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

Today, Sarah Nakasenge looks at the cost of pregnancies among teenage girls with disabilities.

Pregnancies among girls and women with disabilities are more likely to be unintended than those among women without disabilities. Nineteen-year-old Sharon (second name withheld) has a hearing impairment and is a mother. 

The resident of Mukono started having children at the age of 13. In the first three pregnancies, she had twins and has a singleton also, but none of the children’s fathers is involved in raising them. 

During the COVID-19 pandemic, she says, she was lured into sex with bodaboda riders with the promise of food and money. Her mother forcefully took Sharon to hospital for tubal ligation. 

At the hospital, after nurses explained the procedure, Sharon fl ed, saying she wanted to have more children. 

Grace Kyakuwa, a resident of Lungujja Kosovo, on the outskirts of Kampala and living with a physical disability, recalls how she was treated while pregnant at the age of 14. 

“At school, my friends abandoned me, not knowing that it wasn’t my choice. I was raped.” She says she was so traumatised by the ordeal that she did not seek antenatal care. 

“At delivery, I went to the hospital with nothing because I thought I was going to die. In fact, I told my friend who accompanied me to the hospital to call my mother and announce my death,” Kyakuwa added. 

Joan Namugenyi, a 24-year-old, whose legs are crippled, testifi es how she struggled to get services in a government health centre before parting with the sh150,000 that was demanded. 

The resident of Wakiso was in labour at the time. She recalls that one doctor refused to check how far she had dilated because of her disability. She only got attention following her husband’s insistence.

The figures 

According to the Uganda Bureau of Statistics (UBOS) (2018), almost a quarter of Ugandan women have given birth by the age of 18. Statistics of early childbearing among women with disabilities in Uganda is scarce or not known. 

Anecdotal sources indicate that it is high among women with intellectual disabilities, the deaf-blind and those with hearing impairment.

Kyakuwa graduated with a diploma in journalism at YMCA after enrolling herself back in school.

Locally, in the Busoga sub-region and northern Uganda specifi cally, in Buyende, Luuka and Oyam districts, there is an average of 150 adolescents with disabilities getting pregnant, according to Betty Cheptoek, the executive director of Show Ability Uganda (SAU), a non-governmental organisation for youths with disability.

She adds that a number of the pregnancies are from incestuous encounters, that is, with their fathers, cousins and other relatives. 

In Africa, findings published in the Pan African Medical Journal 2021, showed that 58% of women with disabilities (adults) and 36% of children had experienced sexual violence, which, in some cases, results in pregnancy. 

World Health Organisation estimates indicate that 18.5 million girls under 19 years give birth annually in developing regions. Global adolescent pregnancies are expected to increase, especially in sub-Saharan Africa by 2030. On the other hand, about 15% of the world’s population has disabilities.

Locally, the 2016 UBOS Census Report indicates that 12.4% of the population lives with some form of disability. 

That is, approximately 4.5 million Ugandans fi nd diffi culty in doing things and have dysfunction in either seeing, hearing, talking, walking or self-care. 

The disability prevalence among women is estimated at 15%, and 10% for men. 

What went wrong? 

“Most of the young girls, especially those with intellectual disabilities, are left home alone and work as ‘padlocks’. 

And since they are very vulnerable, either passers-by or the family members will take advantage of them and the fact that they can’t easily communicate. As SAU, we take legal action to process the case, often without the support of their families,” Cheptoek says. 

Many girls with hearing impairment are often uneducated and do not know professional sign language, making them highly vulnerable to sexual violence. 

“Often, they fall prey to men who do not stick around to look after the children. As such, both mothers and their offspring end up being a burden to their families and are denied their rights,” Cheptoek says. 

Persons with disabilities often lack information related to sexual and reproductive health, yet they engage in sexual activity, whether consensual or coerced, leading to pregnancy. 

These youths are ignorant about the use of condoms, contraceptives and management of menstruation. Such information is not given at schools and girls with disabilities do not have safe places where they can clean up during menstruation, which leads to increased risk of dropping out of school.

In addition, the girls end up engaging in transactional sex to get money to cater for their basic needs, Cheptoek explains. Many non-governmental organisations have provided youth-friendly services at facilities like Kiswa Health Centre and Ngabo. 

However, youth with disabilities fail to access both the information and structures due to a lack of sign language interpreters and diffi culty in accessing the health facilities, among others. 

Such facilities usually do not have ramps. Cheptoek, who uses a wheelchair, testifi es to how the barrier of access affected her. 

“When I got pregnant as a teenager and went to access services, nurses told me: ‘You have a problem, you will be booked in Mulago, you can’t come here for antenatal, we can’t even talk to you because you’re a caesarean section case,” she says. 

Cheptoek adds that she felt rejected being denied her right to health services simply because of her disability.

Cheptoek in a wheelchair that can access the car behind her with a lift.

Experts say such behaviour usually discourages any teenager from seeking antenatal care and is worse for people with disabilities, who media and other reports have reported being treated inhumanely and their privacy violated.

Cheptoek gives an example of being shouted at while at the entrance of a health facility where she had gone to seek antenatal services. 

The repercussions for teenage pregnancy are many, but it gets worse with adolescents with disabilities. 

Chances of dropping out of school are high. “You’re already a burden to the family and pregnancy is now a second burden to the family,” Kyakuwa says. 

The COVID-19-induced lockdowns exposed many young girls with disabilities to sex offenders and many got pregnant, according to Gorretti Byomire, a lecturer and an advocate for Persons with Disabilities (PWDs).

“Young PWDs are less likely to report abuse. Some do not even know they are being abused,” she says.

Byomire, who is looking after many adolescent mothers who are also living with HIV/AIDS, says while some are excited to re-enrol in school, others are hesitant due to depression, but they are undergoing counselling. 

Also, while there are schools that have opened their doors to teenage mothers, others continue to discriminate against them by readmitting them based on academic or extra-curricular abilities.

Returning to school 

When adolescent mothers with disabilities desire to return to school, parents need to help them, especially with childcare. “This will help them deal with stigma and name calling,” Byomire says. These mothers should also be given continuous counselling, with follow-ups and feedback to enable them deal with the traumatic experience of pregnancy, child birth and childcare. 

Byomire adds that schools need to be considerate. For example, they should make provisions for extra lessons and support in case the mother misses school due to childcare challenges.

“It is not enough to get them back to school. We should work together to create safe environments for our girls to feel at home in their bodies, minds and spaces so as to succeed in the face of challenges,” she adds.

Challenges teen mums face 

In cases where a girl identifies the person responsible for her pregnancy and her family seeks justice, the man/boy’s family disowns the child and even pays bribes for the cases to disappear. 

For example, Kyakuwa says on the day she took her child to the father’s family, she was chased away with knives, leaving her traumatised. 

She was also disowned because of the repercussions of having her child’s father arrested. 

Studies have shown that when adolescents with disabilities get pregnant, there is a high likelihood of them suffering mental health challenges, such as depression and stress. 

If these are not managed, they add a secondary disability to these young mothers. The cost of raising a child single-handedly also traumatises the single mothers as it denies them their rights. 

Instead of them staying in school, they have to fend for their children with limited support from their families, exposing them more to risks of sexual violence. 

Teenage girls with disabilities, especially those with crippled legs, may face a unique set of challenges during pregnancy, delivery, and post-partum. 

According to Henry Mutesasira, an orthopaedic officer at Haven Inclusive Development Foundation in Kampala, some of these challenges include: 

1. Limited mobility: 

The physical challenges posed by crippled legs can make it difficult for them to move around during pregnancy, impacting their comfort and overall well-being. 

2. Access to prenatal care: 

Limited mobility might hinder their ability to access regular prenatal check-ups and medical care, which are crucial for a healthy pregnancy.

3. Increased risk of complications: 

Depending on the nature of their disability, there may be an increased risk of certain pregnancy complications, which could require specialised medical attention. 

4. Emotional and psychological impact: 

Pregnancy can be emotionally taxing for any teenager, and having a disability might add to feelings of vulnerability or stress. 

5. Social stigma and discrimination: 

Teenage girls with disabilities may face societal biases and discrimination, which could affect their interactions with healthcare providers and support systems. 

6. Lack of accessibility in healthcare facilities: 

Some healthcare facilities may not be adequately equipped to accommodate the specific needs of pregnant girls with disabilities.

7. Physical strain during delivery: 

Delivering a child can be more physically demanding for someone with crippled legs, and it might require careful planning and medical intervention. 

8. Increased strain on the body: 

Pregnancy adds extra weight and stress on the body, which may be particularly challenging for those with limited mobility or physical disabilities. 

9. Risk of pressure sores: 

Girls with limited mobility may be at higher risk of developing pressure sores during pregnancy due to increased time spent in a seated or lying position.

10. Postpartum challenges: 

After delivery, they may face difficulties in caring for themselves and the newborn, especially if their disability hinders certain activities. 

11. Lack of access to education and employment: 

Dr. Betty Kwagala, a researcher at Makerere University in Kampala, has also conducted research on the challenges faced by teenage mothers with disabilities in Uganda. 

Her research has found that the mothers face a number of challenges, which are physical, social and economic.

Teenage mothers with disabilities are more likely to drop out of school due to multiple stigma and discrimination there and at the workplaces, which can make it difficult for them to support themselves and their children. 

This makes it difficult forthem to afford food, clothing and other necessities for themselves and their babies, Kwagala says. 

12. Childcare difficulties:

Some disabilities can make it difficult for mothers to care for their babies, such as physical impairments that make it difficult to hold a baby or breastfeed, she adds. 

Mothers with hearing impairments, Dr Kwagala says, may have difficulty communicating with their babies or understanding the instructions of healthcare providers.

Cheptoek with her post-graduate diploma in development leadership at St. Francis Xavier University in Canada.

Interventions 

Last November, MPs proposed that government includes skilling of children, mostly girls who are unable to continue with formal education in the new parish model. 

The development follows the rising cases of defilement and teenage pregnancies. 

Cecilia Ogwal, the Dokolo District Woman MP, also asked that skilling centres be established, equipped and accessible to the girls. T

he centres should be located at parishes to save the learners from walking long distances, which expose them to more risks, recommended the Speaker of Parliament, Anita Among. 

Juliet Kinyamatama, the Rakai District Woman MP, argued that the Government needs to consider incentives to inspire teenage mothers to stay in school. 

She proposed providing the children with food before the re-opening of schools. 

In December 2021, the Government, in partnership with the United Nations Population Fund (UNFPA) and UNICEF, launched a national campaign to address defilement, child marriage, teenage pregnancy, and promote positive parenting. 

The national campaign was spearheaded by The First Lady, Janet Museveni, Vice-President Jessica Alupo and Prime Minister Robinah Nabbanja. 

All ministries, departments and agencies and local governments were directed to take the necessary action to address issues of defilement, child marriage, teenage pregnancy and promote positive parenting in line with the law.

Recommendations 

Strict laws, by-laws and policies need to be enacted, calling for those who violate people with disabilities to be dealt with by the long arm of the law, says Grace Kyakuwa, a resident of Lungujja Kosovo, on the outskirts of Kampala and living with a physical disability. 

She also calls on parents to be empathetic when their children get pregnant and to work out how to resolve the challenge. 

Girls need to be empowered through education on sexual and reproductive health matters. In addition, they should be equipped on what to do when at risk of sexual violence or when exposed to it, Kyakuwa adds. 

Health facilities, especially public ones, need to create spaces where youth-friendly services are offered to both boys and girls. The facilities should be inclusive, that is, open to adolescents with disabilities, for example, having ramps for wheelchair-bound users, says Cheptoek. 

The information should be disseminated in a manner that allows the youth to make informed decisions. Statistics on disability information is also another challenge that Cheptoek stresses. 

She recommends that the government, through UBOS, be deliberate about the statistics in relation to health and other aspects which inform decision-making, as well as advocacy. 

The health ministry needs to train health workers on how to treat adolescents with disabilities humanely. 

Cheptoek says many teenage pregnant mothers shun antenatal services because health workers treat them inhumanely, calling them names and denying them service. 

Family members, friends or caregivers need to support adolescent mothers, which Mutesasira explains, can significantly positively influence their pregnancy experience and the postpartum period.

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

However, the views are not those of the sponsors or the Danish Ministry of Foreign Affairs.

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