By Fahad Musisi and Mariana Kayaga

The international day of the African Child attracts our attention to the cries and tribulations, without exempting health, of children especially in Sub-Saharan Africa, including Uganda, that remain unprioritized and unattended to yet children make a significant demography in this part of the world. In Uganda for instance, the 1995 Constitution of the Republic of Uganda describes a child as someone below the age of consent, which is 18 years. This day that is celebrated annually also reminds us of the 1976 student uprising in Soweto South Africa who marched in protest of the quality of education they accessed, and demanding to be taught in their language.

This day is critical to raising awareness on the continuous need for improving the nature of education provided to children in Africa especially regarding access to information about their sexuality for informed choices. Children are inclined to making wrong decisions because education in Uganda has not fulfilled its mandate of streamlining access to sexuality information. It is not surprising that teenage pregnancies now stand at 25% according to the 2016 UDHS, neither is it by coincidence that discussions around access to contraception are highly polarised, yet national surveys (UDHS) indicate that Ugandan girls are having sex at the age of 15.7 on average and boys at an average age of 16.

The central question is then, does the education system which is not tolerant of sexuality education for children responsive to children’s needs given the statistics as presented above? Is the theme for this year’s commemoration (leave no child behind in development) a reality or a fiction?

Children are more vulnerable than adults and are classified as unable to make serious decisions whose consent must legally be under the care of a responsible adult or custodian. However, custodianship has also not saved children from early marriages below the age of consent. It is one of the commonest social and human rights issue in Uganda, with the 2016 UDHS indicating a 46 percent of girls marrying before they reach the age of 18, yet children are not equipped with enough information. This exposes them to early pregnancies which sometimes culminate into stillbirth, and sometimes unsafe births leading to preeclampsia and sometimes fistula that makes them lose their dignity in society due to the stigma and discrimination it is associated with.

Child marriages are considered illegal in Uganda. Article 34 of the Constitution provides that a child is entitled to basic education which shall be the responsibility of the state and the parents. Since the same constitution puts the age of consent at 18, the implication is it is unconstitutional to marry off any child who is not yet that age.
However, Uganda can still do something to stop child marriages. Empowerment programs for girls, such as the Legal Empowerment and Social Accountability mechanisms utilized by CEHURD in Mukono and Gomba Districts under the DREAMS innovation Challenge Project; Integrating Legal Empowerment and social accountability for Quality HIV Health services for AGYW, are key to providing an opportunity to build skills and knowledge, understand and exercise their rights and develop support networks. Access to information on sexuality must therefore be a central tenet of education since it guides on making right choices, respect for the rights and dignity of children and their peers. The Uganda Strategy to End Child Marriage and Teenage Pregnancy which was launched on 27th October 2015 is therefore an important precursor to protecting the girl-child and ensuring access to their education.

Lawmakers and enforcement institutions need to ensure that laws around early marriages are effectively implemented. Community participation on this must therefore be a pillar in acquisition of first-hand information from the people falling victim of early marriage with a conviction that community prosperity is mainly dependent on the guaranteed future of children, especially the girl-child. The local leadership, cultural and religious leaders must therefore use all the available platforms within their reach to communicate against early marriages and the health hazards this poses.

This will guarantee adequate protection for children with specific focus on the girl-child because their lives also matter and must be an integral part of development.

By: Ngasirwa Patrick

Ester Nagudi is a 13 years old girl from Manafwa District; she is tricked into having unprotected sex and ends up getting pregnant. Ester has no option but to try out an abortion since she cannot imagine herself facing her parents. A friend she trusted recommended an elderly woman who asked her to find a cassava stick. The woman peeled off the outer layer of the stick and told Ester to lie on her back and raise her legs. She pushed the stick inside and pulled it out, only blood spurted out but nothing else came with it.

Ester’s life has never been the same again from that day! This is a story of a girl whose life is taken on a garden path, takes a complete turn for the worst and is made to pay for just one mistake that she made (or was made to make). There are many more horrendous stories that talk about cases of insertion of objects into the uterus, dilation and curettage performed incorrectly, ingestion of harmful circumstances, application of external form and various other methods of unsafe abortion.

I didn’t think that abortion was a conversation we needed to have until my eyes stumbled on that harrowing story, I was taken aback by the facts and figures. For a long time I had always thought that the feminists and their great movement were simply advancing an agenda that only they knew about, I actually thought they were acting up but for the past few days and weeks reality has stared me in the face. It simply never occurred to me that such horrors exist, I had it all wrong!

Two weeks ago, I had the opportunity of starting my internship program. This was with a prestigious organisation called Center for Health, Human Rights and Development (CEHURD), one that has for a long time championed the realization of health rights in our country. Its impeccable record in litigating health related cases is second to none. Sometime last year CEHURD brought a case before the Constitutional Court, asking them to interpret Article 22 (2) of the Ugandan Constitution on whether there is a violation in the failure by the legislature to enact a law that regulates the termination of pregnancies. The fact is that we have no law in place on abortion but is our society ready to have the law? It is this abortion file that I have been poring over for the past fortnight and reality is beginning to check in.

There is a very critical question we need to start by answering. As a country, do we need to follow in the footsteps of our next door neighbors Kenya and Rwanda to enact a law on abortion? If that is answered in the affirmative then we also need to know whether we are ready to accept it. I have been a keen follower of the debate on abortion albeit making little contribution and for every single person who has claimed that it is not a law that we need, religion has been their basis. They have argued that God doesn’t allow killing.

They have also argued that in case abortion is made ‘legal’ then there will be an upsurge in promiscuity. I don’t intend to delve into the spiritual realm because it is one that is complicated to fathom but let us look at the argument of promiscuity because that is what we all understand. The law that should be in place first of all is not one of legalizing abortion; it is one of regulating the termination of pregnancies. The two are not the same, in fact they are completely distinct. The English meaning of regulation is “controlling a conduct.” That in and of itself defeats the promiscuity argument form the onset because if you think women will become loose simply because abortion has been legalized, you have it wrong.

The law will be seeking to put down the various conditions under which one can undertake a safe abortion. So their being loose will not be because the law has been enacted. If anything, it will make them more responsible! The Ministry of Health has itself realised that abortions ought to be carried out, they are something that you cannot dispense with and this is why they have come up with guidelines on the carrying out of abortions. The question then should be, if guidelines can be issued then why not a concrete law?

Many have also attempted to argue that a child (born and unborn) is a gift from God and therefore no one should take their life. That is a given and it is not in dispute. But if a child is a gift from God, then should we also presume that one that is as a result of rape is also from God? Doesn’t the argument become self defeating because then it would mean that rape is no longer a sin itself because a product of a sin cannot be a gift. I have also heard others argue that you could probably be killing a future leader or someone very important. I find this argument very shallow for these reasons.

If one is a victim of incest, would you rather have the shame and embarrassment of an abomination in a family live with you for generations than do away with? Secondly, would you rather save the life of a baby that you are unsure of than ensure the safety of the mother you are very sure of, one who is giving the life and is expected to sustain it until a certain age? These are all choices that we need to have a conversation about because they are about the lives of our people; they are about the lives of our children and the children of our children and for a fact they matter.

At the end of the day, one disturbing fact remains, there is no regulation on abortion and the unsafe abortions will continue. Another Ester will become wasted and the chain will go on. I think it is about time we had this conversation on abortion.

By Specioza Avako

In Uganda today, Tobacco use has remained a significant public health challenge and a leading cause of non-communicable diseases including heart diseases and premature deaths. Annually around 6 million people die from diseases caused by tobacco use, including about 600,000 from second-hand smoke exposure. In 2013, approximately 1.3 million (7.9%) Ugandans used tobacco products. The prevalence of cigarette smoking among adults age 15 and over in 2013 was 5.8% (960,000), the adults were 10.3% of men and 1.8% of women. Smoking from combustible tobacco products contains more than 7,000 chemicals and has not only led to cancers but also cardiovascular (heart) diseases including; stroke, heart failure, aneurysm and coronary heart diseases which have become real tragedy in Uganda.

The World Health Organisation has marked 31 May of every year as the World No Tobacco Day (WNTD), highlighting the health and other risks associated with tobacco use, and advocating for effective policies to reduce tobacco consumption. The 2018 World No Tobacco Day theme was “Tobacco and Heart Disease”. For Uganda, the World No Tobacco Day 2018 celebration was an opportunity for addressing the tobacco epidemic and its impact on public health, particularly on heart diseases that cause the death and suffering of people. It was also an opportunity for Uganda to focus on the Sustainable Development Goals to ensure healthy lives for all and encourage countries to reduce mortality from non-communicable diseases (NCDs).

This year, the Ministry of Health (MoH), the World Health Organisation (WHO), and the Uganda Tobacco Control Advocates including the Center for Health, Human Rights and Development (CEHURD) organized and participated in week long activities which started on 25th May 2018 to commemorate the World No Tobacco day. Some of these activities included a press briefing at the Uganda Heart Institute on the 29th May 2018 and display of ICT materials on Tobacco and cardiovascular diseases (CVD). These activities were crowned by the event on 31st May 2018 which begun with a march from Kanyanya a suburb in the outskirts of Kampala to an open field in Mpererwe market. The colorful procession attracted attention of drivers, residents and pedestrians on the busy Gayaza road as the tobacco control advocates displayed placards and banners on tobacco and heart related diseases. The tobacco control advocates also cleaned the market as a way of giving back to the community.

CEHURD also had a legal aid clinic where lawyers explained the law, roles and responsibilities of different stakeholders in creating a smoke free environment to community members. This legal aid clinic provided an opportunity to explain the nexus between the law and non-communicable diseases and particularly heart diseases. Furthermore it was an avenue of receiving feedback on the practicability, compliance and the implementation of the newly enacted Tobacco Control Act, 2015.

By Serunjogi Francis.

According to the National HIV and AIDS Strategic Plan 2015/2016 – 2019/2020), women and girls in Uganda, constitute the largest proportion of Persons Living with HIV PLHIV – 8.3% compared to men at 6.1% (UAIS 2011). On the other hand, recent UNAIDS data shows that each week in Uganda, 570 young women aged 15-24 get infected with HIV.

During interventions with Adolescent Girls and Young Women (AGYW) in Mukono and Gomba, CEHURD has realized that there are still patent gaps in HIV response and this is attributed to risks encountered by this age group which are linked to social, economic, legal as well as other factors.

As an intervention, CEHURD with technical support from International Development Law Organization (IDLO) and ViiV Health Care under the “Integrating Legal Empowerment and social accountability for Quality HIV Health services for AGYW” project are applying and implementing a Community Score Card in the districts of Mukono and Gomba with different community stakeholders including Community Health Advocates who are AGYW, Justice Actors, Members of community village committees such as Health Unit Management Committees, health services providers as well as Community Based Organization actors.

This process has enabled CEHURD to enhance capacities of different stake holders to utilize rights based local engagement and feedback processes for improving HIV related health service delivery as well as addressing Gender based violence among AGYW. This has been achieved through supporting these different stake holders including AGYW themselves to develop action plans which will be followed to in a process of improving access to HIV services as well as addressing Gender Based Violence. CEHURD has also managed to increase community knowledge and skills in advancing access to HIV related services for, and rights of, AGYW.

During this process, AGWY have been given an opportunity to air out their concerns to both Health and Justice Service providers including Health workers, community village health committees, police officers and local leaders that MUST be addressed if access to HIV related services for this age group MUST be improved as well as Sexual and Gender based violence addressed.

AGYW requested CEHURD to convene more community dialogues with stakeholders such as District Officials, District Leaders, Members of Parliament and Parents as well as Caregivers which platform will further give them an opportunity to air out their grievances that deter them from accessing HIV related services including addressing Sexual and Gender based violence.

CEHURD replied in affirmative to this request and will be conducting community dialogues which will bring together more stakeholders and AGYW hence discussing and coming to a consensus on how to further improve access to quality HIV services for AGYW as well as addressing Sexual and Gender based violence.