Thursday September 26 was World Contraceptive Day. Humphrey Nabimanya, a young mobiliser and leader engaged in promoting awareness on Sexual and Reproductive Health issues shares his observations on the obstacles young people face in using contraceptives for better reproductive health.
High fertility among young people aged 15-24 years is a public health concern in Uganda. Unwanted pregnancy, unsafe induced abortions and associated high morbidity and mortality among young women may be attributed to low contraceptive use.
Young people have identified multiple obstacles to contraceptive use. These include misconceptions; the young people believe that contraceptives interfere with fertility, and they are frightened to use something that can harm their ability to reproduce.
Condoms are believed by both male and female participants to damage the uterus, to get stuck in the reproductive tract and cause death, not to fit properly, to be porous, and to have infectious lubricant. Some young males said they lost confidence in condoms supplied by the government when faulty Ngabu brand of condoms were recalled in 2007.
Young people seem to worry about the impact of side effects and fear that the side effects are permanent. The fear comes from their own and their peers' experiences, and from misinformation given to them by parents/elders to discourage them from having intercourse. Some young women express more fear of the side effects than of pregnancy and HIV/AIDS.
Youth revealed gender inequalities in terms of power, roles, decision making, and negotiation for contraceptive use. The women talked about lack of power in decision making as a key obstacle to use.
Both men and women say that women's purpose in marriage is to produce children. The women recounted partner disapproval and verbal or physical abuse including violence if the man discovers that the woman uses contraceptives. A man can abandon his girlfriend or wife if she insisted to continue using contraceptives.
The women say that initiating a discussion about contraception is generally considered unacceptable, and often the partner rejects such discussions. The young married female say that conflict with the husband and the in-laws is severe when family planning issues are raised.
Some male youths also say that women also oppose contraceptive use and react negatively when men raise contraceptive issues, contending that women fear the risk of not having children following use of contraceptives.
Males say that women are weak and easily influenced to have unprotected sex. In contrast females reckon that men want more children and manipulate women into sexual relations without contraceptives exposing women to HIV/AIDS.
The women further note that men who do not want to use contraceptives are inconsiderate of the woman's future, citing that men make women pregnant to make them dependent. Unprotected sex for men enhances their reputation among other young men in contrast to the situation for women. But men would deny the pregnancy and blame the woman for becoming pregnant. However, some females say that early pregnancy is perceived as a positive incentive for early marriage and was no longer perceived as a problem.
Young people express how fear immobilizes them in their decision-making. They are afraid of the side effects, afraid of getting pregnant and HIV/AIDS without contraception, afraid of the response from their church, and afraid of parent and family reactions. Fear of partners' and parents' reaction is an obstacle to contraceptive use expressed by many young people.
Additionally, young people recount several enabling factors that include female strategies to overcome obstacles, changing perceptions to contraceptive use, fear of contracting STDs and STIs including HIV/AIDS and changing attitude towards a small family size.
Personalized strategies to young women and men are needed to motivate and assist young people plan their future families, adopt and sustain use of contraceptives. Reducing obstacles and reinforcing enabling factors through education, culturally sensitive behavior change strategies have the potential to enhance contraceptives use.
Alternative models of contraceptive service delivery to young people are proposed coupled with information on contraceptive use that is free and confidential to guide the youth to make informed decisions is important.
Humphrey Nabimanya is the Executive Director and Founder of REACH A HAND UGANDA an NGO working with teenagers and young people to improve awareness on sexual and reproductive health issues.