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Beginning today, New Vision is highlighting the challenge of teenage pregnancy in Uganda with a view to finding a solution to the problem that costs Ugandan taxpayers up to sh250b a year in healthcare. 

In the first of 12 stories, Agnes Kyotalengerire looks at how the problem of teenage pregnancies has led to high rate of school dropouts.

Evalyn Nabwiire, 17, is a teenage mother of two residing in Busia district, eastern Uganda. 

Nabwire became a mother after her grandmother forced her into early marriage. She dropped out of school in Primary Two when her grandmother failed to pay her school fees because she was fending for a large family. 

“I loved school and always endeavoured to attend even without my grandmother paying my fees. However, I was always sent back home,” she narrates. 

After failing to get school fees and basic needs, such as food and sanitary pads, Nabwiire was lured into a sexual relationship with a bodaboda rider, which culminated in a pregnancy. 

Given the poor living conditions at her grandmothers’ home, Nabwiire decided to move into the man’s home. 

The conditions of living there were not good either. Apart from not providing for her, the man was not providing food and other basic requirements. 

Amid all that suffering, Nabwiire gave birth to her first child. Sadly, she soon become pregnant with her second baby. Life became more difficult for Nabwiire after delivering her second baby. 

She and her partner quarrelled every day, and sometimes the quarrels ended in fights. One night Nabwiire’s partner returned home drunk, picked a quarrel that resulted in a fight. This left her bleeding profusely. 

Later her partner ordered her to pack and leave his home. At a tender age, Nabwiire became homeless with two little children. 

Currently, she vends vegetables to fend for them. Nabwiire’s struggles of being a teenage mother is not an isolated incidence. 

The national teenage pregnancy rate has stagnated at 25%, according to the Uganda Health Demographic Survey 2016 report, even with efforts aimed at reducing the figure to 15% by 2020. 

This was a decline from 31%, according to the UDHS 2000 report. The indicators, thereafter, stalled at 25% from 2006 up to 2016. 

The UDHS results of 2020 are yet to be released. This means that one in four girls countrywide has had a child or is pregnant. 

When the COVID-19 pandemic hit, the number of adolescents getting pregnant spiked because they were exposed to sexual abuse following the closure of schools. 

Last year, 1,052 teenage pregnancies were recorded daily in Uganda compared to the 985 in 2020, according to a report by the United Nations Population Fund. 

A total of 31,565 pregnancies were registered monthly, a figure higher than the 29,557 recorded monthly in 2020. 

A new report, dubbed “The Economic and Social Burden of Teenage Pregnancy In Uganda – The Cost of Inaction”, reveals that about 250 children below 15 years got pregnant every month in 2021. 

However, the numbers could be higher, given that not all girls go for antenatal care visits. 

Busoga region registered the highest number of pregnancies in girls below 15 years last year, as well as in 2020. Kigezi, Kampala, Acholi and Karamoja had the lowest numbers. 

Worth noting, a total of 34%; about three in every 10 girls, are being married off by the age of 18. Whereas the data was recorded in 2016, the situation on the ground could have changed.

The national picture 

Ten districts plus Lira city in Lango region registered over 30,000 teenage pregnancies last year. 

In 2021, the country recorded about 31,565 teenage pregnancies monthly It is important to note that this data was collected in only health facilities. There are girls who become pregnant and they never seek antenatal care or do not deliver in health facilities. 

Breaking it down, in the last financial year 2022/2023, Alebtong district alone recorded 3,002 cases of teenage pregnancy, according to data from local district. 

Dr Tonny Odung blames the high numbers on biting poverty which forces young girls to drop out of school, consequently engaging in early sex. Gender-based violence that leads to families breaking up is another driver of teenage pregnancy, Dr Odung adds.

He explains that after families break up, the children fail to fend for themselves and also pay school fees. As a result, they drop out of school and end up engaging in sexual relationships for monetary gains. 

Others get trapped into early marriage. To curb the vice, the district local government has resorted to mobilising and sensitising the community dialogues with emphasis on the dangers of teenage pregnancy. 

After failing to get school fees and basic needs, such as food and sanitary pads, Nabwiire was lured into a sexual relationship with a bodaboda rider, which culminated in a pregnancy.

In western Uganda, particularly Kabale, the district health officer, Dr Gilbert Mateeka, says the issue of teenage pregnancy is a big concern there too. 

Dr Mateeka estimates that for a period of 2021/2022, the district registered a total of 1,506 teenage pregnancies, which translates into 125 teenage pregnancies per month. 

In the financial year 2022/2023, they recorded a total of 1,404 teenage pregnancies. This translates into 117 teenage pregnancies per month. He attributes the high numbers to socio-economic drivers, such as poverty, which results in school dropouts because parents cannot afford to pay their school fees. 

“The girls who do not go to school engage in commercial sex for monetary gains and small gifts hence resulting in teenage pregnancy,” he adds.

In an effort to curb the vice, Dr Mateeka said the district leadership has continued to educate and sensitise adolescents on issues of reproductive and sexual health. 

They have provided youth-friendly centres, engaged counsellors to be able to talk appropriately and guide young people on the same issues. Additionally, they work with the schools to raise awareness on sexual rights 

They continue to educate and sensitise the community on sexual health. Additionally, they engage counsellors to be able to appropriately guide teenagers.

Maternal experts speak out 

The teenage pregnancy situation is dire; as the country continues to register young girls becoming pregnant. 

Dr Betty Kyadondo, who is the director family health at the National Population Council (NPC), says although the country has made different commitments on what should be done, nothing has been done to follow up. 

He says this definitely leads to girls dropping out of school, and because many of their parents do not want to stay with them, they will force the girls into early marriages where they will not be supported to go back to school despite the re-entry policy for teenage mothers. 

The other worrying aspect is that most of the girls are impregnated by fellow teenage boys, who are also in school. As such, they can hardly take care of their young families. 

As a result, the girls are going to remain home, they are not learning any skills to help them improve their livelihood. 

Consequently, there will be a vicious cycle of poverty because even when they start their true families and getting children, they will experience or grow within the same poverty. 

They will not go to school or if they do, some will eventually some drop out, Dr Kyadondo notes. She is quick to note that the biggest culprit of teenage pregnancy are parents, who are not supporting their children.

Rural girls more affected 

Despite a range of efforts made by Government and other bodies in Uganda to reduce the rate of teenage pregnancies in the country, not much significant results have been achieved particularly for girls who live in rural areas. 

The trend was observed in 2016 when the rural areas had about 27% teenage childbearing compared to 19% in the urban areas, according to Uganda Bureau of Statistics (2012, 2018). 

Typically, rural adolescents are highly exposed to teenage pregnancy because of the multiple vulnerabilities experienced. 

For example, lack of information and access to sexual and reproductive health services, including contraception, could put them at a higher risk of not only becoming pregnant but contracting sexually transmitted infections (STI). 

Additionally, rural areas are often associated with low economic status or abject poverty, the kind of situation which lures them into transactional sex and early marriage, which contributes significantly to higher rates of rural teen births. 

Prof. Fredrick Makumbi of Makerere School of Public Health cites lack of education as another driver for teenage pregnancy. 

The vice is even higher among girls and young woman with no education. This was observed in 2016, teenage pregnancy in relation to the level of education stood at 34.6% for no education, 28.7% for primary, 17% for secondary and more than 11% for secondary (UBOS, 2018).

Teenage mothers during financial literacy class. (All Photos by Agnes Kyotalengerire)

East African region 

The prevalence of HIV among adolescent girls and young women in Rwanda is 3.7%. 

Prevalence of teenage pregnancy and the associated contextual correlates in Rwanda, a report published in 0ctober 2020 shows an increase in teenage pregnancy rates in Rwanda in recent years is worrying. 

The data indicates that from 2007/2008 to 2014/2015, teenage pregnancy increased from 5.7% to 7.2% of teen girls countrywide and from 14% to nearly 21% among young girls aged 19.

Kenya 

The report, Unintended pregnancies and HIV among Adolescents and Young People: A situation analysis of Homa Bay, Kenya, highlights that one-third (33%) of adolescent girls aged 15-19 in Homa Bay are mothers or pregnant with their first child, almost twice the national average of 18%.

The teenage pregnancy and motherhood rate in Kenya stands at 18%, according to the Teenage pregnancy and motherhood situation in Kenya: the county burden and driving factors; policy brief. 

This implies that about one in every five teenage girls, between 15-19 years, have either had a live birth or are pregnant with their first child. 

The rate increases rapidly with age from 3% among girls aged 15, to 40% among girls aged 19. 

The situation varies by county, with some counties being disproportionately affected than others.

Situation in Tanzania

The national HIV prevalence among adolescents and adults aged 15-49 years decreased slightly from 5.1% in 2014 to 4.8% in 2019. Prevalence among women is higher compared to men (6.2% versus 3.7%).

Over the last two decades, despite wide geographical diversity in absolute levels of incidence, adolescent girls and young women have been disproportionately affected by new HIV infections compared to their male counterparts.

This story was produced with support from WAN-IFRA, Women In News Gender Equality, Diversity and Inclusion (GEDI) grant.

However, the views are not those of the sponsors.

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