According to the Performance Monitoring and Accountability (PMA) survey 2020, 78 per cent of youth aged between 15 and 24 live in the rural areas and majority of them do not attend secondary school. Early marriage and early child bearing in Uganda remains high with 34 per cent of 18 -24-year-old married before age 18 and 27 per cent having their first birth by age 18, in addition to almost 32 per cent of 18 – 24-year-olds having two or more children.
Furthermore, the average age at first sex among girls residing in the rural area is 16, while age of first use of contraceptives is 23. In urban areas, the age at first sex is 17 years and the age of first use of contraceptives is 21 years. Therefore, girls in rural areas are most disadvantaged and are prone to risk due to the significant 8-year gap between first sex and first time utilisation of contraceptives. The obvious consequence is unintended pregnancies, a number of which result in unsafe abortions, increased risk of maternal mortality and morbidity. Worth noting is that early pregnancy is a key driver of early marriage and school dropout.
Sadly, these girls are being deprived of a chance to a normal life due to limited or no access to contraception.
In an era where we have witnessed progress in many sectors and many programmes geared towards equality, and bridging the rural/urban divide, it is abundantly clear that being a girl born and raised in the rural areas places one in a default disadvantaged position that will further inequality. Therefore, the question is, “are we failing our girls?” Access to modern contraceptives in Uganda is being hindered by a variety of factors, including legal barriers such as the age of consent, afford ability, availability, inadequate knowledge characterised by myths and misconceptions and the unfriendly attitude of health workers towards young people seeking SRH services. For girls and women from rural and poor backgrounds, accessibility is further hindered by poverty, community perception, limited knowledge and exposure.
Knowledge and use of contraceptives are central elements to reduce unplanned pregnancies and sexually transmitted infections among young people, but it is obvious that the achievement of these goals requires a more comprehensive approach, with the development of a positive adolescent’s sexuality as a necessary component.
Evidence shows that there is a need to strengthen approaches to provide contraceptives.
Girls who are already sexually active must know about contraceptive use. This calls for ensuring affordability, availability and accessibility of these contraceptive services to give women the choice on whether or not to have a child, when and how to space child-birth as well as have control over their bodies and health. Studies have shown that sex education among adolescents plays a vital role in increasing knowledge and empowering young people, especially against unwanted pregnancy, HIV and STIs. This is contrary to the popular belief that access to SRH information will lead to promiscuity among young people. When girls and women have access to contraceptives, fewer girls drop out of school, fewer girls die giving birth and more women enter the work force.
It is critical to invest in young people through education and access to family planning information and services to seize the demographic dividend. We need to help lift the barriers preventing many women and girls from accessing contraception and empowering them with the information they need regarding their sexual reproductive health.
Therefore, as the world marks International Contraceptive Day today, the Ministry of Health, UNFPA, Uganda Family Planning Consortium and CSOs, including Marie Stopes Uganda, organised a youth conference yesterday and a National Family Planning conference starting today and ending tomorrow. The conference aims to provide a platform for young people to dialogue, share with and lobby policy makers to implement programmes that promote access to SRH information and services for young people to enable them seize opportunities to realise their potential.
Ms Kyateka is the head communications and public relations – Marie Stopes Uganda.