Why Sexual Reproductive Health Has Issues

 

With over 77% of Uganda’s population below 30 years, Uganda has the third youngest population globally. For such a population, and a fertility rate of 7.3, sexual and reproductive health services come in handy.

Reproductive Health Uganda (RHU) a non-government organization affiliated to the International Planned Parenthood Federation is one of the entities promoting and providing sexual and reproductive health and rights services through clinic spread across the country.  This exercise took us to Katego clinic, which also hosts RHUs head office in Kamwokya, a suburb of Kampala.

Walking through the facility creates an impression of a busy center addressing key health challenges for the country. On the walls, a list of services provided is pasted to guide clients on the services and the costs involved.  Did you for instance know that you can have vasectomy at 40.000 shillings? This is just an equivalent of USD14.  This is just one of the services you can get just by walking through the clinic.

Others are provision of contraceptives for prevention of unwanted pregnancies, management of sexually transmitted infections, Post Abortion Care, Breast and Cervical Cancer screening, Condom distribution, counseling and laboratory services.

The center is serving up to 2,000,000 clients annually, most of whom seek family planning services. Jackson Chekweko, the Executive Director at Reproductive Health Uganda told us in an interview that the need is enormous especially among adolescents,  a problem he says is a result of policy challenges “The Biggest thing the government would do is to open up the Health Policy to allow young people to get comprehensive sex education.”

Like several countries in sub Saharan Africa, Uganda faces a huge burden of striving to cope with the ever increasing SRHR needs of the population. The country is challenged with high teenage and unintended pregnancy, a poor referral system, a high number of school drop outs, high STI/STD infection rate, child marriage and high maternal mortality. 

Today at least 67 percent of Ugandan women have their first child before their 20^th birthday. Women in this bracket are twice as likely to die from child bearing, according to James Tumusiime, the Gender and Youth Officer at RHU.

But what even complicates the problem is; frequent and poorly spaced pregnancies, the low rate of assisted deliveries and poor access to emergency obstetric care. Social, cultural and religious values, lack of accurate information and poor support from policy makers has compounded the problem.

This is witnessed in the absence of a unified effort to create a conducive environment for family planning in Uganda, the 2014 annual report by RHU indicates.   This includes increasing the number of service delivery points, updating service provider skills in terms of counselling and contraceptive technology, encouraging couples to space births and encouraging youths to delay first pregnancy.

Nevertheless, the number of people accessing family planning services at the facility increased from 279,642 in 2010 to 809,521 in 2014. Increases have also been seen in services related to post abortion care, HIV/AIDS and sexually transmitted infections over the last four years.

This indicator implies that non government organisations like RHU have improved access to services for the diverse population and social groups spread out in 18 districts in underserved areas across the country.  These services are delivered through clinics, outreaches and Community Resource Persons including Peer Educators, Village Health Teams (VHTs) and Community Based Reproductive Health agents.

Peer educators have actively been involved in monitoring, mentorship and following up of fellow peer, Lucy Kabatebe, the in charge at Katego clinic explains.   “They maintain one on one contact, create personal relationships, and build esteem and prestige, an approach which, according to RHU, has enhanced change in behaviors among the youths” She said.  

The educators have also implemented economic empowerment as a strategy, enabling the youths to gain financial access, control and economic security. Economic empowerment has facilitated the youths to negotiate for safe sex and adopt behavior and social positions that have helped them to maintain positive sexual reproductive health principles.

 

“The Capacity and ability to have our own financial resources and control them reduced on our chances of engaging in unsafe sexual behaviors such as transactional sex, coerced sex, accepting our partners multiple concurrent sexual partnerships and tolerating violence,” one SRH services beneficiary said in a report.

Village Health teams on the other hand are providing injectable depo provera to women in the villages as well as other forms of contraception, an outreach that covered at least 41 percent of the women in the villages who would initially trek to health centers IVs and referral hospitals for similar services.

But this success story is threatened by an increase in the number of cases of maternal and infant mortality.

Maternal morbidity and mortality relate to illness or death occurring during pregnancy or childbirth, or within two months of the birth or termination of a pregnancy. For every maternal death in Uganda, at least six survive with chronic and debilitating ill health.

Although there have been a number of government policy interventions aimed at improving access and quality of maternal services, the problem persists with an estimated 6000woemn dying annually due to pregnancy related causes. This is an average of 16 women per day.

Most of these maternal deaths are due to causes directly related to pregnancy and childbirth unsafe abortion and obstetric complications such as severe bleeding, infection, hypertensive disorders, and obstructed labors.  Others are due to causes such as malaria, diabetes, hepatitis, and anaemia, which are aggravated by pregnancy.

Health systems challenges and poor social determinants of health slow the improvement of women’s and children’s health. Difficult access to quality services, a shortage of trained and motivated health care professionals and shortages of essential drugs and medicines contribute to high mortality and morbidity rates.

According to the World Health Organisation, although approximately 94% of women giving birth in Uganda receive some antenatal care by a healthcare professional (doctors, nurses and midwives), in rural areas, only 36% of women deliver in a health facility compared to 79% in urban areas. Women in the highest wealth quintile were 3 times more likely to deliver in a health facility than women in the lowest wealth quintile.

Organisations like RHU are playing a great role in extending services closer to the people.

Parliaments are however fundamental to the development of issues and critical to improving the health of women and children.  They have a crucial role to play on Maternal Newborn and Child Health (MNCH) issues within the broader context of the health sector and the overall national development agenda.

The work of parliamentarians can help to:

·        Ensure necessary resources are allocated to the health sector.

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·         Enhance legal frameworks to address gender inequality and promote reproductive rights.

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·         Improve access to quality care and medicines among poor and marginalized populations.

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·         Expand maternity protection for working women

·        Construct mechanisms and structures to improve accountability and remedial action, including greater collaboration with civil society.

We hope that the 10 point approach below also guides persons who wish to work with young people in a youth friendly way.

The Wings of Hope

The cost of bleeding every month!   #We of the bleeding vagina ‪#‎MenstruationMatters ‪ #‎MHD15, was one of the posts by one of my Facebook friends this morning.

This girl can be brave. Is she announcing her next red?  I pondered. Often, when the ‘red zone’ pops around, it’s not something we can brag about. You wouldn’t want anyone to know that it’s ‘your’ time of the month.  But Hey, isn’t this the reason we are different from the Men? 

Never mind that the post came while I was listening to an informative  session  on Women’s Sexual and Reproductive health issues in Uganda by Annet Kyarimpa, from Reproductive Health Uganda.  How handy, I wish my Facebook friend was in the same room with me at the time. 

Anyway, the men in this room could have thought that growing up as a girl in Uganda or being a mother is as hard as attempting to beat Usain Bolt in a 100 meter race. Isn’t it such a task? It already sounded like a full time job reading from stories shared by both Annet and earlier by her colleague James Tumusiime. 

My mind was drawn to a young girl who, for purposes of today’s learning, we shall call Rose, going through the agony of being raped by her step father, the trauma of carrying an unwanted pregnancy and the pain of rejection. Rose is treated as an outcast in her home, in her family and in the community.  But what’s Rose’s crime?  

She is a girl.  A girl who is not emotionally ready for sexual encounters, a girl who is not prepared for Marriage , a girl who has no access to health services, a baby who would carry another baby in her unripe womb, a girl who is driven into motherhood by ignorance and poverty.  

Rose would dread ‘that time of the month,’ she would be told to sit in the sand for seven days so that her bleed is absorbed.  She would put together a few leaves and chicken feather to protect herself from showing off the girlhood dilemma. 

It is already a painful experience growing up as a girl. Her future would be doomed if Rose is forced into marriage.  

Rose needs hope, she needs empowerment and she needs to be able to soar high above the frustrations of life.