Ray of Choice Africa (ROCA)
By way of background, Ray of Choice Africa (ROCA) is a youth led centered and focused organization that powers community transformation, development and resilience at grassroots by focusing more on women rights and sexual reproductive health information, rights and justice for young people. Our work in Uganda rotates around facilitating universal access to modern contraception, quality health care and good information to overcome harmful socio-cultural barriers to responsible family planning by young people. We equip young people with accurate and correct information to aid them in making informed SRHR and life decisions.
About AFP SMART:
Advance Family Planning is an evidence-based advocacy initiative that aims to increase resources and political commitment for quality family planning programs, contributing to the achievement of the vision of the July 2012 London Summit on Family Planning; to enable women and girls in some of the world’s poorest countries to use contraceptive information, services and supplies, without coercion or discrimination.
Situational analysis of Mayuge district
Sexual and reproductive health is important to us all, at all stages of our lives. Yet far too many people are denied their right to Family Planning information and services. The vast majority are poor women, men and young people.
In Mayuge, a number of young women and men lack access to contraception and to the sexual and reproductive health information and services they need to choose their family size and improve their own and their children’s life chances. Women each year have unintended or unwanted pregnancies. For too many their only option is abortion in unsafe conditions. Women, especially, need more choice and control over their sexual and reproductive lives.
Findings from Mayuge Health Center IV show that the demand for Family Planning dropped from 2020, due to the Covid-19 lock down. So far, only 465 young people between the ages of 10-24 years have sought Family Planning information and services from the facility, since 2020. The number of teenage pregnancies registered at the facility from 2020 is 6,873.
Further findings from Wabulungu Health Center III show that show that about 70% of pregnancies registered since 2020 are teenage pregnancies. However, NMS and NGOs have played a crucial role in the provision of some Family Planning services.
According to the Health Sector Development Plan 2015/16-2019/20, the trend of Family Planning services in Uganda is improving. However, although the adolescent fertility rate, the unmet need for family planning, and the contraceptive prevalence rate are all rising, the rate at which these improvements are happening is too slow to attain the country’s Vision 2040 much harder. We will use it as the basis for action and work with our partners, and I hope you will find it useful.
We intend to keep at the forefront of the debate on FP and to support the district and partners to uphold everyone’s right to sexual and reproductive health.
Statistics from the National Population Council show that out of the 1.2 million pregnancies that Uganda records annually, 25% are teenage pregnancies.A study carried out by the Makerere University School of Public Health in 2020 showed that the number of teenage pregnancies in the country rose by 28% during the first Covid-19 lockdown in 2020.
At least 644,955 teenage pregnancies were recorded during the Covid-19 lockdown in Uganda, according to the United Nations Populations Fund-UNFPA. Figures from the agency show that since March 2020 when Covid-19 hit the world, an estimated 354,736 teenage pregnancies were reported following the closure of all schools in the country. An additional 290,219 pregnancies were reported between January and September 2021.
Findings from the National Teenage Pregnancy Rate conducted by Uganda Demographic and Health Survey (UDHS) have revealed that Busoga sub-region has the highest number of teenage pregnancies in the country. Research conducted between 2019 and 2020 indicates that Busoga registered as many as 89,347 teenage pregnancies, followed by Tooro and Bunyoro at 57,660 and 57,295, respectively.
Dr.BettyKyadondo, the director of Family Health National Population Council, said since 2018 to date, the country has registered about 350,000 cases of teenage pregnancy across the country, with Busoga topping the list.
According to the National Study report on the impact of COVID-19 on school going girls and young women launched by Ismael Mulindwa, the Director of Basic and Secondary School Education in the Ministry of Education, Mayuge is one of the districts in Uganda with the highest teenage pregnancy rates, with 6,205 reported cases by 2020.
According to Ruth Kibowa, the former Mayuge district Vice Chairperson, 48.5% of girls in the district deliver when they are below 18.
21% of females aged 15-19 in Mayuge district have begun child bearing.35% of these girls have had no education, 29% have got primary level education, 17% have got secondary schooling while 11% have gone beyond secondary school level.
Through case studies, for instance;
Takuwa, a resident of the district says that her daughters dropped out of school at the ages of 13, 14 and 15 due to lack of school fees, and before she knew it, they were all pregnant.“The men who were responsible for making my girls pregnant refused to support them, my grandchildren have also become my responsibility….” she sadly narrated.
Small Nangobi, a mother of seven, says her daughters got pregnant at an early age, leaving her overwhelmed with grandchildren.
Angella Nakafeero, the Commissioner in charge of Gender and Women’s Affairs at the Ministry of Gender, Labour and Social Development attributed the increase of teenage pregnancies to negative social norms, beliefs and practices. She adds that during the lockdown, some cultural norms like Female Genital Mutilation (FGM) that prepare girls for marriage increased since children were out of school.
The country representative of the UNFPA, Dr.Mary Otieno says many girls have been forced to take on the responsibility of motherhood that they are not ready for.
Sexual and reproductive health is a human right, essential to human development. Poor people, especially women and young people, face huge social and economic barriers to sexual and reproductive health.
The comprehensive set of Family Planning interventions the government of Uganda is pursuing is spurred by the recognition that addressing the current situation requires a multi-pronged approach. The contraceptive prevalence rate is an outcome of a combination of factors that include; access to information, education and counselling, family planning commodity security, staff availability and skills, as well as social and cultural influences.
Considerable achievements have been registered and Countries have turned ICPD commitments into policies and action, increased access to a range of family planning options, and in some countries cut maternal deaths. However, faster progress is needed. We face new challenges, in particular the devastating impact of COVID 19 and the biggest ever population of young people entering their reproductive years. Demand for FP services and commodities will continue to grow. Health systems remain weak in many parts of the district, and are deteriorating in some
ROCA will work with district and partners to:
Ø advocatefor policies and resources that address young people’s rights to FP information and services
Ø address social cultural and economic barriers, using a rights-based approach; and
Ø support research, monitoring and evaluation and apply knowledge and lessons learnt in policy and planning.
Our aim is to achieve the following outcomes:
Ø Accessible, high quality family planning choices for young people within the district.
Ø Elimination of unsafe abortion.
Ø Keep young people in school
Ø Greater awareness of sexual health and reduced risky behavior.
Why is access to FP information and services important?
Family planning and modern contraception offer choice and opportunity for women to make informed decisions and have more control over their lives. Enabling young women to avoid pregnancy too early in life, when they are at much greater risk of complications, reduces maternal and child deaths. Better spacing of births reduces child mortality and improves maternal health.
Improving FP is among the most cost-effective of all development investments, reaping personal, social and economic benefits. It will save and improve lives. It will help to stabilize population growth and reduce poverty. Reducing high fertility can create opportunities for economic growth if the right kinds of social policies are in place.
Reproductive rights must be protected, promoted and fulfilled if sexual and reproductive health outcomes are to be improved, particularly for the poor and vulnerable. A rights perspective highlights the importance of empowering women and young people to take their own decisions. It strengthens the ability of poor and vulnerable people to demand and use services and information and to be heard. It also puts emphasis on equitable access to services and women’s empowerment.
What do we mean by sexual and reproductive health and rights?
ICPD defined reproductive health as:
“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes”. Men and women should be able to enjoy a satisfying and safe sex life, have the capability to reproduce and the freedom to decide if, when and how often to do so. This requires informed choice and access to safe, effective, affordable and acceptable health-care services.
And reproductive health care as:
“the constellation of methods, techniques and services that contribute to reproductive and sexual health and wellbeing by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations and not merely counselling and care related to reproduction and sexually transmitted diseases”.
Reproductive rights are defined in the ICPD Programme of Action paragraph 7.3, and are based upon rights recognised in international human rights treaties, declarations and other instruments, including the International Covenant on Economic, Social and Cultural Rights, the International Covenant on Civil and Political Rights, the UN Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), the UN Convention on the Rights of the Child, and the International Convention on the Elimination of all Forms of Racial Discrimination. The 2004 UN Commission on Human Rights explicitly recognized women’s sexual rights as essential to combating violence and promoting gender equity. ICPD and ICPD+5 underlined the importance and contribution of rights to population, reproductive health and gender equality issues. The 2001 UN General Assembly’s Declaration of Commitment on HIV and AIDS reinforced the ICPD commitments on sexual and reproductive health needs and placed a strong emphasis on women’s empowerment. ICPD recognised that people’s sexual and reproductive health needs are rights that they are entitled to demand.
Forty per cent of all unsafe abortions are performed on young women aged 15 to 24 years. Almost all these deaths and illness could be prevented through improved access to and choice in sexual and reproductive health services, particularly family planning and contraception to enable planned pregnancy. Safe comprehensive abortion services can also help eliminate deaths among women who do seek abortion because of lack of choice or control over the circumstances in which they become pregnant. In all settings, effective post-abortion care should be a part of routine services.
Postponing first births until the mother is at least 18 years old is another important factor in reducing child deaths. There is also evidence that short birth intervals increase the risk of death for the mother.14
Failure to uphold various rights in law, policy and practice adds to the barriers that poor women and men face in accessing services and information and adopting healthy behaviours. For example, sometimes women may not be offered contraception without their husband’s consent. Millions of women have no power to challenge violations of their rights. Mechanisms for redress are rare.
Scale of the problem
Young people are particularly vulnerable to problems of sexual and reproductive health. This is widely recognized but too rarely translated into accessible services for young people. The poorest women start their childbearing youngest, between the ages of 15 and 19.
The focus on women and young people should not neglect the role of men and their own health needs. The damaging effect of sexually transmitted infections, unplanned pregnancies and other sexual and reproductive health problems on the lives of women and men cannot be fully addressed without men. Men often lack access to the information and services they need to protect their partners.
Demand for reproductive health commodities is increasing as populations grow, and as young people become more knowledgeable and actively seek out family planning, and condoms for protection against sexually transmitted infections as well as for contraception. Yet many women and men are unable to access the contraceptives and related services they need to plan when and if to have children. Meeting the current gap and future increases in demand will make a huge difference to people’s lives. It will lower reliance on abortion, which for many women is the sole means of regulating fertility.
Accessible, comprehensive FP information and services are the cornerstone of efforts to enable young people to make informed, safe and healthy choices. They need to be addressed within local development plans.
The Mayuge district woman MP, Lukia Nakadama appealed to parents to monitor the movements of their children from home during this sensitive moment.
Child experts and religious leaders say that more needs to be done to address the issue of teenage pregnancies;
Jessica Nsungwa, the Commissioner in Charge of Maternal and Child Health at the Ministry of Health says both female and male teenagers need reproductive health knowledge to be able to bring down the numbers.
Additionally, Reverend Francis Osire, a child programme and youth pastor attributed the high numbers of teenage pregnancies to parental neglect. He says parents need to start parenting and looking after their children instead of leaving them for vultures.
There are significant barriers to behavior change experienced by young people. Abstinence messages have been promoted as a way to promote behavior change. However, evidence seems to suggest that simply telling young people to abstain is not the answer.WHO studies show that sex education delays the onset of sexual activity and increases safer sexual practice. They need the knowledge, skills and assertiveness to make safe decisions and have them respected, including to say no and to delay sex. Research shows that sex education does not increase the number of sexual partners among young people. They need access to comprehensive and confidential services that respond to the realities of their lives. And if they do have sex – and eventually most of them will –they need access to the information and means to protect themselves. Education and information on all aspects of sexual and reproductive health.
• Counselling on and access to a broad choice of family planning and modern contraception for all who want to prevent or space pregnancies.
Ø Care during pregnancy and childbirth for mothers and newborn children including a continuum of skilled attendance before during and in the period immediately after birth, and emergency obstetric care for complications, with effective referral systems.
Ø Care for longer-term psychological and physical problems arising from pregnancy complications and pregnancy loss.
Ø Comprehensive care for women who seek abortions: safe abortion services where legal and post-abortion care everywhere, including counselling on family planning to help avoid repeat abortion.
Ø Supply of commodities (contraceptives, condoms, medicines, etc.) to meet demand. A broad range of commodities must reach those who are most in need but can least afford them.
Improved access to family planning enables increased condom use for HIV prevention, and reduction of mother-to-child transmission. Integrated services can harness resources more effectively. Integration is not straightforward: the arrangement of services needs to recognise the stage of the HIV and AIDS epidemic and the needs of specific groups.
Social policies and action are needed to support communities to develop healthy and supportive social norms and to confront practices that damage FP. These efforts need to be backed up by rights-based legal and policy frameworks.
ICPD shifted the debate about reproductive health from demography to human development. It established consensus on, and commitment to, reproductive health and rights with a renewed focus on women’s needs. ICPD set a new standard for what people are entitled to expect and what policies and plans should address. Countries have made much progress since 1994 in turning ICPD commitments into policies and action, demonstrating their ownership of the Programme of Action. Many countries include FP within their national reporting on progress towards poverty reduction. At the same time, COVID 19still seeks to undermine the consensus and reverse the gains made in striving to increase the FP uptake.
Improving access to FP information and services can be done by using existing resources more effectively, and by building increased political and grassroots support for reproductive rights.
And recent apparent declines in use of contraception in the district suggest that many young people still have little choice. There are growing numbers of young people of reproductive age. Need and demand for FP information and services, especially for young people and women, will continue to grow. Support for effective policy-making, resource allocation and action is needed in the district at this challenging stage of demographic transition.
We are working with partners to develop new knowledge and policy in other areas, including rights-based approaches, and reproductive health especially FP. We will use this position paper as a basis for planning the contribution of all parts of the organisation to improving sexual and reproductive health and for our work with partners. We aim to achieve the objective “Mayuge District Council passes a resolution for all SRHR IPs to integrate FP information and services for young people in their interventions by May 2022”
Dr Rt. Hon Hilary Benn MP Secretary of State for International Development
 Population Reference Bureau and the International Youth Alliance for Family Planning, “Empowering Evidence-Driven Advocacy Among Youth Ages 15 to 24 in Kampala, Kabale, and Mayuge Districts,” unpublished research, October-November 2018
 Uganda Bureau of Statistics (UBOS) and ICF, Uganda Demographic and Health Survey 2016 (Kampala, Uganda and Rockville, MD: UBOS and ICF, 2018)
 National Family Planning Advocacy Strategy Costed Implementation Plan 2020-2025
Dowsett, G and Aggleton, P. Sex and youth: contextual factors affecting risk for HIV and AIDS. A comparative analysis of multi-site studies in developing countries. Part 1: Young people and risk-taking in sexual relations. Geneva: UNAIDS Best Practice Collection, 1999.
Baldo M, et al. Does Sex Education Lead to Earlier or Increased Sexual Activity in Youth? Presented at the Ninth International Conference on AIDS, Berlin, June 6-19, 1993. Geneva WHO, 1993.
Garvey M. Dying to learn: Young people, HIV and the churches. London: Christian Aid, 2003.
TEACH FOR UGANDA
This is a non -profit organisation that develops leaders to expand educational oportunities to all children in uganda. At Teach for uganda, they believe that every child in uganda deserves an opportunity of an excellent education. they recruit train and place top university graduates and young proffessionals in high need primary schools across uganda to serve as full time teachers committed to transforming the education outcomes of less previlledged children through significantly improving their achievements and aspirations in a 2year teaching fellowship.
Mayuge, Uganda – Teach For Uganda (TFU) supported by Student ChangeMakers in California, and in partnership with Warchild Holland and the Ministry of Education & Sports has today launched the 1st digital learning site at Isenda Primary School, Mayuge District.
The digital learning site at Isenda is the first of 10 digital learning sites which will impact over 10,000 underserved children in the rural communities of Mayuge and Luweero Districts.
Uganda’s Minister of State for Primary Education Hon. Nansubuga Rosemary Seninde officiated the launch of the digital learning site and reechoed the government’s support towards bridging the digital learning divide in rural Uganda communities.
“The launch of this 1st of the 10 digital learning sites which will impact over 10,000 children in Mayuge and Luweero districts fittingly captures part of the long-term recovery to accelerate the learning of millions of children who were unable to access remote learning during school closures. If anything, the pandemic has shown us beyond the health sphere that “no man is an island”; that we need each other to strengthen our education system and avert an education catastrophe,” Hon. Rosemary Seninde said.
The minister further highlighted the need to invest in digital learning to bridge in Uganda: “I want to appeal to everyone to see the need for urgent investment in programs that bridge the digital divide in our country. If we succeed in doing this, we will be ensuring that all our children get a quality education and are able to fulfill their inherent potential as productive citizens of our country”.
Teach For Uganda and War Child Holland’s partnership makes Isenda Primary School, the second non-refugee school to pilot the Can’t-Wait To Learn digital learning platform. At the launch, Teach For Uganda’s Executive Director Kassaga James Arinaitwe said;
“Today is a monumental day for our country, our children, and for our future. Since the pandemic and the nationwide closure of all schools, our fellows (teacher leaders) who live and work in 33 of these school communities have witnessed firsthand, the negative effects of this pandemic on these communities but most especially on our youth and children. We are launching this digital learning site to bridge the digital divide in learning outcomes as well as introduce basic ICT skills early on to our most disadvantaged children.”
The digital site uses solar energy to power the learning tablets which are pre-installed with War Child Holland’s Can’t-Wait To Learn (CTWL) digital learning platform that translates Uganda’s national curriculum into serious educative gaming which children can play on tablets and learn skills of literacy and numeracy.
Student Changemakers founders, Nate and Simon Cohen, are at the forefront of this digital learning initiative and have been lobbying resources to harness the transformative power of digital learning in rural underserved communities in Uganda.
“As high school students ourselves, we came up with the idea for Student Changemakers while we were out of school, learning on computers, during COVID19. When we reached out to our friends at TFU to see if we could provide solar, hotspots, and tablets to Ugandan villages, we quickly realized how a little help could go a long way — during COVID and beyond. Now, with War Child Holland’s effort to put the primary school curriculum online, we hope this can be the first step to harnessing the transformative power of digital learning and giving thousands of talented Ugandan kids the opportunity to fulfill their educational potential,” Simon & Nate Cohen said.
Warchild Holland’s Education Advisor Grace Kiiria Okia remarked that their education innovations provide an avenue for children to acquire foundational skills required for transition and further educational achievement, and such collaboration and partnerships provide an opportunity to improve literacy and numeracy skills using gaming approach to learning.
“We believe that it is only through such collaborations and partnerships that we can achieve scalability and sustainability of Can’t Wait To Learn (CWTL) Digital Learning Approach across Uganda. Using the CWTL approach, Teach for Uganda will provide many children the opportunity to catch up on lost learning due to the prolonged closure of schools due to the COVID 19 pandemic. Partnership and collaboration provide the opportunity for us to leverage on resources, skills, and expertise of each other and it is the ultimate goal for the achievement of long-term positive impact.”