Ugandan school girls using contraceptives — report

In Uganda, the discussion on allowing sexually active adolescent girls to use contraceptives to prevent unwanted pregnancies has been a no-go area. 

However, findings of the Makerere University School of Public Health’s Phase 4 panel survey of the Performance Monitoring for Action (PMA) of September-November 2024 indicate that 31.8% of the school-going adolescents are using modern contraception such as oral pills, implants, injectables, patches, vaginal rings, intra-uterine devices, condoms, male and female sterilisation. 

The survey also indicated that about 5% of the sexually active school-going children were using traditional contraception methods such as periodic abstinence, withdrawal and lactation amenorrhoea. 

The survey also revealed that 24.8% of school adolescents aged 15-19 confessed to have had sex 12 months prior to the survey, and about 9% had engaged in sex 30 days prior to the survey.

Worth noting, about 22.7% of the adolescent girls in school at the time of the survey were pregnant. The research was carried out in 141 enumeration areas.

Since 2014, Makerere has conducted the PMA Uganda surveys to monitor key family planning indicators among women and track commodity stock levels in health facilities. 

The surveys are conducted under the leadership of Associate Prof. Fredrick Makumbi and Dr Simon Kibira of Makerere University. 

The survey findings were unveiled by Makerere School of Public Health together with the health ministry on April 2 at Four Points Sheraton Hotel Kampala.

Commenting about the statistics of the sexually active adolescents in school, Dr Kibira said: “This is a big problem because these are our children who should be in school, but they are already having sex.” 

Kibira, who doubles as a senior lecturer in social and population science at Makerere University, said young girls should have adequate information on sex in order to prevent other disastrous effects, including unwanted pregnancies, HIV and other sexually transmitted diseases. 

“This data goes beyond pregnancy implications and points to HIV because they are having unprotected sex,” he said. 

Kibira said there is a need to push the age at first sex to be a little higher and make sure that when the young people engage in sex, they know the consequences. 

He called upon parents and different stakeholders to ensure adolescents abstain from sex.

Out of school adolescent

According to the report, 49.6% of out-of-school adolescents were using modern methods of contraceptives, and about 4.4% used traditional methods. 

Notably, 71.5% of the adolescents who are out of school admitted to have had sex in 12 months before the survey, while 40.5% had sex within a 30-day period. Of those who were sexually active, 13.9% were already pregnant.

What stakeholders say

Lira district health officer Dr Patrick Ocen said although adolescents are engaging in sex, Uganda’s reproductive and health policy only permits them to offer the youngsters sex education, sexually transmitted disease testing services and treatment while emphasising abstinence.

He, however, said during the back-to-school season, school girls approach the health facilities requesting for long-term injectable contraceptives. Lira is among the districts with the highest teenage pregnancy prevalence at 26.7%, way above the national figure of 24%. 

Ocen said the district is also registering poor pregnancy outcomes among teenage girls. Dr Peter Ddungu, the country director of Marie Stopes Uganda, said the data on sex among adolescents calls for candid conversations. 

“This is a behavioural change issue and we need to take the bull by the horns,” he said. 
Annah Kukundakwe, the country programme manager for Ipas Africa Alliance, a non-governmental organisation, urged the Government to ensure appropriate interventions reach all young people across the country. 

“A co-ordinated effort among these stakeholders will be essential in developing sustainable and impactful solutions,” she said. 

James Mukwaaya, the head of monitoring and evaluation, research at the Inter-Religious Council of Uganda, said the use of contraceptives among adolescent girls is a behavioural issue. 

“This is not about how many family planning commodities have been supplied; it is rather a behavioural issue. Do parents know what to do in order to nurture morally upright citizens who can appreciate that abortion and engaging in sex early is bad?” he said.

What population experts say

The presidential advisor on population and family matters, Dr Jotham Musinguzi, said the policymakers and technical people need to agree on what should be done. 

“If you are going to say that adolescents should access family planning, how and where do they access it. If you say they don’t, then what else are you putting in place for them,” Dr Musinguzi said. 

The director family health at the National Population Council, Dr Betty Kyadondo, said when the girls go to health facilities, they are given contraceptives because they want them.

Ministry of health speaks out

The senior medical officer in charge of the adolescent and school health division at the health ministry, Dr Allan Kasozi, said the number of adolescents engaging in sex is saddening. 

“This is an indicator that the interventions in place are not effective, hence the need to have new strategies,” Kasozi said. He said early sex can result in early marriage, high school dropout rates and teenage pregnancy.

Interventions

The commissioner reproductive and child health at the health ministry, Dr Richard Mugahi, said the ministries of health and gender have a framework that emphasises information in schools and communities and those who go to seek services at health facilities. 

He added that the two ministries are engaging gatekeepers such as cultural leaders and giving them information on the impact of their inaction and how to protect young people.