Uganda teen pregnancies' plan under fire

A new Ugandan sex-education campaign to reduce teen pregnancy, maternal mortality among young women and girls, and the cost of post-abortion medical care, is generating heated debate.

The one year campaign "Let Girls Be Girls" was officially launched on 13 July by the Health Ministry and UN Population Fund (UNFPA). It aims to address the growing vulnerability of girls to early pregnancy and birth related complications, and hopes to reduce deaths among young mothers aged 15-24 from the current 24 percent to 15 percent by July 2015.

The programme provides free contraceptives to adolescents in schools, and sex education to local communities, parents, pupils and teachers on the rights children have to a safe and secure environment within their homes, schools and communities.

"Our campaign is 'Let Girls Be Girls' and not young wives or mothers. Our emphasis is on sex education and empowering girls and boys to say no to early sex before marriage and to report men and boys disturbing them," Zainab Akol, principal medical officer, family planning, at the Ministry of Health, told IRIN.

"We want them [girls] to preserve their fertility and not do abortions. We also want all those who get pregnant to return and complete school," she said.

According to the 2011 Uganda Demographic Health Survey (UDHS), 24 percent of female teenagers are either pregnant or have given birth already. About 14 percent of young women and 16 percent of young men had their first sexual encounter before the age of 15, while 57 percent of young women had their first encounter before the age of 18, the survey found.

Twenty-four percent of female youths aged 15-24 have had an abortion. Although there are few studies on abortions, some 297,000 abortions are performed annually, with 85,000 women treated for complications, according to a 2013 Guttmacher Institute report entitled Unintended pregnancy and abortion in Uganda.

Criticism from Ethics Ministry, churches

However, Uganda's Ethics and Integrity Ministry and religious leaders have opposed the campaign on the grounds that it promotes sexual immorality and promiscuity among youths.

"The provision of contraceptives to the adolescents is totally against our church teaching on marriage. We condemn and can't allow it. The campaign encourages sexual immorality and promiscuity," Rev. Vincent Karatunga, executive secretary, inter-religious dialogue at the Catholic Secretariat, Kampala, told IRIN.

24 percent of female teenagers are either pregnant or have given birth already "Sex is preserve for marriage. Any sex outside marriage is against, and contradicts, the plan of God, which is a sin. Sex is meant for procreation not for pleasure or self-satisfaction," he said.

"We were not consulted on this campaign. What is it for? What kind of morals are they trying to promote," a senior government official in the Ethics Ministry told IRIN. "The initiative will increase the rate of sexual immorality among the youths in our country."

Uganda is a deeply religious and conservative country; 85.4 percent of the population are Christians, according to the 2002 Uganda Population and Housing Census, the last date a census was conducted.

But Uganda's minister for primary health care, Sarah Opendi, appealed to cultural, religious institutions and ordinary Ugandans to embrace the initiative for its sustainability and effectiveness.

"We can't afford to pretend and shy away. There is already a big problem. Rather than to blame us on moral grounds, people should come out and support this campaign. We can't continue with the worrying teenage pregnancy rates, among the highest in the world," Opendi, told IRIN.

"We need collective effort from religious, cultural leaders and other stakeholders to fight this vice in order to save our young girls. We need support to prevent the causes of teenage pregnancies and their consequences," she said.

"Aggressive legal and community response to sexual violence and coercion that young women routinely experience will help address the epidemic of unsafe abortions that young women in particular are vulnerable to in Uganda," Asia Russell, director of International Policy, Health GAP (Global Access Project), told IRIN.

Early marriage, no family planning

Early marriages are the lead cause of teenage pregnancies in Uganda. Over 90 percent of the teenage pregnancies are among girls who are married before the age of 18, according to the Guttmacher Institute report. While the consensual age for sex under the country's constitution, and the legal age at which to get married, is 18, poverty and cultural practices force girls into early marriages.

Almost half of Ugandan girls are married by the age of 18, according to UNFPA.

"Child marriage denies a girl of her childhood, disrupts her education, limits her opportunities, increases her risk of violence and abuse, and jeopardizes her health. Child marriage results in early and unwanted pregnancies, posing life-threatening risks for girls", said UNFPA.

Inadequate access to reproductive health services, particularly family planning, is also a contributor to teenage pregnancy. Three in 10 (31 percent) girls aged 15 to 19 report having an unmet family planning need, according to the Guttmacher Institute report. Women are considered to have an unmet need if they wish to space their children's births or limit childbearing but are not using contraception.

Uganda's modern Contraceptives Prevalence Rate (CPR) stands at 26 percent, according to the 2011 UDHS. Only 30 percent of married women of reproductive age use any form of contraception.

As a result, the Guttmacher Institute estimates that "more than half of pregnancies in Uganda are unintended, and nearly a third of these end in abortion."

Yet, the laws in Uganda restrict abortion and are unclear, leading many women and girls to seek clandestine, unsafe or even self-induced abortions.

"Laws and policies on abortion [in Uganda] are unclear and often interpreted inconsistently, making it difficult for women and the medical community to understand what is legally permitted," noted the Guttmacher Institute.

High maternal mortality ratios

The campaign hopes that by lowering teenage pregnancy they will be able to curb maternal mortality ratios, which remain stubbornly high.

Uganda is currently not on track to meet the Millennium Development Goal (MDG) to reduce maternal deaths, and had a mortality ratio of 438 per 100,000 live births in 2011. Out of 6,000 mothers who die annually due to pregnancy and birth-related complications, about 24 percent of them are teenagers, according to the 2011 UDHS.

"This campaign is very timely, especially as Uganda evaluates itself on the failure to achieve MDG goal number five to improve maternal health. Adolescents and young adults are particularly at risk of unintended pregnancy," Joy Asasira, program officer, human rights documentation and advocacy, Center for Health, Human Rights and Advocacy Development (CEHURD), told IRIN.

"However, addressing teenage pregnancies in Uganda, requires a multi-sector approach, and as such, ministries like that of education and sports, gender, labour and social development, cultural and religious institutions have to be involved in order to ensure sustainability and effectiveness of this campaign," she added.