Access to sexual reproductive health services a human right

By John Byarugaba

The mission of the Reproductive Health Division in Uganda is to attain the highest possible level of health for all the people in Uganda through the development and implementation of appropriate Sexual and Reproductive Health (SRH) policies, guidelines and strategies.

The components of SRH are safe motherhood, family planning, adolescent health, and prevention and management of unsafe abortion. Others are prevention of reproductive health tract infections including STI/HIV/AIDS, infertility, reproductive organ cancers, obstetric fistulae, and management of gender-based violence and female genital mutilation.

According to the 2016 Uganda Demographic and Health Survey, (UDHS), 28% of women who would like to access SRH services including contraception, do not do so. The survey further shows that 49% of women between 20 and 24 got married before their 18th birthday. Thus it is not surprising that Uganda has one of the highest teenage pregnancy rates in the world, persistently stagnating between 24% and 25% in the last two decades. High levels of teenage pregnancy correlate strongly with the rapid population growth. With an annual population growth rate of 3%, Uganda has one of the fastest growing populations in the world.

One of the major strategies for reducing fertility is ensuring access to quality integrated sexual and reproductive health services. Reducing persistent inequalities and ensuring equal and universal access to reproductive health and rights is one of the keys for Uganda to obtain middle income country status by 2040.

The current Sustainable Development Goals (SDG) clearly demand that by 2030 there should be universal access to sexual and reproductive health-care services. These include family planning, information and education, and the integration of reproductive health into national strategies and programs. The Contraceptives Prevalence Rate (CPR) is low at 24%, and the unmet need of Family Planning (FP) is at 41%.

A significant proportion of Ugandan adolescents have limited access to sexual and reproductive health services, and where they exist, they do not address their needs. SIHCI calls upon our government to ensure that the national policy guidelines and service standards for SRHR are adhered to, are based on human rights obligations and commitments that place gender equality at the center, address root causes of inequalities and poverty, and create a strong role for civil society engagement.

In the context of health, it is essential that the government of Uganda fully reflects the need to realize sexual and reproductive health and rights. This includes not only the need to ensure that SRH services and information, including comprehensive sexuality education, are accessible, acceptable, available and of good quality; but also that the right of individuals to make decisions about sexuality and reproduction, free from violence, coercion and discrimination, is fully realized.

Only when women and girls' human rights are at the centre of the SDGs framework, and only when civil society has a meaningful role in determining the future of the citizens shall we truly achieve meaningful and sustainable development. We hope that the government can work with us to make this a reality.

Support for Integrated Health Care Initiative (SIHCI) calls upon the government to:

1. Implement all the components of sexual reproductive health and rights as enshrined in the national policy guidelines and services standards for sexual and reproductive health and rights.
2. Review policy goals and objectives to improve the sexual and reproductive health and rights of everyone in the country.
3. Ensure that implementation of reproductive health care delivery systems operate at the national, district, health sub-district and community levels.
4. Integrate SRH services into existing health services which is in line with Ministry of Health policy such as capacity building, infrastructure improvement, health commodities/logistics, effective referral across services, community sensitization about the existence of integrated services, monitoring and evaluation.

Writer is the Executive Director, Support for Integrated Health Care Initiative (SIHCI)