In Uganda, Adolescents constitute the highest demographic segment yet their sexual reproductive information and health services to meet their needs are still limited.
With such gaps, adolescents still face a multitude of health challenges, like teenage pregnancy, gender violence, sexual, emotional, or domestic abuse, early marriage, teenage pregnancy, and female genital mutilation/cutting making it hard for them to fulfill their potential.
According to the Ministry of Health, presently, 25% of Ugandan teenagers become pregnant by the age of 19. About 49% are married before their 18th birthday and they start getting babies until their mid-40s.
It is very important to note that to some extent, our healthcare facilities have geared the stigma among the young people because they are not ready to take up youth-friendly services, limited priority is put on such services and there is a lot of biases from the healthcare providers.
There has been a drop of 20% in oral contraceptive use among young people who are sexually active because of the disruptions in the access of the sexual reproductive health services between April-June 2019 and April-June 2020.
Urgency is needed throughout the nurturing process of adolescents to get human capital development which is the centerpiece of government planning said Prof Peter Waiswa at a recent adolescent health webinar.
Titled Responding to Adolescent Health Challenges during the COVID-19 Pandemic and beyond, the webinar was organized on the 12th October 2021 by Makerere University School of Public Health (MakSPH) in partnership with development partners and was chaired by Prof Peter Waiswa who is also leader of the MakSPH Maternal Newborn and Child Health Center of Excellence.
“How can we respond to the adolescent challenges better so as we can get the opportunity of harnessing human capital which links with our country’s development?” asked Prof Waiswa during the webinar.
National policies on adolescent health have been a bit delayed and the consequences on these young people are far-reaching which has affected and is still affecting them even through the current closure of education institutions
According to UNESCO, over 90% of children in the primary school age, and over 80% of children in the lower secondary school age are enrolled in school globally. By promoting healthy behavior from early childhood through the school setting, it would benefit not only the children themselves but also their families, peers, and communities at large.
In addition, schools are strategic platforms for delivering preventive health care services, and these services are considered as an extended arm of primary health care. Therefore, schools provide an efficient and effective way to reach large numbers of the population.
That now schools are closed and children are out of school for protection reasons against the spread of the pandemic, this means there is limited access to sexual education, so there has been an increasing emergency on adolescent health issues concerning gender-based violence at 28% across the country, teenage pregnancies, obesity and malnutrition, anxiety and depression loss of employment to the young people plus the economic tension that has lowered the purchasing power for many families and community at large has been experienced.
Much pressure has been put on the young people to fight for survival and this has prompted them to get engaged in dangerous activities which have put their health at stake. Needless to say, the effects spill over on to their health, economic and social status.
The Population Secretariat indicates that of the 1.2 million pregnancies recorded in Uganda annually, 25% of these are teenage pregnancies. There are more than 300,000 teenagers who get pregnant which accounts for the bulk of unwanted pregnancies, which end up in unintended births or abortion.
According to the Uganda Demographic Health survey 2016, 1 in 4 adolescent women aged 15-19 are already mothers or pregnant with their first child. Teenage childbearing is higher in rural areas (27%) than in urban areas (19%).
The Ministry of Health Uganda has issued guidelines that will help in the continuity of essential health services for adolescents and this will help in calming the storm on adolescent health challenges.
According to Dr Justine Nabwire, from the division of adolescent and school health in the reproductive and child health department ministry of health Uganda, the ministry came up with the continuity of care guidelines to tackle adolescent health issues.
“The Ministry is strengthening governance and coordination mechanisms for essential service continuity at the national and sub-national level, define high priority essential services and provide guidance on a set of targeted immediate actions at the health facility level to re-organize and maintain access to essential quality health services,” she said at the webinar, adding: “Monitor continuity of essential health services and provide the necessary support to sustain quality essential services.”
Furthermore, the ministry of health is engaging more with districts and communities in regard for training for the response to address the existing gaps in terms of mental health, drugs abuse, transactional sex by the young people, teenagers that got pregnant during the lockdown, and governments capacity to meet the requirements for social distancing and PPE.
Unfortunately, our healthcare facilities are not yet well placed to take on the existing demand neither ready to take on the youth-friendly services with this many young people still face stigma and discrimination. A lot of biases from healthcare providers have given limited priority put on providing youth-friendly services and efforts to review the policy have hit a dead rock.
Need to review the adolescent health care policy and target adolescents with sexual behavior change campaigns and take advantage of the already existing opportunities and revise our interventions.
“The bio-medical approach is not enough to solve the crisis at hand, there is a need for dialogues to engage the community, cultural and religious leaders because nothing can be done without them, everyone should get on board to solve the problem of teenage pregnancy,” said Dr. Justine Nabwire.
Hon Dr Ayume Charles a representative on the parliamentary health committee and Koboko municipality member of parliament during his remarks pledged that the health committee is ready to engage and help in the integration of adolescent health into routine health services that go up to the health center iii level.
They are open to help in terms of access to information, funding, and legislation because the parliament is aware that there is a big gap that needs to be closed.