sexuality Education Framework was developed in response to the urgent need for a National Policy Framework on Sexuality Education and Development and dissemination of related materials.

The Health Journalists Network in Uganda (HEJNU) members in partnership with Uganda Cares teamed up at a media science cafe held on 29th May 2019, to understand what is happening to this National Sexuality Education Framework and why it has not yet been implemented. 

Below are the highlights and excerpts from HEJNU media science cafe by Esther Nakkazi:

Speaker 1: Denis Lewis Bukenya, the Deputy director, Naguru Teenage Information and Health Centre

Overview of the Uganda comprehensive sexuality education framework:

There has been a ban on comprehensive sexuality education in Uganda. But comprehensive sexuality education is a global word which is used to mean that we talk about aspects of sexuality from a rights best angle, where everyone is equal, where there is a choice. 

What sparked off the ban were schools that had curriculums looking at comprehensive sexuality education. Parents groups got concerned and petitioned the ministry of Education and Sports.

The ban has been fueled by a lack of information but also because Ugandans don't come from a background of ‘rights-based’ living. When it was banned a secular was circulated to all stakeholders signed by the ministry of Gender, Labour and Social Development.

It said we need to pause comprehensive sexuality education because of the misconception in schools and advised that the Ministry of Education would lead by coming up with a framework which it did and it was launched in May 2018 by the first lady and Minister of Education.

The process of developing the framework was long and tedious. I don’t want to talk on behalf of the technocrats or anyone but I know there is a bit of fatigue because we feel we are not moving as fast as the country needs the sexuality education framework.

The framework was premised on basically two things; The framework is values based. Do you all have values? Are your values the same as your neighbor? If the framework is values based we have religious, cultural and ethical values. 

It also has six principles; God-fearing, parental role in child up-bring, the centrality of the family in child upbringing, age-appropriateness, risk avoidance and lastly preparedness, response and rehabilitation of learners.

The principles and values provide for the basis of whatever we might need to pay attention to it as journalists of HEJNU.

The framework also has four themes; sexuality and human development, sexuality and relationship, sexuality and sexual behavior and sexuality and sexual health all of which have specific topics.

In theme 1 which is sexuality and human development, it includes ‘knowing oneself’. There is male and female reproductive anatomy and physiology; puberty; human reproduction; body image and sexuality.

In the sexuality and relationships theme, there are types of love, dating, and courtship, preparing for long term relationship, good versus bad relationships, marriage and family.

In sexuality and sexual behavior, there is sexual abstinence and faithfulness, gender-based violence (GBV), and deviant sexual behaviors.

And in the last theme of sexuality and sexual health the topics are menstrual health and hygiene; prevention of pregnancy; importance of antenatal and post-natal care; Abortion and risks associated with it; Sexually Transmitted Infections/Diseases; HIV and AIDS; Care and Support of people suffering from STI and STDs including HIV; Non-communicable diseases and Sexuality.

Targets of education are covered in the framework distributed across the age ranges; early childhood (3-5 years) for pre-primary leaners in nursery, lower primary; (6-9 years) from Primary 1 to 4, upper primary (10-12 years) from primary 5 to 7, lower secondary (13-16 years) from senior 1 to 4 and lastly A-level/tertiary institutions 17+ years senior 5 to 6 students , tertiary institutions of learning for example colleges, institutes and universities.

The comprehensive sexuality education package is provided according to that age and that is where we get to age appropriate terms. I want to comment that I am aware that there's been reactions and discussions about this framework and it comes largely from the Catholic faith.

They have questions about the package especially for the early childhood (3-5 years) for pre-primary leaners in the nursery, lower primary. But also of things like marriage and family, mostly how they are packaged.

I know that there are certain things that are within this framework that I don't believe in and I don't agree with and it's because of the lens I have and I believe in. 

We shall wait for whatever step the country decides to take but right now we can only lobby and give a lot of information so that people understand what we are talking about ‘a rights based approach’ other than ‘values based approach’.

Some of the right's best approach aspects are not agreeable because they are not ‘Godly’ and they say are not acceptable. Ladies and gentlemen that's all I can give you as a preamble. Thank you.

Speaker 2: Bridget Jjuko, AVAC Fellow

The schools have been using other documents for example under PIASCY. So does this mean that you know PIASCY is not operational anymore? If it is how is comprehensive sexuality education going to be integrated into what already is happening in schools?

We have issues like different themes. From the civil society point of view, we say we need to equip the teachers. There is no way that we ought to give this information to children without teachers knowing exactly what they are talking about. That is very key.

The comprehensive sexuality education package is meant to guide what information is being given in school and it is true we have our children in school but they don't spend most of their time in school. What happens when they leave school? If there's going to be a document to guide what is happening in schools or information that is being shared in schools there's a lot of information shared out of school regarding sexuality.

We have a lot of partners outside the schools sharing ‘values based’ information so how is this going to either contradict or integrate with the information that is already going on outside our schools.

I know that the Ministry of Gender is working on a sexuality education framework for the ‘out of school’ and again a lot of engagements were done when this document was being developed. It will be very instrumental and important for the in school and out of school and what kind of information they are sharing together.

So for me as an advocate, it doesn't make sense empowering a person that's in school and leaving another when there's going to be that difference in information. There's going to be a clash. There should be many more engagements right now to avoid the big backlash.

We should actually be up to date on what exactly is happening with this document where it is in the system. Is it implemented? What role do you play as a journalist in the implementation of such a document?

As civil society, we are worried about the Catholic fraternity which runs almost 90 percent of our schools. So if they do not agree with this there's going to be a very big backlash. And right now as steps are going forward to make sure this is implemented those are very key aspects. Those are very key people to involve and engage to make sure that they are on board.

Should the comprehensive sexuality education bill be withdrawn, of course not! It is a very good document but we just want to be sure that it does what it was meant to do. The other thing we are going to know is actually is it going to work and we've been having these discussions so let's try and implement this. From implementation, we are going to learn that there are certain things that are not supposed to be the way they are or that they are things that deserve to be changed.

About how long it will take to be reviewed - the budget and things like that? This is like any other policy document or a framework that can actually be reviewed to incorporate those things. But I don't think it can be withdrawn. I think we are not going to use it but before we need to try it and see how exactly this is going to work for us.

Hilary Beinemigisha, Editor, The New Vision Newspaper;

As media, we have a role to play in this framework and I will summarize the roles in five points: Explain the framework, comply with it, support it, appraise it and evaluate it.

Our first role as media is to explain the framework because we have the audiences and have the platforms. The second role is to comply because the framework faults the media so much that we are the ones bringing bad habits among the children. The third one is to support the framework. Support it as you appraise it as we support it.

If you go to the ministry and you ask any question about this framework some of the technocrats say we finished our work and handed it to the minister. She went and changed a few things. We cannot challenge it without losing our jobs. So let the implementers do their job and start implementing but they say don't quote me.

Alice Kayongo, Programme officer, Uganda Cares;

One of the other areas where the ministry of education is at right now is that they want to harmonize with all stakeholders and precisely this means they want to harmonize with the Catholic church who are the ones a bit uncomfortable with the framework.

The ministry now has the Life Skills Summit every year on sexuality education being conducted at a regional level. It replaces the Youth Conference that used to be conducted yearly. What happens is they gather young people in a central place and then talk to them about this thing called sexuality education but they are doing it a little differently as they identify student leaders from different schools because it's hard to gather all the students. One summit has been held in Kampala region already, held at the Kololo air strip with over 2000 student leaders gathered for three days.

The other thing that the ministry of education is doing right now is that they are planning on resource materials with questions like what exactly do learners need? What do teachers need? This is exactly what Bridget alluded to in her talk because the teachers have no guide. 

So we have a comprehensive sexuality education framework but the teachers don't have a specific date on how they should talk to learners but the ministry says it is in the process of drafting materials for learners, materials for teachers and training materials.

Lastly, in the bid to harmonize with all stakeholders a meeting is planned on the 20th of June. The meeting will be between the ministry and key stakeholders I should say I think it's the technical working group meeting as well as the Episcopal Conference or the Catholic Church. We hope that this meeting should be able to give us a tiebreaker on this issue so that we can move on. 

Otherwise, as of now, we know there were several printed copies of the sexuality education framework at the ministry that awaits to be distributed. They would have been distributed immediately after the launch but I think they await the Episcopal conference because the Catholic church said they don't agree.

My opinion is that let us try out what we have and see how exactly that this is going to turn out. This comprehensive sexuality education framework is meant for in school but unfortunately, we have children out of school. From the engagement, we have had all stakeholders are looking at a child who is at the center of all this issue.

If we have two documents for children in school and out of school what does this mean? Should they be able to talk to the other documents they have created. Otherwise, if we have two documents that are totally different. We are bringing up children that have totally different with the same exact mindsets and different information.

We also need to realize that some of the children that are out of school are in unique settings and come from unique backgrounds which gets me to the other question of age appropriateness. If you find that a 6-year-old has gone through certain things in life that makes them a 15-year-old. That information that you're giving them as a 6-year-old is actually not going to help them when we speak from a public health aspect.

I think these documents need to be aligned so they can save a child at whatever level they are at that as parents you'll know that. I mean I'm a parent. I have an eight-year-old and the discussions you are going to have with them may be different from what you give for example Fresh Kid ( kid musician). 

The environments that they go through that as children are different and although we are looking to protect them but there those that don't have that protection that needs this information.

We are then doing an injustice by not talking about certain things because we are worried that our morals are going to be demolished. That is where age-appropriateness comes from, the setting of the child needs to be looked into and with those two documents in school out of school.

For me, it doesn't matter. A child is a child wherever they are. And the mere fact that a child is just vulnerable. Now the other things that make a child vulnerable are there you know. A child is a child they are vulnerable. They need information.


Tuesday, June 18, 2019

Civil Society actors seek to protect Murchison Falls tourism site

Civil Society actors have written to the Electricity Regulatory Authority (ERA) to reject the application by Bonang Power to conduct a feasibility study and other activities leading up to the development of a dam at Murchison Falls.

In the protest letter dated 17th June 2019, the civil society actors protest against plans by ERA to issue a licence to Bonang Power and Energy Ltd to develop a 360MW power plant at Murchison Falls.

The falls and the entire Murchison landscape are already under threat from oil activities as over 70% of the oil under the Tilenga project is found in Murchison Falls National Park (MFNP).

The actors also call on ERA and government to promote the exploitation of clean energy such as off-grid solar as opposed to hydropower dams and oil in protected areas.

The letter raises concerns that Murchison Falls landscape is already under immense pressure from oil activities; no more pressures should be allowed. This is more so the case because tourism remains one of the biggest sources of government revenue; it earned the country over $1.6 billion in the 2018/2019 financial year.

On the other hand, development of hydropower dams has increased Uganda's debt burden amidst a few returns. The country's debt burden stands at $11.5 billion and dams are responsible for over 30% of this debt yet few returns are being experienced from them. For instance, only over 20% of the population has power. Poverty has also increased and the much-touted industries arising from increased power generation have offered insufficient and mostly poor-paying jobs.

Uganda is also producing excess power which citizens and industries cannot afford; this drives the tariff up. Another dam amidst excess power will further drive up the tariff. Moreover, Uganda is already over-reliant on hydropower yet to ensure sustainable energy supply amidst climate change threats, countries need to diversify their energy mix.

The government also faces legal action and international shame should ERA allow a dam to be developed at Murchison Falls. The dam would lead to more degradation of the Murchison Falls landscape, which is against international agreements that Uganda is a signatory to, the letter reads.

The signatories to this letter from the Acholi and Bunyoro sub-regions where the planned dam will be located also demand that :

(i) ERA should not approve the application to undertake studies for the development of a hydropower dam at the Murchison Falls. The Murchison falls ecosystem is important in the survival of species such as the Nile crocodile, fish, and others. Moreover, the falls and MFNP provide employment, foreign exchange and are a source of national pride. The above services cannot be replaced by electricity moreover which Ugandans cannot afford to consume.

(ii) Explore alternative energy sources. Uganda is richly endowed with alternative energy resources such as solar and wind. However, these resources remain largely unexploited mainly because Uganda is concentrating on hydropower. In line with aspirations under the Sustainable Development Goals (SDGs) and the Sustainable Energy for All (SEA4ALL) initiative, Uganda should invest more in other energy sources especially off-grid solar and avoid over-reliance on grid-based hydropower. In addition, in line with aspirations under the Paris Climate Change Agreement that Uganda is a signatory to, the government should promote investment in clean energy over oil and should avoid oil activities in protected and critical biodiversity areas including in MFNP.

(iii) UWA should not issue a permit for a dam at Murchison falls:

(iv) Citizens should say no to ERA and the government’s proposal to destroy Murchison Falls: It is only the citizens of Uganda who have the power under Article 1 of the Constitution that can save the Murchison Falls. Only the citizens can stop the single biggest challenge facing our country today, the dominance of politics over governance institutions. Key institutions such as the National Environment Management Authority (NEMA), UWA, National Forestry Authority (NFA), ERA and others that are entrusted with the responsibility of conservation and ensuring that developments benefit citizens without destroying the environment have been pushed on the sidelines by selfish and corrupt politicians. The institutions are being used by politicians to destroy the environment. This is why the country is in an environmental mess characterized by loss of forests, wildlife reserves, wetlands, river banks, lake shores, and others. Citizens must campaign against the destruction of Murchison Falls and all critical biodiversity areas of Uganda. We encourage companies like Bonang Power and Energy to desist from being part of the destruction. Instead, they should invest in other clean energy sources such as off-grid solar.

(v) Civil society: Non-governmental organizations(NGOs)and other civil society groups should work with us to mobilize and empower Ugandans to stop environmental abuses in the country. Only strong civic competence will compel government and institutions such as ERA to know that this country belongs to the people of Uganda and our biodiversity must be used in a manner that meets the needs of the present and future generations.

Sunday, June 16, 2019

Study exonerates suspect contraceptives from risk of HIV

By Esther Nakkazi

The good news from the long-awaited trial on a link between three contraceptive methods and increase in the risk of HIV acquisition has brought a sigh of relief, will boost confidence for family planning and reassures women who are at the centre stage.

The results are reassuring at many levels and a winner for all women using contraceptives and those intending to use them, the men who support their partners to use them, the providers who now have more confidence in dispensing them, the researchers and the funders who ensure they are forever available on the market.

We now know that there is no increased HIV risk for women using the injectable depot medroxyprogesterone acetate (DMPA), the implant Jadelle and the copper intrauterine device (IUD) according to results from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomised clinical trial.

It is NOT contraception that puts women at a risk of HIV.

ECHO adds the most robust data about contraception safety and effectiveness with solid evidence. It is a much better world for women to know that none of these 3 methods increase the risk of acquiring HIV.

DMPA or Depo is an injection given into the muscle. It is given every 3 months there may be a 6-9 month delay in getting pregnant after the last injection. Jadelle has 2 thin, flexible rods filled with progestogen inserted under the skin of a woman’s upper arm. It lasts up to 5 years but can be removed any time with a rapid return to fertility once removed.

The copper IUD has a ‘T’ shape and is made of soft but strong plastic with copper bands and has a ‘tail’ made of 2 strings. The health worker places it in the womb and it can last up to 10 years, although it removed at any time and fertility returns immediately.

In Uganda two of these researched methods, Jadelle and depot are the two highest used contraceptives by women which help them put off unwanted or avoid high-risk pregnancies, space childbirth, prevent maternal and infant deaths every year. The unmet need for family planning in Uganda reduced from 34.4% in 2011 to 28% in 2016.

In the countries where the ECHO randomized clinical trial took place, at the 12 sites in Eswatini, Kenya, South Africa, and Zambia depot is the number one choice. Women love it because it is discrete and in not all but some circumstances the shot is the only long-acting option on the shelf.

It is good to know that the contraceptives under the ECHO study were highly effective and acceptable further endorsing their primary purpose. The study says participants used either of the three methods assigned to them for 92% of the time they were in the study.

However, we should know that over 150 million women worldwide use modern methods of contraception for family planning and some do not necessarily use the three methods in the ECHO trial so these results cannot be generalised to other contraceptive methods that were not included in the study.

Unfortunately, the study had high HIV incidence and high Sexually Transmitted Infections (STIs) recorded among the 7,800 women who participated yet they were given an optimised level of prevention.

Except for condoms, no contraceptive method protects against HIV or other STIs, and thus women at risk of HIV infection who are using contraception should also be advised to use condoms.

Moving forward we know now that Depot, Copper IUDs and Jadelle has nothing to do with the HIV infection it is high time to invest more in programs to protect women against HIV.

Isn’t it logical that HIV prevention services and family planning should be integrated? African governments can also avail more funding for contraceptives and HIV prevention and enforce that the two are provided in one place.