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 28^th 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).