By David Roger Walugembe
ON 17th October 2013, Uganda will commemorate the safe motherhood day under the theme “Teenage pregnancy - an obstacle to Safe Motherhood: Let us stop it now”.
The objective of the day is to raise awareness about maternal health and lobby for better ways of controlling maternal death. Uganda is ranked ninth on the list of countries with the highest adolescent pregnancy rates in Sub-Saharan Africa.
Statistics indicate that 24% of the adolescent girls become pregnant before the age of 19. Additionally, 13% of maternal deaths and 27.8% of deaths among adolescents in Uganda are primarily due to unsafe abortions.
Against such a background, a supportive environment for safe motherhood programs especially those designed to reduce teenage pregnancies and its effects is urgently required. But what constitutes a supportive environment for safe motherhood programs?
In brief terms, this entails policies that are favourable to the provision, use of reproductive health care as well as social norms and cultural practices that promote positive reproductive health behaviours.
Uganda is among the many LMICs that have developed policies aimed at delaying and protecting teenage girls from becoming pregnant. These include; the National Health Policy, the National Adolescent Health Policy, the National Policy on Young People and HIV/AIDS, the Sexual Reproductive Health Minimum Package, the Minimum Age of Sexual Consent Policy (set at 18 years of age), the defilement law and a Universal Primary Education – (UPE) policy.
Additionally, Uganda released the National Policy Guidelines and Service Standards for Reproductive Health Services in order to provide direction for reproductive health service provision and set national rules and regulations.
Despite the availability of these policies, little remains known about how they are being implemented and to what extent they have been effective in combating teenage pregnancies. Funding shortfalls have been reported to hinder the dissemination and implementation of these policies across the country.
As a result, various stakeholders lack knowledge about the country’s health policies and awareness of individual roles and responsibilities in implementing these policies. For example, although the National Adolescent Health Policy states that pregnant adolescent girls should be readmitted to school after they have delivered, Uganda’s Education Policy is silent on this issue. Instead of offering social support to pregnant girls, most school systems send them away!
Terminating studies at adolescent age due to pregnancy and motherhood blocks access to information, limits future employment prospects and enhances prospects for second pregnancies. According to World Health Organisation (2011) social norms, traditions and economic constraints are among the factors that influence marriages of over 30% of girls before 18 years of age, with around 14% marrying before the age of 15.
A supportive environment with evidence informed policies effectively developed, implemented, enforced, monitored and evaluated can ultimately contribute to stopping teenage pregnancies and achieving safe motherhood.
Such an environment will improve teenagers’ access to quality reproductive health information; enhance their self-esteem and confidence to use existing services. It should invest substantial efforts to understand the individual social and cultural factors affecting teenagers’ reproductive health outcomes and design policies that address them appropriately.
Ugandan policy makers especially parliamentarians ought to exhibit strong and visible efforts to prevent teenage pregnancies including enacting, reforming and enforcing laws that prohibit: marriage of girls before the age of 18, coerced sex and severely punish perpetrators.
Coordination across sectors is urgently required to ensure that policies which encourage increased formal and non-formal educational opportunities are enforced. Furthermore, funding should be provided to operationalize existing policies including the National Policy Guidelines and Service Standards for Reproductive Health Services.
This will ensure increased access to contraception, adolescent-friendly services and post-abortion services, as well as support for unwanted pregnancies and services for single adolescent mothers.
Rigorous evaluations on the effect and impact of the existing policies also need to be urgently undertaken to influence evidence informed decision making.