Debate about contraceptives for teens rages on
Thursday December 13 2018
Immaculate Nakabugo, now in her 20s got pregnant at 16, dropped out of school and never went back.
She had been 13 and in Primary Six when her HIV/Aids positive mother suffered a relapse.
The mother had been diligently taking her antiretroviral drugs when she fell ill, so the family did not realise that an opportunistic disease like tuberculosis could still strike.
The TB left their mother’s CD4 count almost non-existent. The delay in treating tuberculosis meant she spent years recuperating.
Ms Nakabugo, the oldest girl in the family, shouldered the burden of being bread winner and caregiver for her mother and three siblings.
“For my Primary Six and seven, I went to school for about a total of two weeks. The rest of the time I cared for my mother, night and day, and for my siblings,” she says.
When Ms Nakabugo was not taking care of her family, she was attempting to maintain her mother’s business — selling Katogo (a mixture of bananas and beef, or groundnuts paste cooked together and commonly consumed for breakfast) in her neighbourhood.
But with so much work and the lack of an adult’s attention, the business soon collapsed, leaving the family, with no source of livelihood.
Ms Nakabugo speaks of one particularly hard day, when she had been contemplating the amount of boiled water she would need to force feed her wailing siblings before they could sleep.
But at around 8pm, one of her brother’s friends who had been working at a nearby Shell fuel station arrived and gave her money to buy sugar, maize flour and other necessities for the family with a proper meal.
This boy continued to support Ms Nakabugo, without asking for anything, until she was 16 when he asked for sex.
“My mother had warned me against early sex, so I was uncomfortable with the idea but I was so grateful for what he had done for me, I never thought about rejecting his request,” she says.
From that encounter Ms Nakabugo became pregnant with her now six-year-old twins. As her mother could never afford to feed the extra pair of mouths, Ms Nakabugo dropped out of school to fend for her twins.
For Ms Nakabugo, it was not that she was immoral or did not know not to engage in sexual activity when young. It is poverty that compromised the traditional morals, of not engaging in premarital sex that she had been taught.
Despite the belief among many policy makers in Africa that poverty is an excuse that girls use to engage in sexual activity, experts say this is widespread across sub-Saharan Africa.
Dr Natalia Kanem the UN Population Fund executive director says their research has found that in part, the lack of comprehensive and sexual reproductive health education can be blamed, as the decision by parents and religious leaders to treat sex as a taboo subject has placed young women in a space where their bodies are not treated with enough respect
This is coupled with poverty and deprivation on the continent, putting young women in space where sex is used to carter for the economic needs.
“That is why an adolescent girl has a higher risk of contracting HIV/Aids on this continent than anywhere else in the world,” says Dr Kanem.
Dr Kanem adds that, as a result, the cohort, that is made up of young women in sub-Saharan Africa is the only one where HIV/Aids infection rates are on the increase.
In addition to acquisition of HIV/Aids many of the adolescents that get pregnant from these sexual encounters die in child birth.
“Pregnancy in our teenagers is lethal, as it is the leading cause of death among girls aged 15 to 19,” says Jose Rimon director of the Institute for Population and Reproductive Health at Johns Hopkins University.
Some of the deaths are blamed on girls’ bodies not being ready for child birth, while other cases are due to unsafe abortions.
To solve the dangers that are associated with child birth among young girls, Dr Kanem advises governments to start providing comprehensive sexual and reproductive health education, as well as contraceptives for those who need them.
According to her, through their work at the UNPF, they have discovered that coercion is an important factor in explaining pregnancies among adolescents.
This coercion she says takes many forms as it can be rape or the kind that is due to economic necessity, a common option for girls in sub-Saharan Africa.
“The so-called sugar daddy phenomenon is widespread on this continent” she explains.
When governments provide sexuality education and contraceptives for girls that need the services, young women can then appreciate their bodies better.
For those who are going to decide to engage in sex anyway, the education and availability of contraceptives allows them an opportunity to protect themselves against sexually transmitted diseases and unwanted pregnancies.
But in Uganda, the provision of comprehensive sexuality education and contraceptives is something that has been opposed by policy makers.
In 2017, girls like Ms Nakabugo, who find themselves exposed to early sex, were given two choices, to abstain or risk getting pregnant and contracting sexually transmitted diseases by Joyce Moriku the Minister of State for Primary Healthcare.
Technocrats in the Ministry of Health had come up with a policy which stated that every sexually active individual should have access to family planning information and services when they need them.
But Dr Moriku rejected this policy alleging the technocrats had colluded with civil society organisations to pervert ten-year olds with contraceptives.
As a result of the Dr Moriku’s protest, the technocrats agreed to change the policy.
Dr Placid Mihayo, the family planning co-ordinator at the Ministry of Health, says the guidelines have since been amended to recognise Uganda’s age of consent.
As a result, the government now requires that anyone below the age of 18, who needs contraceptives, bring along a guardian to provide consent on his or her behalf.
“Since most guardians are unwilling to give consent, it is impossible to provide family planning services to those under 18,” Dr Mihayo says.
While this means that the many youths engaged in sex before adulthood will be exposed to sexually transmitted diseases and early pregnancy, Dr Moriku says this is the parent’s problem and not the government’s.
According to the 2016 demographic health survey, half of all women aged between 25 and 49 had their first sexual encounter before they were seventeen.
In a phone interview, Dr Moriku said that girls, who become pregnant before they are 18, are the parent’s responsibility.
According to her, giving contraceptives to 15-year-olds would mean government is taking over the duty of parenting.
“How does a 15-year-old become pregnant? How did she become sexually active? Was she brought up by a tree?” the Minister asked.
This view is backed by First Lady Janet Museveni and Minister of Education who says she expects parents across Uganda to be like her and ensure that their daughters remained virgins until marriage.
Joyce Nyachwo who was an adolescent mother and now a peer educator, accuses government officials in Uganda of forgetting the realities of the populace.
Ms Nyachwo cites herself as an example.
While not from as poor a family, as Ms Nakabugo, she too had to resort to a man to care of some of her financial needs.
During her days at Lubiri senior secondary school, her father would struggle to pay school fees.
After paying school fees, Ms Nyachwo’s father would give her Ush10,000 ($2.7) to cover everything including stationary, transport, panties, sanitary pads and pocket money.
“He would give me that money and I would know that was all he had, so I never asked for more,” she says.
Ms Nyachwo started depending on boyfriends for her pocket money and school needs. When she got pregnant, she stopped going to school and has since depended on casual jobs to take of herself and her child.
“The problem with the politicians is that they think teenagers are homogenous. They sit in their mansions and assume that all teenagers live like their children, with parents taking care of everything,” says Nyanchwo of ministers like Mrs Museveni and Dr Moriku.
Dr Mihayo agrees with Ms Nyanchwo that it is impossible to stamp out early sex among adolescents and encouraging abstinence.
He says instead it makes sense to provide contraceptives for those in need, because the reality of young people choosing to engage in early sex, mostly for financial reasons is common in Uganda.
Dr Mihayo says that given the high correlation between Uganda’s poorest regions and the high child marriages, as well as teenage pregnancies, it is unlikely that morality would solve these problems.
He cites Bunyoro, Busoga, Kasese, Karamoja and West Nile as places with the highest incidences of 13 and 14-year-olds getting pregnant.
The teenage pregnancy rate in these areas is above 30 per cent above the national rate, which stands at 25 per cent.
The consensus among technocrats is that providing contraceptives to sexually active girls from poor backgrounds is an important tool in breaking the cycle of poverty.
“Family planning is a tool that is central to women’s empowerment and to sustainable development. And among those who would benefit most are the young people who are in danger of being trapped in sequels of poverty,” says Dr Kanem.
But Dr Kanem says that while they have the data to show that comprehensive sexual education and giving contraceptives to youth who need them works, as UNFP they can only work within the parameters provided by government.