Christine Nagasha, (23) a resident of Isingiro district dropped out of school while in senior two after she realized that she was pregnant. The man responsible for her pregnancy, who was also her schoolmate disowned the pregnancy leaving her in a dilemma. Going back home, her parents threw her out of the house asking that she goes to the person responsible for the pregnancy to take care of her.
Nagasha was left homeless with no one to run to so she resorted to sleeping in churches with no food to eat.
“I would move from household to another to get petty jobs, but people were also not paying me while my status was also affecting my health since I was not having regular meals. By the time I was due for labour, I had nothing to use so some midwives abandoned me for other mothers who had the requirements.” she narrates
Nagasha notes that one of the elderly midwives in the hospital identified her struggles and she purchased some items such as a kaveera, cotton wool and some baby clothes.
“After giving birth I stayed in the hospital despite being discharged because I had nowhere to go. After one month, a good samaritan took me on as one of her children and that’s how I survived.” she says
Nagasha notes that she regrets the pregnancy because it frustrated her education and yet the boy who was responsible for the pregnancy continues with schooling.
This case contributes to the statistics where thousands of girls drop out of school because of unwanted pregnancies. From the 24% in the previous surveys, the 2016 Uganda Demographic Health Survey put teenage pregnancy at 25%. Thus a slight increase in a statistic that’s already amongst the highest in sub-Saharan Africa. This means 1 in every 4 girls aged between 15-19 years in Uganda is either pregnant or already having their first baby.
Nagasha wishes she had known about family planning to protect herself from such a situation. “I would like to appeal to government to ensure that the girls are educated about their sexuality and how they can stay in school without pregnancies. The midwives in hospitals should also understand that some girls are abandoned by their parents and relatives and so go into labour without the requirements.” She appeals
Although she is aware of the different Family planning commodities that she can choose from to avoid another unwanted pregnancy, she couldn’t get a long term method from her nearest health facility.
Nagasha shared her story during the women’s day pre-event press conference at Imperial Royale hotel in Kampala. The conference was convened by Health Systems Advocacy project partners which include HEPS-Uganda, ACHEST and Amref Health Africa.
The press conference was aimed at launching a survey report on accessibility, affordability and availability of Sexual Reproductive Health Commodities in 124 public, private and Mission hospitals.
According to Denis Kibira, the Executive Director HEPS-Uganda noted that the survey results indicated frequent stock-outs of SRH commodities especially long term family planing methods were highly demanded but unavailable in the public facilities.
“In general, SRHC availability was inconsistent. Birth control pills were available in only 47% of facilities. Also, contraceptives were generally more commonly available in the public sector than in other sectors: injectable contraceptive, the most commonly used contraceptive in Uganda, was available in 86% of public sector facilities, but only available in 57% private and 25% of mission sector facilities.” he noted
The survey also indicates that stock-outs were quite common in the public sector (12%), and lasted on average almost 20 days per month while in the public sector specific SRH Commodities were stocked-out at up to 36% of all facilities.
“The suboptimal availability of contraceptives makes it difficult to access the commodities, which likely contributes to the about 30% of women in Uganda who were experiencing unmet needs for family planning in 2015.” Kibira noted
The 2016 Uganda Health Demographic Survey-UDHS indicated that maternal mortality has reduced from 438 to 368 deaths per 100,000 live births. However, according to Kibira, the survey indicates rampant stockouts of Magnesium Sulphate, a drug prescribed for pregnant mothers with onset of high blood pressure, also called pre-eclampsia, one of the leading causes of maternal deaths.
He also adds that there is inconsistent availability of other pregnancy drugs such as dexamethasone, used in the management of preterm labour whose availability was also low in the public at 36%, private 55% and mission 43%.
“Oxytocin, used to induce labour and in the prevention and treatment of post-partum haemorrhage, was commonly available in the public sector (90%) but less commonly available in the private and mission sectors. Misoprostol, also used to induce labour, was commonly available in the public sector (88%) but less common in the private and mission sectors (50%and 55% respectively.” he said
Dr. Patrick Kagurusi from Amref Health Uganda said that the government needs to review the budget for SRH services.
“The Ugandan government should increase its budget allocation for the purchase of sexual reproductive health commodities. Specifically, the Ministry of Finance, Planning and Economic Development (MoFPED) must avert future stock-outs through increased budget allocations for sexual reproductive health commodities to Increase affordability and availability of reproductive health commodities to all persons in the reproductive age group. Measures to avoid delayed financial disbursements that contribute to stock-outs of all commodities must also be considered.” he noted
Paul Gabula of ACHEST notes that the government needs to retain the health workforce such that long term family planning methods can easily be administered to those in need.
The report also indicates that staffing is especially challenging in remote, rural areas, where some facilities have less than 30 percent of positions filled.
“Attracting and retaining skilled health workers continues to be a challenge for the government-led health sector in Uganda; according to the 2015/16 annual sector performance report, only 71 percent of approved positions have been filled.” he said