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A World Of Equal Chances

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.

An African Child Deserves a Chance to Reach their Full Potential

” 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%.

Clifton

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.

A Call for Applications for the 2023 Media Fellowship on the Role of Media in Achieving Reproductive Equity

Center for Health, Human Rights and Development (CEHURD) invites applications for the media fellowship on sexual reproductive health and rights, 2023. The media fellowship is aimed at expounding on the role of media in achieving reproductive equity for young people in Uganda. It also aims at building a network of journalists who can boldly report on sexual and reproductive health and rights for young people in Uganda and beyond.

This year’s fellowship is designed to strengthen capacities of media personnel in progressive and positive reporting about SRHR. Media plays a fundamental role on advancing reproductive equity once equipped with accurate and appropriate information on sexual and reproductive health and rights. The focus for this year’s fellowship is SRHR for young people in Uganda and beyond.

Deadline for application is 19th June, 2023.

Call for Participation in the 10th Annual National Inter-University Constitutional Law Moot Court Competition

Center for Health, Human Rights and Development (CEHURD) invites universities with schools/faculties of law in Uganda to participate in the 10th Annual National Inter-University Constitutional Law Moot Court Competition. The moot is scheduled to take place on 26th and 27th October 2023.

The 10th Annual National Inter-University Constitutional Law Moot Court Competition is themed; “Advancing Reproductive Health and Gender Justice in Uganda”

Uganda’s Constitution articulates a commitment to attain gender equality, but there is still a gap between policy and practice. Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and a central tenet of advancing gender justice. Uganda has a high maternal mortality ratio, and there are still challenges in ensuring the right to reproductive health services and information. Promoting gender-equitable attitudes and behaviours and improving sexual and reproductive health are essential to advancing gender equality and sexual and reproductive health among adolescents.

This year’s competition will enable students to debate on how access to information as a key component of Sexual and Reproductive Health and Rights (SRHR) for young people promotes their sexual and reproductive health, and gender justice. They will dissect the extent to which the lack or information on sexual and reproductive health bears a ripple effect on the right to Education and Health through the use of a hypothetical moot problem.

Students will demonstrate the need or otherwise, for the advancement of reproductive health and gender justice through access to information by highlighting the Constitutional rights, referencing international treaties and conventions that Uganda has ratified, emphasizing the obligation to promote and protect reproductive health and gender equality.  The students will also break down gender justice by discussing the need to address sexual and gender-based violence, discrimination, and harmful cultural practices that affect girls and young women and marginalized groups in Uganda clearly denoting how that is easier when young people are empowered with age-appropriate information.

The main objective of the Moot is to train students in practical aspects of litigating health and human rights within Uganda’s Courts of Law. This kind of arrangement helps bring out lawyers that understand key constitutional and health issues beyond what they are taught in class. The Moot specifically aspires to train students in legal writing, professional conduct and demeanour, court decorum and trial advocacy while arguing cases and preparation of Court pleadings.

We call upon universities that are interested in participating to fill »» this form as an expression of interest to participate by Friday, 30th June, 2023 at 5:00 PM (EAT).

#CEHURDMOOT2023 #GenerationGender #ReproductiveJustice #GenderJustice

Investing in women’s Health is not a mere humanitarian call, it is a human right and development issue

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation.

By Fatia Kiyange

Every year, on the 28th of May, the world marks International Day of Action for Women’s Health. The day symbolises the importance of giving attention to the health of women and girls. It reminds nations that women’s rights are human rights. Reflecting on the World Health Organization’s definition of health, women’s and girl’s health means that women and girls are in a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Women play an indispensable role in the health of their families and consequently their communities. Because of this, investing in their health is an investment in population health with positive implications for the country’s overall development.

Women’s health, especially in lower-income countries is influenced by many factors. These range from social, cultural and economic to gender, biological factors and place where they live. These come with a myriad of barriers which make it difficult for women and girls to access health care services at the time and in a place where they need them. This constitutes an injustice and a violation of the right to good health and well-being for women and girls, consequently affecting their physical, psychological, mental and spiritual state.

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners. Uganda’s maternal mortality ratio is still high at 336 per 100,000 live deliveries, and this translates into 18 deaths per day. This is way above the target of reducing maternal mortality to less than 70/100,000 births under Sustainable Development Goals. Important to note is that 28% of maternal deaths are among young women aged between 15 to 24 years. Early and unwanted teenage pregnancies are still high with a prevalence of 25%, one of the highest in East and Central Africa and with a national target of reducing it to 15% in the National Development Plan III 2020/21-2024-25. Our child marriage rate also remains very high at 43%. Despite the high total fertility rate of 5.4 contributing to the high population growth rate of 3%, the country has a high unmet need for contraception and other family planning services of 23.8% with a national target of reducing this to 10%. The HIV prevalence among women (7.6%) is higher than the national rate of 6.2%. Sexual and gender-based violence has remained high with spousal violence reaching 56% and sexual violence at 26%. A total of 12,715 cases of defilement (among children 0 -17 years) were reported in 2022 according to the Police crime report for the same year with 653 of these happening among children aged 0 – 8 years.

There are also health conditions women and girls suffer because of their biological make up. These range from reproductive cancers like breast cancer, cervical cancer, to menopause, pregnancy and menstrual cycle challenges. Urinary track infections and sexually transmitted diseases present more in women with undesirable effects.

It is now common knowledge that the Covid-19 pandemic and some of the response measures exacerbated indicators for sexual reproductive health, especially among young people and heightened the need for specific health services, such as mental health. However, emphasis for post-Covid recovery have been placed more on stimulating economic recovery programs. Attention towards access to quality health care for the most vulnerable members of our society could be given more attention to realise full recovery from the multifaceted impact of Covid-19.

All nations are working to realize the 17 SDGs by 2030 and committed to prioritise progress for those who are furthest behind by pledging to “Leave No One Behind”. Uganda among the first countries to develop a national development plan in line with SDGs for which Universal Health Coverage (UHC) under SDG 3 on good health and well-being is central. UHC means that all people have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliation) without the risk of financial hardship when paying for them. Given their economic challenges, women and girls especially those in the remotest areas are more likely to experience catastrophic expenditures on health which push them further down into poverty. A common and practical example is the reality of women and girls having to bear the cost of sanitary pads or their equivalent every month for the larger part of their lifetime.

As a country, we must reflect deeply on the underlying causes of these persistent reproductive health challenges of women and girls and set out to address them in the most honest and transparent way. Only then will we be able to realise Uganda’s Vision 2040 which identifies human capital development as fundamental for development. Human capital development contributes to the National Development Plan (NDP) III’s goal of increased household incomes and quality of life through increased productivity, inclusiveness, and well-being of the population. The Goal of the Human Capital Development Programme (HCDP) is to improve the productivity of labour for increased competitiveness and better quality of life for all. The challenges women and girls face in accessing health care services have to be addressed in order to realise this goal. We also have to reverse the population growth rate and structure which is largely constituted by a dependant young population.

Uganda has several policy and legal frameworks, which if well implemented can lead to improvement of indicators for the reproductive health of women and girls and consequently the health of families and communities. Examples of these are: Uganda Family Planning – FP2030 Commitments; the National Family Planning Costed Implementation Plan II; the National Sexuality Education Framework; 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School settings in Uganda; 2018 Uganda National Parenting Guideline and the second National strategy to end child marriage and teenage pregnancy 2022/2023 – 2026/2027, among others. For full implementation of these frameworks to be realised, financial resources must be allocated.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation. The projected reduction in budget allocation to the health sub-programme in 2023/232 will work against the realisation of the country’s goal of the Human Capital Development Programme (HCDP) of improving the productivity of labour for increased competitiveness and better quality of life for all.

The Writer is the Executive Director at the Center for Health Human Rights and Development (CEHURD).