Reproductive health rights in Uganda; Conventional versus modern approaches

September 26, 2018 was observed as World Contraception Day and the motto of this year was to create awareness about several methods of contraception available around the world.

The mission for the year was to improve awareness of all contraceptive methods available and enable young people to make informed choices on their sexual and reproductive health. For Uganda, the significance of this drive cannot be understated considering the high burden of teenage pregnancies, exposure to HIV/AIDs and other such risks that come with adolescents and teenagers being exposed to unsafe sex.

According to the Uganda Demographic Health Survey (UDHS) 2016 report, 25 % of adolescents aged 15-19 in Uganda have began giving birth. That is 1 out of every 4 girls. The Uganda Population Based HIV Impact Assessment (2016-2017) on the other hand, states that as of 2016, the estimated HIV prevalence among adults (aged 15 to 49) stood at 6.5%. Women are disproportionately affected, with 7.6% of adult women living with HIV compared to 4.7% of men.

There have been international and national efforts both by the Government and civil society actors, to address this issue. The ministry of Health recently launched a drive dubbed “Live your Dream” aimed at fighting teenage pregnancy and enabling Ugandans to live life to the fullest. Organisations such as Reach A Hand Uganda (RAHU) are championing this cause, much to their credit, using young voices and champions. Part of this work has been around policy advocacy within government and Parliament for among others youth friendly policies that provide and guarantee.

 

On 26th September a group of remarkable young and passionate youth champions under their umbrella African Youth and Adolescents Network (AFriYAN), held an interactive engagement with the Parliamentary committee on Health. It was an insightful interaction that provided both clarity and controversy, around modalities of addressing the pressing reproductive health rights affecting young people.

What made this interaction really fascinating was the contrast of ideas on reproductive health rights for young people. On one hand the AfriYAN champions made for a plea the provision of reproductive health services including contraceptives for young people (teenagers). This was coming in part from their lived experience as young people, and what they see around them. On the other hand the MPs on the health committee and more specifically the female MPs were opposed to the idea of providing contraceptives to under age(below 18) girls. It was a debate between choosing convention or adopting the modern options made available by technology and science in dealing with reproductive health concerns. Times have changed and the environment in which children are raised and live predisposes them to all manner risks. Girls as young as 14 are dropping out of school to raise fatherless children and yet the modern contraceptives if properly utilized can contribute in reducing this risk. And yet, this is not an option that many policy makers are comfortable with.

“Morality” whatever it means, has been used as the standard argument by MPs for regulating and addressing the reproductive health needs of young people. It underpinned the motion to ban comprehensive sexuality education in 2016 by Parliament. “Why don’t you leave the age for contraception to those old enough to legally have sex?” asked on MP. “Why don’t we work on changing the mindset instead of advocating for contraception?” another female MP asked.

However, young people are exposed to sex at such a tender age and the safe spaces for them to openly discuss these with parents, teachers and leaders is shrinking. Sharon a youth champion remarked thus, “Parents are not listening. The environment is toxic for discussing these issues especially anything to do with sex is taboo. We’ve been taught webs of silence when it comes to issues like sexual and reproductive health. So what then should we do?”

The youth champion made a compelling case that we must think about solutions that resonate with the current context and environment young people are raised and not to hide our heads in the sand and stick to traditional approaches, which for all intents and purposes have not yielded fruit.

However, what became apparent in the conversation was the divergence in approach on sexual reproductive health rights. The Female MPs took on a motherly tone to the conversation, sharing their experience of being raised and how they raise their children. They emphasized the utility of traditional and cultural values towards sex as way of raising teenagers and adolescents, encouraging abstinence as a preferred course of action.

Even though they disagreed on the approach, they converged on the need for action, by everyone concerned to stem the HIV/AIDs scourge, and the teenage pregnancies bedeviling young people today, where 1 in four girls in engaged in unprotected sex by the age of 18.

In much of the developed world, access to family planning options for young people is convention. In our context, the idea teenage sex is seen as taboo, with the age of consent being 18 and so family planning options are not even given due considerations, especially by the Government.. Much of the injunction, as expressed by the MPs on the health committee, is underpinned by concerns on health risks of exposing young girls to contraceptives, and the moral culture and taboo about sex, which prohibits open and candid discussion about sex.

For those championing the cause for contraceptives, there is need for more research and evidence, if traditional biases and prejudices on sex are to be addressed but also the controversy surrounding contraceptives for adolescents.
At the heart of this debate, however, the salient question is on who should wield the power over women’s bodies and how they deal with them.

Listening to these young people advocating for the reproductive health needs of their fellow young people, and the injunctions from older men and women who wield the power to enact polices, I realize this is going to be a long battle. In the end I hope we pragmatism supersedes our personal biases.