A Second Chance at Self-Determination

Jhpiego’s work with teenage mothers in Tororo and Bukedea

Sixteen-year old Maria suspected she was pregnant when she missed her period. Because she was terrified of how nurses at the health facility would react if she went in asking for a pregnancy test, she decided to buy a self-test kit. The result was negative, and Maria was relieved.

Four months later, she was admitted to a hospital with severe malaria and learned through initial tests that she was, in fact, pregnant. Maria almost lost her life and her baby. She and her boyfriend of two years had not used protection. Maria thought she was too young to become pregnant. She also feared that she would get caught buying condoms or getting them from the hospital. As a good Catholic girl from a staunch religious family, Maria was expected to abstain from sex until marriage.

Maria’s case is not unique in Uganda. Limited access to sexual reproductive health information and services, coupled with the judgmental attitudes of health providers, contribute to an environment where adolescents are vulnerable to both early and unintended pregnancies and sexually transmitted infections.

One in four girls between the ages of 15 to 19 in Uganda has given birth or is carrying her first child. In a country where sex before marriage is frowned upon and abstinence-only messages dominate reproductive health interventions for young people, these numbers should compel us to act.

Growing up as a young woman in rural Uganda, I never learned about sex from my mother. Neither had most of my friends because conversations about sex are taboo. Instead, I received my sex education from friends in the School Youth Club. A decade later, sex talk remains taboo in many homes. However, unlike a decade ago, young women and men can readily access information through the Internet, digital TV, and print media.

That said, access to sex information alone is not sufficient in curbing high-risk behavior that results in teen pregnancies. We must address other socioeconomic factors that influence the health outcomes of young Ugandans. Early marriages and traditional practices that make young women vulnerable to both sexual exploitation and abuse keep teenage pregnancy rates high. We must enforce laws that stop these harmful practices. We must also ensure that young people have easy access to healthcare services that are friendly and meet their unique needs.

Jhpiego in Uganda

In July 2016, I joined Jhpiego Uganda as a Global Health Corps fellow. I have often said that this has been one of the most rewarding experiences of my life because I have been able to practice my passion for communications while at the same time showcasing the incredible work of Jhpiego. Jhpiego is a not-for-profit international organization affiliated with Johns Hopkins University. The organization has been active in Uganda since the late 1980’s, working with the Ministry of Health and other partners to improve the lives of women and families.

As an organization that is improving lives of mothers and families, Jhpiego is concerned with the high mortality rate of adolescent mothers. The WHO reports that pregnancy and childbirth-related complications are the leading cause of death among adolescent girls in developing countries. To address this problem, Jhpiego is implementing initiatives that are sensitive to the needs of adolescents in order to increase their access to reproductive health services in 15 countries, including Uganda.

Through a demonstration project focused on adolescent health, Jhpiego is training health providers in the Eastern Uganda districts of Tororo and Bukedea on delivering quality and youth-friendly services to prevent subsequent pregnancies among adolescent girls and mothers.

Health providers practicing with an arm model during a training on contraceptive implants (Photo: Jhpiego Uganda).

Teenage pregnancy in Uganda is heavily frowned upon. Stories of adolescent mothers being renounced by their parents and subject to extreme violence and abuse are common. Institutions do not support young mothers either. Although the Ministry of Education encourages pregnant students to continue school as long as they can, stigma and shaming from fellow students and school administrators often force pregnant students to leave school. Healthcare facilities aren’t any more welcoming. Unfriendly attitudes of health providers are often cited as one of the factors that keeps adolescents from health facilities.

In essence, the life, dreams, and aspirations of a pregnant adolescent come to a standstill. In Maria’s case, she has discontinued school:

“That was the most difficult part; having to quit school. I know that it is going to be long before I go back to school since I have to breastfeed for at least six months. I feel like I have lost so much time.”

Despite this setback, Maria’s parents are determined to see their daughter return to school. Maria’s mother has promised to take care of the baby to enable Maria to join secondary school in February. Maria is one of a few lucky adolescent mothers who get that chance. For hundreds of thousands of adolescent mothers, life takes a different turn. Often, they are forced to marry the father of the baby (if they were not married already). Before long, a second, third, and fourth child is on the way, and the woman has limited control over what happens in her life.

The Jhpiego Differentiator

Many of the current interventions that seek to curb adolescent pregnancies merely focus on preventing the first pregnancy, leaving limited options for teenagers who are pregnant or already have children. Additionally, such interventions have major limitations especially in cases where teenagers are married off by relatives or being sexually abused by their relatives or elders.

Bukedea, a remote area with high levels of poverty, and Tororo, located on the Kenya-Uganda border, have some of the highest teenage pregnancy rates in the country, estimated at more than twenty-five percent. Driven by these overwhelming numbers, Jhpiego’s unique project focuses on helping teenage mothers appropriately time-subsequent pregnancies. The project builds the capacity of health service providers to offer youth-friendly sexual and reproductive health services, and utilizes trained champion adolescent mothers to bring services and commodities closer to their targeted peers.

With support from family, relatives, and community initiatives, an adolescent mother can resume her education after the baby arrives, and either start a business or acquire skills. An unplanned subsequent pregnancy, however, can shatter such dreams.

The project gives young women such as Maria the power to determine both their future and the future of their children. Most significantly, the project is testing a transformative model that could be scaled up nationwide and contribute to better health outcomes for adolescent mothers in Uganda. Making that a reality offers the promise of a bright future, not only for Maria and other adolescent moms like her, but for the country as a whole.

Ritah Namwiza is a 2016–2017 Global Health Corps fellow working in the Uganda office of Jhpiego, an international health organization and affiliate of Johns Hopkins University.

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