Teen moms: The pain in accessing medical care

On Thursday, we marked the World Population Day. The 2013 theme, Focus is on Adolescent Pregnancy, brought to mind about 16 million girls of less than 18 years, who give birth each year. Another 3.2 million undergo unsafe abortions. Carol Natukunda now raises the issue of teenage pregnancy, where the UN argues that adolescent pregnancy is not just a health issue, but also an issue of development

That night, her mother fumed and threw things in all directions.

“Leave my house now!” she shouted, “You are not my child anymore.”

Even though Nambooze (first name withheld), was terribly scared, she refused to leave.

“Mom, I am sorry I embarrassed you. But I am not leaving this house!”

The 15-year-old Senior Three student was eight months pregnant. Her mother had not even noticed because, as a charcoal seller in Kasambya trading centre in Mubende district, she was always running up-and-down, trying to make ends meet. She would wind up the day too tired to find out if all was well with her daughter. Moreover, she could barely afford her children’s school requirements.

So, when Nambooze found a man to cater for her needs, she kept it under wraps. He was a shopkeeper and he would give her money and books.

“When my mother asked where I was getting the books, I kept quiet and she ignored me,” recounts Nambooze.

When she got pregnant, a friend advised her to have an abortion. But out of fear, she kept the baby, after all, her boyfriend was happy this would be his first child. When her shape became too suspicious for school and home, she decided to let the cat out of the bag. Her mother consulted family elders, who advised her to send Nambooze away from home. But Nambooze refused to leave.

Faced with a stubborn girl, Nambooze’s mother changed her mind and let her stay. She later delivered her baby boy, Fabian. He is one year old now. Nambooze returned to school and she hopes to sit her S.4 exams this year.


The school policy
Lawrence Lumbuye, the head teacher of Kasambya School, says Nambooze is not the only one who has dropped out due to pregnancy, and returned to school after delivery. “Since 2010 when we started allowing girls back to school after delivery, 10 have returned to complete their studies. They are usually 15 o 16 years old.

“We got a lot of resistance from the community. People think we are encouraging teenage pregnancy. But if a boy can continue school after making a girl pregnant, why not the girl? We cannot bury our heads in the sand.”

He says some teachers and students were apprehensive, until he asked them: “What if this was your daughter or sibling?”


Why high teenage pregnancies

Lumbuye attributes the high teenage pregnancy to commercial sex in slums, and the fact that parents are too busy for their children.

IN NUMBERS..

1/4

In Uganda, one out of four teenagers, in the age group 15-18, is either pregnant or has a child, according to the 2011 Uganda Demographic and Health Survey. He also condemns parents who force their children to get married once they realise they are pregnant.

He also says society makes it hard for the girls to access contraceptives and sex education. “The nature of people is, that they will have sex. While we want abstinence, the reality is it cannot happen.”

With the help of the United Nations Population Fund (UNFPA) and the Red Cross, the school has introduced a youth corner, where adolescents access information on reproductive health. They are also counselled on matters of relationships.

59 years
The life expectancy of Ugandans has gone up to 59 years, from 54.8 in 2010

The figures

According to a statement from UNFPA on World Population Day, about 16 million girls, of 15-19 years, give birth each year. It states that and complications from pregnancy and child birth are the leading cause of death among girls in this age group, especially in developing countries.

A total of 90% of the pregnant adolescents in the developing world are married and most of these not out of an informed choice. Often, it is a consequence of coercion, desperate circumstances, discrimination, rights violations (including child marriage) or inadequate education.

“There are over 600 million girls in the world today, more than 500 million of them in developing countries,” the UNFPA executive director, Dr. Babatunde Osotimehin, said.

“With the right skills and opportunities, they can invest in themselves, in their families and their communities. However, pregnancy jeopardises the rights, health, education and potential of far too many adolescent girls, robbing them of a better future.

In Uganda, one out of four teenagers, of age group 15-18, is either pregnant or has a child, according to the 2011 Uganda Demographic and Health Survey. This is because the majority does not have access to contraception. This has resulted into unsafe abortions and unnecessary deaths, resulting from several complications that come with child birth, such as fistula and excessive bleeding.

“The main problem is the age. Many have underdeveloped pelves and cannot deliver normally because they are too small,” says Josephine Namuleme, a midwife at Kasambya Health Centre III. She says out of 70 deliveries which were done in May, almost half of them were young mothers of below 20 years.

UNFPA proposal

According to UNFPA, adolescent pregnancy is not just a health issue, it is a development one as well.

“Teenage pregnancy is deeply rooted in poverty, gender inequality, violence, child and forced marriage, power imbalances between adolescent girls and their male partners, lack of education and the failure of systems and institutions to protect their rights,” their World Population Day statement reads. They added that this was the reason adolescent pregnancy was the theme.

“We want a world where every pregnancy is wanted, every child birth is safe and every young person’s potential is fulfilled.”

UNFPA advises governments to break the cycle of adolescent pregnancy by investing in adolescent girls, enacting and enforcing relevant laws and promoting community-based efforts that support girls’ rights and prevent child marriage and its consequences. “Adolescents and youth must be provided with age-appropriate comprehensive sexuality education, to develop the knowledge and skills they need to protect their health throughout their lives”.

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A midwife administering a Tetanus dose to a pregnant woman at Naguru centre

Reproductive health services not youth-friendly
By Agnes Kyotalengerire


Many youth fear visiting health centres to be treated for sexually transmitted infections, because the services are not youth-friendly. Even society has not spared them; it is judgmental.

Miriam Namugere, an officer with the Ministry of Health, says the youth need friendly reproductive health services, conveniently located, affordable and acceptable.

The ministry has adolescent health policy guidelines, which demand reproductive health services to adolescents to offer opportunities for a safe and supportive environment. The guidelines also require accurate information and values about health and development needs, building life skills to protect and safeguard their health and obtaining counselling services.

Henry Ntale, the behavioral change communication and advocacy manager at Naguru Teenage Information and Health Centre, says there was low access to health services by young people due to socio-economic and biological factors.

For example, he explains, the youth were afraid to approach facilities that screen STIs and pregnancy, fearing to meet their relatives or people they know. The health providers were also unfriendly.

“They would criticise them for indulging in premarital sex or demand an explanation why they needed contraceptives.”

“So, in 1994, Naguru Teenage Information and Health Centre set up the first programme to offer youth-friendly reproductive health services,” says Ntale.

He says about 110 young people go for treatment, HIV counselling and screening and seeking pregnancy-related services like contraceptives, testing, antenatal and post-natal services.

Namugere says the health ministry is working with partners like UNFPA to pilot a three-point access model approach, in 23 health facilities in Kanungu, Mubende, Katakwi, Yumbe, Kotido, Moroto, Kaabong and Oyam districts.

The approach brings schools, communities and health facilities together. The schools are linked to facilities with trained peer educators, who counsel and refer the youth. In addition, the facilities offer recreation games and educative videos. The services are embedded so that young people can get information about reproductive health services.

Dr. Jotham Musinguzi, the director of Partners in Population Development for Africa Region, says there is need to train young heath personnel to handle the growing number of adolescents.

Challenges

Musinguzi says the number of youth is growing tremendously and straining the available facilities and the human resource.

There are also challenges of whether to teach the adolescents about condom use or contraceptives, says Ntale.