Last week, the International Centre for Research on Women (ICRW) held a special session on the gaps in sexual reproductive and health rights of women in Uganda at Serena Conference Centre.
Speakers from different women- rights, activist-orientated organisations, representatives from various ministries and policymakers took to the floor, highlighting their moments in this women’s month of March.
Despite significant progress in addressing sexual and reproductive health and rights in the country, numerous challenges continue to persist. Evelyn Opondo, the ICRW Africa director, noted that in the five decades since the founding of ICRW, not enough progress has been made, as there are many challenges that are involved and have evolved with time.
She further noted that examining the state of Sexual and Reproductive Health and Rights (SRHR) and gender in the past year has been very challenging because things like diversity, inclusion and calls for solidarity, among others, are being bastardised and stigmatised in many societies.
“The challenges are interconnected to all other aspects of life. Throughout life, there are power dynamics that gag women from adolescents to the old women,” she said.
THE STATUS IN UGANDA
Dr Chima Izugbara, the director, Global Health, Youth and Development Research at ICRW, said data gathered from the research is sobering. Last year, around February, under ICRW, Dr Chima worked with the SRHR community, like practitioners, researchers and people from the community, to understand what would be considered a gap in the SRHR in different parts of the country.
“Many things have changed; Donald Trump came to power in the USA and the global landscape is changing. Just it was said, Uganda will be one of the countries to suffer from the freeze in the USA not to mention the fund cut by USAID that had been a major help to the said communities,” he said.
After interviewing more than 70 people purposely selected from their specific areas, he discovered there are longstanding and emerging issues concerning these rights. Alarmingly, adolescent pregnancies have been and still are a major problem in women’s SRHR.
“Young girls in rural areas are prone to getting pregnant before they reach the age of 18, and over 36% of all pregnancies are unintended and often lead to unsafe abortions and severe negative health consequences for the girls involved,” he said.
“We keep talking lightly about teenage pregnancies and forget the fact that they are a result of defilement. Regardless of whether the girl consented, it is important to recognise that sex with a girl below the age of 18 is legally considered defilement.”
There has been a persistent and increasing prevalence of cross-generational and transactional sex. With Covid-19, Uganda saw a boost in transactional sex, a coping method adopted by many women in the rural sector.
Especially around the mining areas of Uganda, where we even see prostitutes migrating to Kassanda from Kampala when the gold rush season hits or a new vein has been discovered. Rose Wakikona, the deputy executive director at the Women’s Pro Bono Initiative, noted a few of these inconsistencies and how effective they are to their users.
For instance, the policy permits teenagers to obtain contraceptives without parental guidance. But the hindrance in the practice comes when the minister for health says on national TV that we don’t give contraceptives to children, so the health worker selling them is put in a dilemma, and the child will do away with contraceptives altogether.
“Parliament’s abortion laws, amended in 2006, allow abortion when there are maternal or foetal complications and only when the mother’s life is in danger. The contradiction here is that it’s very much dependent on the appetite of the judge when a teen is taken to court for abortion,” she said.
She also noted the lack of regulation, especially around assisted reproductive technologies, giving an example of the Ugandan woman surrogate being paid 6.5 million dollars and losing her uterus; she had to give up the baby and remain infertile, and because she signed a contract saying she is aware of the complications involved and has no right to the child, she has to walk away with that scar for life.
There is a high persistence of maternal mortality in Uganda. In Uganda the maternal mortality ratio is estimated at 336 deaths per 100,000 births, which translates to about 6,000 women dying every year due to pregnancy-related causes.
And gender-based violence is another significant long-standing problem, with a high percentage of the victims experiencing physical or sexual violence, especially in the rural areas.
LONGSTANDING ISSUES
Limited access to SRHR-promotive information and resources for young people, some of the problems that have been going on for a long time with SRHR are mother-to-child HIV/ Aids transmission rates and prevalence, FGM, early marriage, early sexual debut, and early childbearing; not enough people being able to get and afford SRHR services for important groups and subpopulations; and sexual violence against children.
The rise of social media has a double impact on SRHR. Despite the numerous mental health implications for its users, the internet has significantly bolstered SRHR efforts, albeit with fewer benefits than drawbacks for rural women.
Among the emerging issues, there is often neglect toward the impact of climate change and disasters on SRHR in the country. There is little understanding about the implications of climate change on SRHR, and yet there are various reasons as to why SRHR are under threat in the face of an unstable and unpredictable environment.
Climate change comes with issues like an increased temperature, air pollution, climate-related diseases and food insecurity, among many others.
WHAT ARE YOUR THOUGHTS ON THE REALITIES OF SRHR IN UGANDA?
Dr Stella Bosire, the executive director of the Africa Centre for Health Systems and Gender Justice, opened the panel discussion, noting that after Covid-19 pandemic, there was a spike in gender-based violence, HIV/Aids and sexually transmitted infection rates, with an increase of up to 60% of the young women in the country being victims.
“Actually, HIV/Aids fatigue is due to inadequate government coverage of the issue. It is rhetorical to keep saying we are a young continent when we cannot address the issues facing our young population in the nation,” she noted.
Betty Kyadondo, a senior medical doctor and the outgoing head of the Family Health department (FHD) at the Population Secretariat, unfolded the exclusion and neglect of SRHR for the elderly.
“I have been on this journey for a while but hardly heard any discussion on SRHR among the old people in our country. Because Ugandans view menopause as old and stigmatize it at many social levels. The gap is that the older women and men experiencing menopause or andropause, especially erectile dysfunction, do not know where to go to get help. Even at 35, you can start experiencing the perimenopause phase.
Dr Bosire further noted that, although there are many innovations in the health sector such as in vitro fertilization (IVF), one cannot access it without at least $5,000. She noted that IVF is not always successful on the first try and that you have to try a couple of times before success, and each time you try it, you have to have $5,000 ready at your disposal.
“Many young people are experiencing cysts, fibroids and many others, but because the intervention is expensive, we don’t have a way to keep them in check; so, they decide to let nature take its course,” she noted.
“After identifying the gap, we need to curb the stigmatisation of abortions and contraceptives among the rural populations of our country. We must raise awareness because it is this ignorance about their bodies that is leading the young women to stray, an idea that seemed to unify the minds in the room to curb the challenges surrounding SRHR-related services. The government needs to properly define the laws concerning these issues in rural areas, as the research has already been done; only so much can be done by this organisation in the current economic state.”