Teenage pregnancies may destroy Budaka district

By Julius Odeke.

 How poverty, illiteracy and ignorance are facilitating teenage pregnancies in one of Uganda’s districts and helping to create a great burden on the country’s National Treasury.

A fourteen-year-old Miss. Grace Kantono, walks ponderously with an observable tired gait. Strapped to her back is the burden of her two-year-old daughter; and she is going to a not-too-far away private clinic at Budaka Town Council, two kilometres from her village of Nakibuku.

It is early morning. In her slow, dragging and lacklustre steps, four-and-half foot tall Kantono, slight in frame, of not more than 40 kilogrammes, wants to reach the facility before it gets full of other patients. It is in a bid to access medication early, lest it rains on her way back home.

The pregnancy Kantono is carrying is of her second child.  The child on her back was conceived when she was 12. It made her an unwanting mother. She had to drop out of school – at Primary Three level.

Her body language shows that life has not been a bed of rose flowers. She is emaciated and has to rest often. She has lost weight and strength due to breastfeeding; and the low intake of food. After a few tens of metres, she has to sit down. It is to gain strength to continue in the arduous journey.

While at the health facility, Kantono sits desolately under a quiet mango tree pondering how she was lured into sexual intercourse at 11 years. She is waiting to be called by the Nursing Assistant, tending to patients in a tiny room.

“I have ruined my future,” she whispers to this writer, adding, “I am contemplating abortion but I have been warned against doing it by the elderly women in my village who say I will die.” She looks more troubled than most women in the village, this writer has seen.

Kantono’s dream of becoming a nurse, who would instead treat patients from Nakibuku village, has all but been shattered. She is the first-born child in a family of four. Her parents had a lot of hope for her since she was a bright pupil.

Kantono’s mother, Ms Eseza Naibale, 35, says: “My daughter has killed all the ambitions that we had as a family over them.” With tears running down her cheeks, Naibale narrates, “My husband is a difficult person. Up to now, he still thinks that I conspired with Grace in what has happened.”

“When I sit down thinking about the confusion in my family, I feel like the earth should open up and swallow me, whereby I will never be seen in this village again. My daughter’s pregnancies have helped to breed a lot of confusion between my husband and I – and our marriage is at breaking point,” she adds.

Kantono is equally contrite. In my interview with her, she mourns; “I would have completed my Primary Seven by now, had I not engaged in a bogus relationship. It was with a village mate whom I considered to be my soulmate; it has turned out to be torture for me.”

The “torture-mate” she is referring to is, Mr Peter Kirya, a 15-year-old boy, quite irresponsible. On learning that she was pregnant, the second time, he has since disappeared from the village. She says; “When I went to their home, I was told that Kirya is not at home and that they did not know where he had gone. It is now more than a week since his disappearance. He has left with nobody to support me while I am in this situation.”

When Kantono attempted to talk to Kirya’s parents, to her dismay, they and other family members, sat in a clan meeting and resolved not to welcome her to their home. “They claim that they don’t know me. His parents and relatives have disowned me,” she refers poignantly at this indiscretion.

“At home, my parents are fighting almost every day because of my condition. I have caused a lot of problems for them, especially Mum, who is bearing the wrath of my dad. In fact, I have become a burden to my Mum,” she added.

In Budaka District, Kantono’s tribulation is not unique. Another teenager, Miss. Patience Gimbo, 15, from the nearby Naboa sub-county, finds herself in a similar situation. She also delivered a baby girl at the age of 15. The pregnancy occasioned her dropping out of school, too.

Kantono and Gimbo are among the more than 1,600 teenage girls in Budaka District, who get pregnant annually before they reach the age of 18. They form the 24.7 per cent of teenage girls in the district. It is not only Budaka; the statistics get worse, countrywide.

Uganda is one of the countries in sub-Saharan Africa with the highest rates of teenage pregnancy, with over 25 per cent. It implies that one in every ten pregnant women, is a child, below the age of 18.

A United Nations Children’s Education Fund (UNICEF), report categorising the country by its regions, shows that child marriages are highest in the North at 59 per cent; West, at 58 per cent; while in the Eastern and Central regions, they are at 52 per cent, each. West Nile is at 50 per cent; South West at 37 per cent; and, Kampala, the lowest figure, is at 21 per cent.

The UNICEF report notes that; “The number of adolescent girls in Uganda, conceiving before attaining the age of consent, has slightly increased to 25 per cent in the last seven years.”

The rise in early child-bearing has been attributed to low education attainment among girls between 15 and 19 years. At least three in every ten of them, have no education; and also, three in every ten, have only attained the primary level of education.

In its report, the Uganda Bureau of Statistics (UBOS), basically concurs with the UNICEF report. It indicates that, nationally, every four out of ten, teenage girls between 15 and 19, are found to be pregnant.

Currently, the Ministry of Health (MoH) and other stakeholders are implementing a four-year partnership programme on how to curb teenage pregnancies and school dropouts. This programme is being piloted in nine districts, which are: Budaka, Mbale, Bukwo, Kween, Mayuge, Namayingo, Iganga, Bugiri and Kalangala. The £10 million programme is being funded by the Netherlands Embassy, here in Kampala.

According to Mr Richard Kabanda, the MoH’s Commissioner of Health Services In-charge of Health Promotion, Education and Strategic Communication, “In 2020 to 2025, women of reproductive age of 15 to 49 years, will constitute 48 per cent of the total population, and teenagers of 13 to 19 years, will make up 17.3 per cent.”

The overall cost for MoH for implementing the Family Planning and Advocacy Strategy Plan is estimated to cost, at least Shs77 billion. This is entailed in the breakdown as: 2020/2021 Shs16.3bn; 2021/2022 Shs13bn; 2022/2023 Shs16bn; 2023/2024 Shs14.2bn; and, 2024/2025 Shs17.2bn, having a total of Shs77,027,649,891 bn.

“The aim of the programme is to tackle teenage pregnancies and child marriages in the above-named districts,” says Mr Michael Muyonga, the HEROES for Gender Transformative Action, Programme Manager. He adds that, “Communities have been trained and empowered to champion on issues on how they can derive solutions for sustainable outcomes on basic life skills, that will help to deter early pregnancies and marriages.”

HEROES is a consortium of four non-governmental organizations (NGOs), operating in ten districts and they include; the African Medical and Research Foundation (AMREF), Mifumi, Condraid and the International Centre for Research on Women (ICRW), which carried out an assessment in Budaka District, revealing that it has the highest burden of teenage pregnancies. “This programme empowers the ordinary people to take charge of their sexual and health issues and it helps them to exercise their rights to a life free of violence,” Muyonga believes.

In Budaka, Muyonga says, “It has empowered young girls, boys and women as they are now able to make informed decisions on sexual reproductive health rights. It has been a fulcrum in the fight against sexual and gender-based violence.”

He notes that the maternal mortality ratio/100,000 live births in the nine districts shows that Mbale registered 247, Kalangala 156, Bukwo 149, Bugiri 128, Iganga 127, Namayingo 50, Kween 42, Mayuge 37 and Budaka 27.

This translates to the teenage pregnancy percentage rates of Kween at 29 per cent, Budaka at 27 per cent, Mayuge and Namayingo, each at 26 per cent, Bugiri at 25 per cent, Iganga and Mbale each at 22 per cent, Bukwo at 19 per cent and Kalangala stands at 13 per cent.

And their representation in sexual gender-based violence (SGBV), in 2021, stood at Bugiri 1,521, Mayuge 1,074, Budaka 925, Iganga 782, Bukwo 594 Namayingo 564, Kalangala was 525, Mbale 473 and Kween 95.

Muyonga is optimistic that, “This programme of empowerment and livelihood among the benefiting communities will be able to contribute to a reduction of cases in teenage pregnancies, ending child marriages, and in turn, will increase access to adolescent reproductive health services.”

A recent UBOS statistic puts Uganda’s population at 45 million people.  It projects that it will grow to 69,746,400 by 2040, which is at an average of 3.0 per cent, yearly. With this, MoH’s Kabanda notes that, “The country’s demographic profile comprises the youngest population, globally.”

He adds that, “This younger population has the potential to make or break Uganda’s prospect of attaining Vision 2040, due to the high fertility rate of young people below 15 years, which is practically half of the total population.”

A 2020/2021 – 2024/2025 report by National Family Planning Advocacy, attributes the sharp rise in Ugandan teenage pregnancy and births exclusively to the increased levels of poverty, cultural norms and illiteracy levels.

It notes: “The long-term rise in teen pregnancy and teen births has been brought about by teenagers engaging in sexual intercourse, without using contraceptives and irresponsible decisions.” The poor use of contraceptives is attributed to cultural norms and religious beliefs that bar females from using them.

Nationally, in a representative sample of more than 5,000 teenagers, aged 15 to 19, at the two different time periods (2020 and 2021), there is high sexual activity coupled with poor contraceptive use. This is reflected in a Pregnancy Risk Index, at these dates, which notes rural communities as poverty-stricken. The risk index has steadily risen at an annual rate of ten per cent.

Statistics obtained from the health department in Budaka Hospital indicated that for the period between January to December 2021, the facility recorded 1,675 teenage pregnancies. The District Biostatistician, Mr Kizito Agwaro said, “Our records show that from 2021 to mid-2022, Budaka District alone, has recorded 3,395 teenage cases.”

From January to July 2022, the figure moved to 1,720. “This indicates that 25.8 per cent of teenage girls got pregnant before the age of 18. This is quite extremely high, and something must be done to address this trend by all stakeholders,” Agwaro advises.

He adds, “It has become challenging to the district’s resource envelope and it has made the situation hard.” Agwaro also attributes this to the high poverty levels among the local people, as poverty conditions force young girls to marry at a tender age.

To support this assertion, Gimbo, the young affected girl, narrates: “Even the young men [husbands] are not economically stable. They, too, depend entirely on agriculture as a source of income, which is not all that sustaining. They cannot support our young families.”

Agwaro holds that the dependant population is too young to work and most of them spend their full time at school, yet they consume the bulk of public services and exert pressure on the delivery of services, like education and health.

Budaka District statistics highlight the sub-counties with the highest teenage pregnancies, thus; Budaka Town Council recorded 219, Lyama 182, Kameruka 158, Iki-Iki 156, Kamonkoli 139, Kaderuna 122, Kakule 121, Katira 112, Kachomo 104, Nansanga 98, Budaka Sub-county 64 and Mugiti 61.

As seen in Budaka, in 2016, there were more teenage pregnancies in rural areas, standing at 27 per cent as opposed to urban areas, which stood at 19 per cent.

The Uganda Population Secretariat indicates that 1.2 million pregnancies are registered annually, 25 per cent of these are teenage pregnancies. In Budaka, according to the District Health Officer (DHO), Dr Elisa Mulwani, the majority of these mothers, who seek antenatal services, are young girls between 15 to 19 years, accounting for 20 per cent of teenage girls.

Mulwani adds. “Early pregnancies in Uganda remain a big challenge. It’s unfortunate as cases of teenage pregnancies keep increasing, every day.”

It has, therefore, forced the management at Budaka Hospital to set up a counselling room, as health experts offer to advise on the dangers and risks of early marriages. He notes that, “This has been compounded with various factors like poverty, illiteracy levels among the rural communities.”

He expressed fear that the figure could be much higher than that, when compared to the levels of teenage girls getting married at a tender age, adding, “Most of these cases are unwanted pregnancies, that eventually result in unintended births, abortions and deaths.”

A sample of figures obtained from a few health centres there indicates that 1,975 cases of teenage pregnancies were recorded from the month of March to December 2021. For example, in Kaderuna Health Centre III, 220 cases were recorded, followed by Kamonkoli Health Centre III with 197 cases; and then, Budaka Health Centre IV with 190 cases.

There were 174 cases registered in Kameruka Health Centre III, and in Naboa Health Centre, 168 teen pregnancies were recorded. Mulwani says most of these pregnancies are from learners, both in Primary and Secondary schools.

Referring to the Uganda Demographic Health Survey 2021, he revealed that, 14 per cent of women and 16 per cent of men, had their first sexual encounter before the age of 15; while 57 per cent of young women, had their first encounter before the age of 18.

According to him the survey notes, “The drivers of all these are because of poor parenting, coupled with the hostile environment, including high levels of poverty.” Early marriage, early initiation of sex and lack of information, are noted to be the leading drivers of teenage pregnancies. 

Mulwani admits that lack of access to Reproductive Health information and support services, forces teenagers into early sex, while poverty and cultural practices continue to force many girls into early marriages. He says that “Just like any other African society, the choices of women’s reproduction in Uganda are significantly influenced by social norms, cultural values and religious beliefs.”

UBOS, too, agrees with this assertion that there is a distinctive link between poverty and early pregnancies, as seen by the data that adolescents from poor families are more likely to get pregnant than those from upscale family backgrounds. The pregnancy rate for adolescents from these families stands at 41 per cent, while that for adolescents from wealthier families is at 17 per cent by 2021.

“Budaka may be among the leading districts with the highest number of teenage mothers with at least each household recording at least a teen mother that has got pregnant, or has had a child,” Mulwani reports. He also refers to the National Family Planning Report, indicating that about 15 per cent of mothers, visiting the health facility, are teenage girls.  Yet, the number of teens who do not visit the health units, due to stigmatisation, is increasingly bigger. “This is quite a worrying trend that needs concerted efforts to sort out,” he quips.

Mulwani explained that the costs related to teenage pregnancies remain a big burden for the country since they are often not able to complete the Primary and Secondary cycles. Consequently, many children of teenage mothers are unable to get an education and they, too, are likely to fall into poverty, creating a vicious cycle of early pregnancies, illiteracy and poverty which may be difficult to break.

He talks of Budaka District as having a high fertility rate that stands at 7.3 per cent much higher than the national percentage of 5.3 per cent. The school dropout rate in Eastern Uganda is at 37.3 per cent, according to the Ministry of Education and Sports Report 2017.

In Budaka, 93 abortion-related cases were recorded with Budaka Health Centre IV leading with 72 cases, followed by Kameruka with eight cases; and, Kaderuna, Kamonkoli, Sapiri and Kerekerene with two cases each, respectively.

The modern Contraceptive Prevalence Rate (CPR) stands at 34.7 per cent, while the unmet need for family planning is 34.5 per cent. The couple year of protection (CYP) was 7,578, while the women of child-bearing age proportion, stands at 20.2 per cent (56,414). The expected number of pregnancies stands at five per cent (13,964), and the expected number of birth (expected deliveries) is at 4.85 per cent (13,545).

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