On 2nd March 2021, the office of the Chief Administrative Office Butalejja with support from the Uganda Youth and Adolescents Health Forum organized a one-day Butaleja district policy dialogue on addressing maternal mortality and maternal morbidity due to teenage pregnancies and Unsafe abortions among young people. The meeting was attended to by 52 participants (F 21,30M). The policy dialogue was organized under the following objectives;

1.Create a platform for inter-generational dialogue between young people, policymakers, and community leaders on the state of young people’s sexual and reproductive health issues and their impact on the district’s maternal and child health indicators.

2. Discuss key multi-sectoral strategies and seek joint commitments and actions from policymakers, community leaders, and social workers on protecting and advancing the sexual reproductive health rights of young people.

3. Build the capacity of leaders to understand the specific SRHR and gender needs of young people and key roles they can play to support young people to meet these needs.

4. Provide a space for young people to present key recommendations in the position paper generated during the young mother’s forums held in Mbale and Butalejja.

Mr. Mwesigye Patrick while giving his brief remarks explained to the participants that maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy while maternal morbidity refers to any physical injuries or disability directly related to pregnancy or childbirth. A participant mentioned fistula as one of the birth injuries and explained that it’s an abnormal or surgically made passage between a hollow or tubular organ and the body surface or between two hollow or tubular organs for example passage between the birth canal and the rectum. As stakeholders in the room, each one is playing their part and we are going to brainstorm on what we aren’t doing right as health workers, young people religious leaders, and cultural leaders. Why do we still have teenage girls getting pregnant? If girls have access to contraceptives will that address the issue of teenage pregnancy and unsafe abortions? Will the reduction of SGBV reduce maternal mortality?  We need to understand what we can do to end these injustices, there is a reason as to why we are all together in this room.

Dr.Siraj Kizito the DHO of Butalejja in his opening remarks thanked the participants for honoring the invitation and informed them that Mr. Mwesigye Patrcik and Ms.Nakyegera Norah from UYAHF are the minds behind the policy dialogue. Butalejja is the 3rd most fertile district in Uganda out of the 136 districts with Amudat being the most fertile district in Uganda.  These rankings were made about the statistics around teenage pregnancy that were done countrywide. From the findings, Amudat has a child-bearing range of 9-10 children per mother while in Butalejja is currently at a range of 8 children per mother. The biggest challenge is that these mothers have these children but they are not properly spaced and the mothers can’t provide these children with basic needs. It should be noted that most of these mothers start giving birth in their teenage years. Butalejja district has the youngest grandmother in the world. Masamasa, Musaba, Kakyoga have the highest populations in the district. Dr.Siraj Kizito shared the drivers behind the increased teenage pregnancies in Butalejja district.  Poverty is one of the leading causes of teenage pregnancy and some parents look at their daughters as a source of wealth. These daughters are looked at as a commodity that they trade for dowry with or without the girl’s consent. Boda Boda cyclists and brokers for the rice (businessmen, shopkeepers) seduce the teenage girls into having sex by buying them rolex, offering Boda Boda riders and some pocket money. When these businessmen have made sells they look around for brokers to help them hook up with young girls ‘said Dr.Siraj Kizito’.There are some religious beliefs as the Islamic faith which states that once a girl starts menstruation she is mature enough and ready for marriage. If we have many people go by this act the end will be very disastrous because of the various challenges associated with teenage pregnancy and child marriages. The majority of the adolescent girls in Butalejja have inadequate knowledge of contraceptives which puts them in a very vulnerable position. This is greatly contributed to the none involvement of adolescents and young people in district programs, their poor involvement in such programs makes it hard to identify the challenges they are facing. The adolescents in the audience informed Dr. Siraj Kizito that they have to move long distances to access contraceptives because they are scared of meeting their parents or relatives at the family planning service points in the nearby health centres. Dr.Siraj Kizito pointed out that leaving adolescents with caretakers alone in homes is a huge temptation as seen from the high numbers of incest that have been committed during the lockdown. There is a big number of teenage girls who were impregnated by their relatives.

When adolescents are faced with unwanted pregnancies they look around for cheap people to help them carry out abortions. The people they ran to do all sorts of things to terminate these pregnancies and the adolescents do all this without the knowledge of their parents. The parents get to know when the girls are suffering from complications associated with unsafe abortions. One of the major complications of abortion is anaemia that comes as a result of over bleeding and adolescent girls always keep quiet because they are scared of the reaction that they will get from their parents or caretakers who only get to know when the girls are severely anaemic. Septic abortion is an abortion complicated by pelvic infection. Septic abortion is the biggest killer of the adolescent girls that carry out unsafe abortions and in situations where they survive, they are unable to conceive as their fallopian tubes will be blocked. That is the reason people in the community usually say that the reason these people aren’t able to conceive is that they were cursed by the aborted babies. This is brought by the sepsis in the poorly managed abortion. There is a need to have youthful health workers on board as the adolescents aren’t comfortable when dealing with the older /elderly health care providers. Adolescents tend to be more free and relaxed around youthful health workers.  Dr.Siraj Kizito concluded his remarks by requesting participants to use media as it can be a good platform to sensitize people about the dangers of unsafe abortions and teenage pregnancy. He also requested UYAHF to set up an Adolescent Health clinic in Butalejja where the adolescents will find youth-friendly services that can be offered as the one in Mbale.

State of maternal and child health with a focus on adolescent and youth SRH 

Mr. Were Luke the biostatistician made a presentation on the state maternal and child health with a focus on adolescent and youth SRHR targets and indicators. Mr. Were Luke stated that there has been a rise in teenage pregnancy deliveries (10-19years) in Butalejja in 2019 they were 3596 deliveries and in 2020 there were 3633 deliveries. Busolwe health center registered a decrease in teenage deliveries(10-19years) in 2019 there were 650 deliveries while in 2020 there were 595 deliveries. This decrease can be attributed to the increased referrals made to Tororo Regional Referral Hospital because teenage mothers usually have complicated deliveries. He shared that the increase in teenage pregnancies can be attributed to poverty among families, cultural/religious beliefs, high school dropouts, peer influence, gender-based violence amongst families, lack of youth-friendly corners where peers could converge and discuss issues affecting them, and COVID 19 pandemic. The restrictions created a big challenge when it came to the accessibility of SRHR services. Teenage pregnancy has several implications on the lives of teenage mothers such as girls who start producing early have high chances of having more children, poor nutrition of infants and mothers, high mortality of infants and mothers, involvement in illegal abortions, increased GBV among the community, increased pressure on/ over-stretching of the health care system, inability to have employable skills especially the girls among others.

To effectively address the issue of teenage pregnancy and its challenges we need to;

  • Mobilize and sensitize communities about the importance and uptake of contraceptive services.
  • Improve quality and access to affordable contraceptive services.
  • Encourage social and economic empowerment of women
  • Promote girl child education which will delay and reduce the number of child marriages.
  • Carry out community outreaches and avail contraceptives commodities to the people in the communities
  • Develop By-laws on early girl marriages
  • Enhance the capacity of health workers to provide a wide range of contraceptives services

After his presentation there were a couple of reactions from the participants such as there are increased numbers of teenage deliveries that aren’t captured since some of these girls give birth from home, religious leaders should be involved in sensitizing the congregation about the dangers of teenage mothers not giving birth from hospitals, male involvement is crucial while advocating for SRHR since most of the misconceptions around contraceptives and teenage pregnancy in the community are spread by men. This is because of the inadequate information that they have around the issues. Mr.Mwesigye shared the example of an article that was published in the Daily Monitor where a man killed his wife when he discovered that she was taking family planning pills. The deceased woman was reported to her husband by a friend, when the man heard of this he strangled the wife leaving behind 7 children.

Mr. Were Luke making a presentation around the state of maternal and child health with a focus on adolescent and youth SRH

Panel discussion

The panel discussion on experiences and challenges encountered by service providers young people face in accessing SRHR and SGBV services and information was moderated by Mr. Nimwijuka Osbet from RHITES-E.  The panel had 8 panelists; Hyuha Richard DCDO Butaleja, Sr. Sarah Amusagut health worker from Busolwe hospital, Mugaba Agatha UYAHF Change Champion, Ofwono Martin Luther Religious leader, Akol Christine DEO Butaleja, Geoffry Family Planning adviser RHITES-E, counsel Asiimwe Ann from justice centre Tororo and the Omukuka Apollo Lyadda  Bunyole cultural representative.

From their submissions, it was clear that health workers need to have refresher pieces of training on how to provide youth-friendly services since adolescents and young people shun the health facilities because of how they are constantly treated by the health workers. Adolescents and young people are often faced with intimidation from parents and perpetrators when it comes to issues related to SRHR, SGBV, and contraceptives. Many adolescents want to take up contraceptives but face challenges of rude health workers and threats from their parents.  Currently, Busolwe hospital has a youth-friendly corner and they ensure to offer their services with a youth-friendly approach and hope to have many adolescents and young people turning up for services.

Mr.Waya Richard LCV Butalejja while giving his remarks informed participants that Butalejja is among the districts with the highest prevalence of HIV. He tasked the other participants from other districts to compare their statistics with Butalejja and try to analyze the reasons Butalejja isn’t doing well. In western districts of Uganda, you hardly find adolescents and young people engaging in unconstructive activities like playing matatu, smoking opium among others which isn’t the case in Butalejja. Adolescents and young people prefer to wake up just engage in unconstructive activities. The amount of money allocated to Butalejja by the government in the budget isn’t sufficient to solve Butaleja’s numerous problems. The Butalejja local government is calling upon donors and NGOs to offer support and suggested that when planning, donors should be kept engaged in youth programs. Program designers should design projects that will ensure youth are kept fully occupied. He also said the district local government is on the verge of passing a by-law on teenage pregnancy. Butalejja local government welcomes the idea and is willing to partner with any organization moving in that direction. In the meantime, let stakeholders and partners work together with religious leaders to combat teenage pregnancy.

Hon. Mugenyi Milly while giving her closing remarks informed the participants that there is an organization called Uganda Women Parliamentary Association (UWOPA) which is a parliament caucus comprising of all women members of parliament. They are currently advocating for three bills that are being debated in parliament; the sex offenders bill, the marriage, and divorce bill, and the employment suction bill. Let everyone interest themselves in these bills because they will help us solve some of the challenges we have in the community. Teenage pregnancy is a multi-sectoral problem that isn’t going to go away right now but each one of us has a role to play. Let these contraceptive consultations be easily accessible so that women and girls do away with unwanted pregnancies. She concluded her remarks by asking everyone at the dialogue to be exemplary to their families and communities because they have been empowered with knowledge on how to handle adolescents and young people to enable them to make informed choices.

 Mr.Mwesigye called upon, Hon. Mugenyi Milly, Dr.Siraj Kizito, Mr.Waya Richard, Canon Ofwono Martin Luther to sign on to the commitment board. After they signed the other participants got the chance to make their commitments.

Participants committing to action to advance quality and non-judgmental SRHR services and protections of young people from Sexual and Gender-Based Violence

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