Why Mental Health Should be Integrated into Sexual and Reproductive Health Services
’’I was impregnated by my uncle. He was staying with us in our home. He threatened to kill me if I told anyone that he had defiled me. When he learned that I had become pregnant, he ran away, and up to now, I don’t know where he is.”
–Rehema, Age 15, from Luuka District in Eastern Uganda, shared her story with Anadolu Agency
Stories like Rehema’s are not rare occurrences. A 2021 report by UNICEF indicated a 22.5% increase in teenage pregnancies between March 2020 and June 2021 in Sub-Saharan Africa. UNICEF acknowledges that many girls who are pregnant are pressured or forced to drop out of school, which can impact their educational and employment prospects and opportunities. Early pregnancy and childbearing can also have social consequences for girls, including reduced status in the home and community, stigmatization, rejection, and violence by family members, peers, and partners, and early and forced marriage — all of which can trigger adverse mental health outcomes. Furthermore, serious health conditions such as obstetric fistula, eclampsia, puerperal endometritis, and systemic infections in the short and long-term tend to also have mental health-related, co-morbid conditions.
When critically assessing the intersection between mental health and sexual and reproductive health (SRH), teenage pregnancies are only a drop in an ocean. Mental health problems can be a result of concurrent or past SRH events and vice versa. Research has shown that people with serious mental illness tend to have more lifetime sexual partners, limited use of contraception, and unplanned pregnancy among women, which leads to a greater risk of sexually transmitted infections including HIV.
The adolescence stage, during which SRH services, such as information, are key is also a time when young people undergo a lot of physical, mental, and psychosocial changes and are therefore susceptible to varying degrees of mental stress. The stigma and discrimination that arise from physical changes, such as menstruation, can also trigger poor mental and physical health. This stigma and discrimination can also lead to isolation from family, social exclusion, low self-esteem, and fear of sexual abuse (when menstruation precedes child marriage), which are all risk factors for psychological distress.
It should also be noted that gender-based violence (GBV) with its pervasive negative consequences on SRH is both a cause and a consequence of mental health challenges. A report by CEHURD Uganda indicates that women suffering from intimate partner violence are less likely to adopt contraception and are 46 to 69 percent more likely to have an unintended pregnancy. Abusive partners are 83 percent more likely to coerce a pregnancy, through forced intercourse or birth-control sabotage, and women in abusive relationships are 2.7 times more likely to seek an abortion. There is also an explicit linkage between alcohol and substance use disorder with GBV.
“The effect of alcohol on the cognitive capabilities of individuals lowers inhibitions and heightens patriarchal ideologies, thus arousing dominant toxic masculinities that often lead to violence by men towards women.” - South African Commission on Gender Equality
While designing interventions to promote SRH, it is very critical to appreciate the bi-directional relationship SRH has with mental health. This includes psychological distress and stigma resulting from adolescent bodily changes such as menstruation, mental illness affecting the use of contraception, encouraging risky sexual behaviors, and gender-based violence as well as alcohol and drug use being a key risk factor in teenage pregnancies and sexual abuse. Therefore, integrating mental health services such as psychoeducation and psychotherapy by providers of SRH services can go a long way in offering holistic care to both individuals and their communities thus improving general SRH outcomes.
Charles Mwanje was a 2020–2021 Global Health Corps fellow and currently serves as the Behavioral Health Programs Officer at Jhpiego–A Johns Hopkins University affiliate.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
