By Beatrice Nyangoma
Immaculate Akankwasa 19, a resident of Karumere village, Kisoro town council in Kisoro district vividly recalls the day she went to hospital for a pregnancy test and she was found positive.
At the age of 14 years, Immaculate had her dreams of being a nurse washed away. She could not be allowed to sit her Primary Level Education examinations and she was married off to the father of the pregnancy.
“My parents forced the man responsible for the pregnancy to marry me and take care of me. After giving birth, the man asked me to go back to school and that he would be paying for my school fees. But when I reached senior two, he told me that he was tired of paying and he suggested that I sit home as he takes care of me.” she says.
Akankwasa would later get her second pregnancy unexpectedly because she had wanted to quit the marriage because the man had started mistreating her.
“I had started doing petty jobs like washing clothes for people in the village and I was planning to go back to my parents but then I realized I was pregnant again. Two months after giving birth, the man chased me from the house and I was left homeless with two children.” she says
Akankwasa regrets having left school because of a man she thought would love her forever. she wishes she could turn back the time to make better decision of staying in school.
Annie Modesta Budongo, the in-charge of the women’s ward at Kisoro hospital says that at least two girls show up at the ward seeking maternity services everyday . She adds that every month the hospital records at least one case of a teenager seeking for abortion or has aborted else where unsuccessfully.
“We get girls as young as 13 years who come for antenatal services while others come seeking ways of getting the pregnancies terminated.” she says
In the month of July this year, Kisoro hospital recorded 250 deliveries out of which 61 were mothers aged between 10 and 19 years while 50 teenagers out of 256 deliveries were recorded in September.
Francis Munyarubanza, the Kisoro district Education Officer notes that teenage pregnancies have increased the number of girls dropping out of school.
He notes that out of the 11,000 girls that enrolled in primary one in 2010, only 2,234 registered for the Primary Leaving Examinations in 2017 meaning over 8,000 girls had dropped out.
“We don’t know what to do when it comes to teenage pregnancies. Whereas some girls drop out because of finances, the general picture shows that the highest percentage drop out because of unwanted pregnancies.” he notes
The situation is not unique to Kisoro district as Kabale teenage pregnancy statistics are equally alarming.
According to Mandera Immaculate, the Acting District Health officer, the district recorded 2,264 girls between the age of 10 and 19 out of the 15,278 women who went for antenatal services which is 14.8% in 2015/2016.
Mandera notes that 1,637 teenage girls delivered from the public health facilities out of a total of 10,510 mothers which is 15.7%. In the same year, 1,461 teenage girls sought for family planning services out of the 18,723 clients registered at health facilities which 7.8%.
Contraceptives an option?
Budongo notes that even in the absence of approved guidelines by the ministry, she still gets cases where girls seek emergency pills. She adds that although she issues the contraceptives to them, she fears that she does this putting her job at risk.
“I am human too and a parent. I don’t feel comfortable when I deny such a girl in need contraception to secure her future. But I know the ministry has no policy for that and the only way explanation I can have in defense is that the family planning registration book has provision where we can record the teenagers.” she says
On 29th September, the Ministry of Health rejected to launch revised guidelines that would see teenage girls access to contraceptives from public health facilities on grounds that the ministry had not made enough consultations with the stakeholders.
Prof. Anthony Mbonye, the Director General of Health at the Health Ministry during the second national conference on unsafe abortion informed the participants that the ministers withheld the guidelines on grounds that they were approved by junior officers. He however noted that he strongly believes that girls should have access to contraceptives.
“I strongly believe, and they can fire me because of my opinion but I strongly believe that the adolescents should get access to contraceptives! In Uganda women of reproductive age have access to contraceptives. It doesn’t mean that we go to their homes and churches to distribute them.”he said
However, Ruzaza Christopher, the Health Services Coordinator at the Diocese of Buhabura notes that the ministry of health officials should not pretend that they do not see what is happening in the country. He notes that the longer the government delays to launch the guidelines the more girls will drop out of school because of unwanted pregnancies.
“Let us put other factors aside and allow the girls who cannot abstain from sex to have access to contraceptives instead of letting them drop out of school. There is nothing as bad as a child growing up knowing that he/she was an unwanted child.” he says
He adds that the health ministry only needs to package the information well so that the girls know the side effects of contraceptives and how they risk getting infected by HIV.
Ruzaza however notes that the government needs to invest more in family planning commodities at health facilities if the policy is going to be effective.
“We already have an unmet need for contraceptives as a nation. This implies that if we are to have that provision for the teenagers, we need to double the supply.” he adds.
Dr. Stephen Nsabiyumva the Kisoro District Health Officer notes that the policy on contraceptives for teenage girls has been delayed. He says that the ministry has the mandate to ensure that the girls are not impregnated by provision of youth friendly services including contraception.
“Regardless of religion, culture and morality, we need the contraceptives urgently. We cannot continue looking at our girls dropping out of school and ending up in miserable lives and yet we can do something to prevent this.” he said
However, his education counterpart Runyabuzanza disagrees saying that this is likely to lead to more moral decay among the girls.
“I think we need a comprehensive policy on parenting. Giving girls contraceptives will just worsen the situation. Yes the statistics are alarming but contraceptives are not the solution. Let the ministry look at the other drivers of sexual promiscuity and address them as a whole.” he said
The newly released data from the Uganda Demographic and Health Survey 2016 (UDHS) conducted by the Uganda Bureau of Statistics between June 12 and December 18, 2016, indicate a 1 per cent increase in teenage pregnancy from 24 per cent in 2011 to 25 per in 2016.
The report indicates that Teso sub-region has the most numbers of childbearing adolescent girls, standing at 31 per cent, and Kigezi sub-region with the lowest at 16 per cent. Tooro, Bunyoro and north-central sub-regions also have high levels of teenage pregnancy, standing at 30, 29, 30 per cent respectively while Kampala City registered the lowest rate of teenage pregnancy at only 17 per cent.