Case story on teenage pregnancy Safe Motherhood hood

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The Uganda police released it’s annual Police Crime Report of 2021 which highlighted that sex related offences and defilement rates within the country increased, the police reported 16,373 sex related crimes in 2021 compared to 16,144 cases reported in 2020 indicating an increase of 1.4%. A total of 16,545 persons were victims of sex related crimes, out of whom, 14,482 were female juveniles while 378 were male juveniles, 1636 were adult females and 49 were adult males. In the case of defilement, 14,570 cases of defilement were reported in 2021 compared to 14,230 cases reported in 2020 with aggravated defilement increasing by 1.6% ,while simple defilement increased by 2.3%.  A total of 354,736 teenage pregnancies were registered in 2020 and 196,499 in the first months of 2021 and most of these were as a result of sexual violence.

Sexual violence is an inhumane conduct that not only undermines and violates the rights of a person, it affects the physical and psychological health of the victims. In addition to affecting the individual the sexual gender based violence burden curies social and economic costs on families, societies and governments in 2016 the United nations estimated global cost of violence  againist women could amount to about 1.5 trillion dollars. (UN Women),an equivalent of about one hundred and twenty fiscal budgets of Uganda of the financial  year 2021/2022,such costs impact development processes across all sectors directly and indirectly. The extremities in the numbers of sexual violence in the country show a gap in the nation’s duty to protect its citizens from sexual violence by creating a safe and healthy environment in which to comfortably live which are rights protected under international law and domestic law but also put young girls who are already in a vulnerable position as they are not protected, in a precarious situation of dealing with teenage pregnancies that result from sexual violence and the burderns that come as a result.

The law has a clear stance on sexual violence under The Penal Code Act under S. 129 as it provides that defilement is defined as having sexual intercourse with a person under 18 years of age. This means that the current law punishes the defilement of both girls and boys. If convicted, such a person is liable to life imprisonment.  The law  further provides for the offence of aggravated defilement,which makes one on conviction liable to suffer death.  The circumstances for under which aggravated defilement is provided are:Where the person defiled is below the age of 14 years, Where the offender is infected with HIV, Where the offender is a parent or guardian or a person in authority over, the victim, Where the victim of the offence is a person with disability or, Where the offender is a serial offender. Other offences in the penal code act include; indecent assault, incest and unnatural offences.

CASE STORY

K. E, a 12 year old  in Kasese District and a mother to 1 year old baby with microcephaly and developmental abnormalities delivered on 10th July 2021 at Kilembe Hospital having been referred from Kasanzi H/C II was reported to have been defiled by unidentified person as she had gone to fetch water and became pregnant as a result. She was reported to have attended ANC 4 times and tested HIV negative. She was reported to have been referred but failed however due to financial constraints until she was funded by a well wisher while in labour to go to Kilembe where she delivered from. The minor who stayed with her grandparents since she was 5 years old after the death of her father who had been separated from his wife. Despite the grandfather’s insistence that she go back to school and resume her education in February this year, she still has to keep going home to breastfeed and take care of her child who is unable to crawl or sit due to the developmental abnormalities.  The grandfather has no established source of income but sometimes affords meals for supper and lunch. He has also ensured that he provides the scholastic materials necessary for her education. The community reports that the grandfather has a suspicion of the maternal uncle who has gone missing since the issues of defilement and incest arose could be the alledged perpetrator of the sexual violence against K.E.

The medical report indicates that KE is not only faced with the social challenges of having to take care of a special needs child with neuro – developmental abnormalities while being a child herself but she also faces a lot of stigma and psychological trauma.

This is a lived reality for so many young girls in rural areas in Uganda today despite the many laws and policies mandated to protect these lives. The case of K.E opens highlights the gory dangers young face that initiate deadly consequences to their delicate lives everyday.

SAFE MOTHERHOOD FOR ADOLESCENT AND YOUNG PEOPLE

Coincidentally, Uganda is currently celebrating Safe motherhood Week from the 24th of October – 28th of October 2022 through the Safe Motherhood conference where different stakeholders are making commitments on different aspects of the SRHR of young people to stop circumstances like these from happening to girls’ like K.E. Under the theme “ Strengthening delivery of Adolescent and young people’s safe motherhood responsive health services” the ministry of Health organised the pre- adolescent and young people safe motherhood conference where teenage pregnancies were highlighted as an ever growing pandemic that not only jeopardises the maternal health of young girls but also makes them vulnerable socially, psychologically and economically. It was noted that there should be access to family planning and contraceptive information and services to ensure that young people and girls are able to safely access maternal services for intended pregnancies.

The conference highlighted the need for youth responsive services that speak to the effects left by Covid and now the Ebola virus but also empower young people socially and economically. The stakeholders  committed to collectively work together in strengthening young people’s voices in safe spaces while harnessing their creativity. Commitments to increase access and delivery of health services and information to young people in all their diversity were made. The need to move these commitments from boardrooms into the community and ensure their functionality and effectiveness to ensure that all health services and information are not only said to be accessible but are indeed accessible to young girls and women.

The right to health mandates that girls like K.E are able to access timely affordable, accessible, available and quality health services despite their physical location and socio-cultural circumstances. The fact that K.E could only access maternal services after the philanthropy of a well wisher because the referred labour services were inaccessible due to financial constraint illustrates that despite the commitments made every year there is still a gap which is still visible as K.E can not access medical services for her baby and psychosocial needs for herself. Therefore there is need to hold the different accountable for the different commitments during this week in commemoration of safe motherhood.

The multi-sectoral nature of health services is key and there is need to continuously highlight the same as the nation commemorates safe motherhood. The right to health internationally includes the social determinants of health which are the non-medical factors that influence health outcomes. WHO defines them as the conditions  in which people are born, grow, work, live, age and the wider set of forces and systems shaping the conditions of daily life and these forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. Therefore safe motherhood for young people can only be an actuality as and when the social determinants among young people are reflective and influence safe motherhood. The multi sectoral nature of safe motherhood and the sexual reproductive health of young people is important as not only does it directly affect the sexual reproductive health of young people but also creates circumstances which make it impossible for young people to access these safe motherhood responsive health services.

These indicators include Gender Based Violence and not only has this contributed to the teenage pregnancy pandemic but the increase of the same continuously endangers young women and girls to circumstances where not only their physical health is put in jeopardy but also affects their psychological, social and economic well being. Despite the existence of laws and policies protecting young women and girls from GBV, there is a consistent increase in sexual violence against young women and girls exacerbating the already unfavourable sexual reproductive health circumstances. These also create mental health issues like trauma not to mention the stigma created for survivors like K.E hindering them from living their life normally and comfortably. The fact that poverty stricken rural areas experience the highest numbers of GBV highlights the intersectionality of safe motherhood where girls like K.E are disadvantaged due to multiple factors and as such cannot access information or services curtailing their right to the highest attainable standard of complete physical, mental and social well-being. Therefore as we highlight safe motherhood there is need for stakeholders to ensure that all elements of the multi sector are functional and crevices which endanger and exacerbate the vulnerabilities of young women and girls in all their diversities are curtailed.

The minister of Health, Hanifa Kawooya signed the commitments that were made by the ministry of Health in a bid to strengthen delivery of Adolescent and young people’s safe motherhood responsive health services, however stories like K.E’s still occur in Uganda. Therefore in commemoration of safe motherhood, the remainder is that the  government of Uganda has a duty to protect K.E. from sexual violence, fulfill its duties and responsibilities towards K.E’s sexual reproductive health rights but also promote an environment both with the means of policy and implementation which enables K.E’s well being. The safe motherhood week is not only meant to celebrate the journey Uganda’s health system has covered on its road to progressive realisation of the right to health for all young girls but also a platform to create awareness of the still existent gaps whilst holding stakeholders accountable for the different commitments made.