Should Teenagers Freely Access Family Planning Services?
At least 360,000 teenage pregnancies occur each year in Uganda. Four in every 100 teenage girls are either pregnant or have had their first child, according to 2016 Demographic Health Survey.
Experts warn that these figures would get worse due to effects of Covid-19 such as closure of schools that is throwing more teenagers to idleness and inclination into sexual activities.
16-year-old Judith Atim (not real name), from Apac district, will not be in position to go back to school even when government reopens schools.
Atim was in early April, at the onset of Covid-19 lockdown, impregnated by her teenage boyfriend.
As a community norm, Atim is being forced by her parents to go and start own family with the boyfriend who is not prepared to take care of a wife.
The boyfriend, who also preferred anonymity, told this reporter that he couldn’t get condoms or any other birth control method to use during the intercourse because of the lockdown measures.
“Everyone is talking about her pregnancy and the parents want her to leave home and come into my house,” says 18-year-old boyfriend.
Utterances like that from Atim’s boyfriend continue to draw mixed reactions from parents and policy makers in communities where strong allegiance to culture and religion is still paid and promiscuity is not tolerated.
The clearest display was in 2017, when Members of Parliament rose against the Health Ministry after proposing to provide contraceptives to school going teenagers.
Experts and activists are, however, asking for a shift in thinking to effectively address the growing burden of teenage pregnancies in the country.
They say teenage pregnancy is building a chain of poverty and an unproductive population due to low level of education girls attain because of early pregnancy, and for boys -starting to care for a family without clear source of income.
Dr Carole Sekimpi, the Country Director of Marie Stopes Uganda says access to family planning among teenagers is essential to curb the problem of teenage pregnancies and it is after effects.
“Around 360,000 teenage pregnancies occur annually. The unmet need for family planning among adolescents aged 15-19 years is estimated at 30.4 percent with a total demand of 52 percent,” she said while citing the Demographic Health Survey of 2016.
Although against the will of parents and most policy makers, Marie Stopes promotes the use of family planning among teenagers.
“Covid-19 is going to aggravate the problem because people can no longer get sexual reproductive health commodities like condoms when they need,” she expressed her worry.
Ms Kullein Ankunda, the Communications and External Relations Officer at Jhpiego, another organisation that promotes use of family planning commodities, say teenagers in the country start having sex as early as 9 years.
Ankunda says people should move out of the cocoon of thinking their children are not indulging in sexual activities and come out clear on educating teenagers about using contraceptives.
“We know that people are starting to have sex at the age of nine or twelve. The reproductive health education needs to happen. People are doing it [having sex] secretly,” she said.
The sex education expert adds; “Most them [girls] are getting wrong information on contraceptives. We [Jhpiego] have allowances for teenagers to come and get the knowledge even if they are not coming to get the actual family planning commodities.”
She said that with enough knowledge, “when the time comes and they are involved in sex or when they want to have sex, they have the knowledge [on the right thing to do].”
Parents, religious and cultural leaders, care providers and policy makers are not sure whether granting free access to contraceptives for teenagers is the right idea.
For instance, according to the Ministry of Health proposed National Policy on Sexual and Reproductive Health that couldn’t be passed by Parliament in 2017, school going teenagers should be allowed to access family planning services and commodities.
The Ministry had said there is need to focus efforts on delaying sex debut and increasing contraceptive use among sexuality active adolescents.
However, legislatures such as Mr Onesmus Twinamatsiko from Bugangaizi East, refuted the proposal saying that by doing that, government would be fueling early sex indulgence among children.
“The programme by Ministry of Health to introduce family planning services to girls is so unhealthy,” he told Members of Parliament.
A 2012 study by Dr Grace Nalwadda and team from Makerere University, among teenagers on the use of contraceptives, found that that socio-cultural expectations and contradictions are some of the biggest challenges in accessing the services.
“Service providers had misconceptions, they had negative attitudes towards the provision of contraceptives to young people, and they imposed non-evidence-based age restrictions and consent requirements [from parents],” the report reads in parts.
A number of religions bar people from using family planning commodities in totality and the least chance is that it will grant teenagers that permission or support.
Catholic and some born again doctrines for instance promote “natural family planning,” which relies on abstinence for unmarried and not having sex in fertile phases for couples.
These groups make significant number of population of parents the country who may not buy-in into the idea of using family planning among teenagers.