By John Vianny Ayebare

In his book, Animal Farm, written many years ago, George Orwell tells us about Moses the tame raven who had made it a mission to convince other animals that there was a better world somewhere in what he called Sugar candy Mountain. Moses said that in that world, it was always holidays, and sugar and cake grew on hedges. Anybody visualizing such a world would imagine a world where everyone’s rights are respected, a world where life flourishes and good health reigns supreme.

Every 11th of July, the world remembers the World Population Day which was established by the United Nations in honor of the 11th of July 1987 when the world population hit the five billion mark. What has happened in terms of population growth since then has been extraordinary. Within just 36 years, the number of people gracing this little planet has increased by more than half to an estimated eight billion.

On one hand, this increase in population should signify increased opportunities and a well-developed support system where we all feel treasured and respected, on the other hand, it gives us an opportunity to reflect on the population issues such as family planning, gender equality, violence against others especially the vulnerable, discrimination, access to sexual reproductive services, among others.

The United Nations Population Fund (UNFPA) notes that women contribute 49.7 percent of the total world population, yet it is also evident that despite their special role in this very aspect, they still face uncertainty about their own lives while giving birth. It was revealed early this year that every two minutes, a woman dies during pregnancy or childbirth. Imagine the shame you must accept to the effect that by the time you finish reading this article, at least 3 women will have died. In Uganda, the situation is no different. About 5,500 women die every year while trying to play their natural role of bringing life on earth. This translates to one woman dying every one and a half hours.

The Constitution of Uganda is to the effect that it is the responsibility of the government to direct the health policy in the country. This position is also reiterated in a number of international instruments. For Example, Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women goes further to oblige states to ensure that women access appropriate services in connection with pregnancy, confinement and the postnatal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation. Uganda ratified this covenant without any reservations.

While the government has taken great strides to improve the conditions of women and girls through affirmative actions in representation, and education, there is a lot more to be done if we are to achieve the sustainable development goal of ensuring healthy lives and promoting well-being for all, which aims at reducing maternal mortality ratio to less than 70 per 100,000 live births. The following should therefore be done to salvage the situation.

• Strengthen the Village Health Teams to increase their capacities in monitoring the health needs of pregnant women in their jurisdictions.
• Men should be encouraged to welcome family planning methods especially those which are male centered, and to support women in accessing family planning services.
• Establish progressive budgetary commitments at both national and local levels to meet maternal needs and avert the likely dangers of refusal to attend to pregnant women because of their financial incapability. The Abuja Declaration made 22 years ago where African states committed to spending at least 15% of their budgets to the health sector should be respected.
• Strengthen Public Private Partnerships to ensure ease of access for both antenatal and postnatal care.
• Provide strict policy guidelines on stocking contraceptives and sexual reproductive services in all health centers to avoid stock outs.

Women should be empowered to make informed choices through unfettered access to sexual reproductive health services while removing barriers such as cultural beliefs, discrimination, violence, and lack of information as far as sexual reproductive services are concerned. This way, we will start looking at a world of 8 billion people as that in Sugar candy Mountain where dignity, happiness and respect for all matter.

The writer is an Intern at the Center for Health, Human Rights and Development – CEHURD.

By Clifton Irahuka – Health service provider

Ms. X, a 16 year-old walked into a facility for the first time and was later confirmed to be 4-months pregnant. She came in with neither companion nor sure of who owns the pregnancy. Her family had rejected her and she dropped out of school. Her friends advised her to use some herbs to end the pregnancy. She followed the advise of peers but was later  worried after noticing vaginal bleeding, but had no idea on what to do next, which help to seek and where to seek it.

The tears she’s been shedding since she saw the blood were triggered by her recall of how others bullied her on one day when she stained her dress at school. At the time, she had no access to menstrual pads and neither could parents provide. She was in a dilemma. This prompted her to sleep around with older men to earn some money for her survival. Her cry for them to at least use condoms fell on rock-filled ears because they are men, had the money and thus her decision and choice didn’t matter.

The scenario of Ms X is a true reflection of an African girl born in a poor, less literate and rural family who like many others, is burdened with high fertility rate, risky sexual behaviors, peer pressure into early sex, forced into early marriages, lacks education, lacks family support, with a low socio-economic status and low use of contraceptives. Many of them find themselves in such scenarios but with no help. That is the African child!

On June 16 every year, the world marks the International Day of the African Child. This day commemorates the Soweto Uprising, which took place in South Africa in 1976. On that day, thousands of black students protested against the apartheid government. The protests were met with violence, and hundreds of students were killed.

The International Day of the African Child is a time to reflect on the challenges facing children in Africa. One of the most pressing challenges is teenage pregnancy, a serious problem in Africa. Uganda has one of the highest rates of teenage pregnancies in sub-Saharan Africa, estimated at about 25%.

According to UNFPA, one in five girls in Africa will become pregnant before the age of 18. This has a number of negative consequences for girls, including but not limited to increased risk of maternal deaths, reduced educational opportunities, increased poverty and increased risk of sexual violence.

Some of the factors that contribute to teenage pregnancy in Uganda include:

• Limited access to sexual and reproductive health services: Many girls like Ms X in Uganda do not have access to sexual and reproductive health services, such as contraception information and services. This makes it difficult for them to prevent pregnancy, and can also put them at risk of unsafe abortion.
• Early marriage: According to the Uganda Demographic and Health Survey (UDHS, 2016), 19% of girls aged 15-19 are married or with a partner. Many girls lack family support, are under peer pressure to engage in early sex and the outcome is unplanned teenage pregnancy.
• Limited access to education: Girls who do not attend school are more likely to become pregnant as teenagers. 22% of girls who had never attended school were pregnant or had given birth, compared to 12% of girls who had completed secondary school (UDHS, 2016).
• Poverty is another major factor in teenage pregnancy. Girls like Ms X from poor families are more likely to drop out of school as well as experience sexual violence, which puts them at increased risk of becoming pregnant. They experience power imbalance with cross generational men denying them a choice of contraception further engaging is high risk sexual behaviours.
• Gender inequality and cultural beliefs also contribute to teenage pregnancies significantly.

On the International Day of the African Child, we must recommit to ending teenage pregnancy in Uganda and some specific things that can be done to achieve that include:

• Provide access to contraception which is one of the most effective ways to prevent teenage pregnancy. Governments and NGOs can work to increase access to information and use of contraception by making it more acceptable, affordable, and available.
• Provide sexuality education: this is essential for teaching young people about their bodies and how to prevent pregnancy. Governments and schools can work to provide  sexuality education that includes information about contraception, sexually transmitted infections, and healthy relationships. This could be age appropriate information
• Address the root causes of teenage pregnancy: Teenage pregnancy is often a symptom of other problems, such as poverty, gender inequality, and lack of education. The duo can work to address these root causes by investing in education, providing economic and entrepreneurial skills and opportunities, and promoting gender equality.

By taking these steps, we can help to reduce the number of teenage pregnancies in Africa and give all children the chance to reach their full potential.

The writer is a Midwife and Sexual Reproductive Health and Rights Advocate.