Cover story

Mary Achom, 16, is a school dropout.

She cuts a figure of a haggard desolate teenager as she walks into Ngora hospital. She is among 20 girls below 18 years that drop out of school due to pregnancy-related issues. On this particular Wednesday morning, Achom and other girls had come to Ngora hospital for a caesarean section birth.

Achom’s boyfriend Agingiroi, 17, disappeared after impregnating her while she was a P.6 pupil last year at Orisai primary school in Kapiri sub- country, Ngora district. Hers is a story of dropping out of school following a pregnancy, a phenomenon that still dogs many Ugandan girls.

It is a story of a teenage orphan girl who stays in a toilet-size single room with her grandmother. Achom’s parents died of HIV/Aids 10 years ago. Achom’s grandmother Edith Achom said they did not report Agingiroi to police for fear of starting up family wrangles in the village. She feared the consequences that could accrue from hostile neighbours.

The dark-skinned younger Achom speaks with remorse, each word revealing the pain in her body. I find her lying helpless on her hospital bed, cuddling her new baby with the left arm. Although happy with her new bundle of joy, Achom reveals that she at one time attempted to abort.

“Achom got obstructed labour since she was too young to deliver normally and this [called for a] C-section to avoid fistula or any deaths that might occur in the process of [natural birth]. She had a borderline pelvis and the baby was too big it couldn’t pass,” Dr Gorrett Ibilat, the acting Medical Superintendent, Ngora hospital, said.

An anal fistula - an abnormal channel or opening between the anal glands and the skin – can cause bleeding and discharge when passing stools, and can be painful. However, Ibilat said they have experienced very few fistula cases in the hospital ever since she joined, just because they try as much as possible to discourage women from giving birth at home where they can easily get complications and end up getting fistula.

She said majority of the teenage girls get obstructed labour when they fail to deliver naturally, since their bodies are still young and are mainly defiled by boys in the same age group, who disappear after impregnating them.

“We have a great number of teenage pregnancies due to high defilement rate in the area and every day we receive many cases from police who come for examination,” Ibilat said. “Many girls here are defiled and forced into marriage at a tender age due to poverty. They are looked at as a source of wealth for their parents who force them into marriage while looking for cattle as bride price.”

Ibilat said poverty in Ngora district had caused many girls to become pregnant before their bodies were ready, in spite of universal primary education (UPE). Majority of them abandon school completely after delivering and others end up acquiring HIV/Aids.

Teenage pregnancy has far-reaching implications not only for the mother, but for the nation too, and is a major contributor to maternal and child mortality, in addition to the vicious cycle of ill- health and poverty.

To solve this problem, the Population   Secretariat has handed over a cheque of Shs 10m to the District Chief Administrative Officer for this year’s World population day, whose theme is “Invest in preventing Teenage Pregnancy: Let girls be girls”.

Hannington Burunde, the head of Information and Communications at Population Secretariat, said the theme was selected due to teenage pregnancy problems in Africa, in Uganda and in Teso sub-region – particularly Ngora district, which has the highest number of pregnant teenagers.

“We are advocating for anybody who has capacity to engage in activities that can prevent early pregnancy which contributes a lot to maternal deaths,” Burunde said.

Ngora district midwife Beatrice Agoro said 39 girls below 20 years attended antenatal care out of the 230 total attendances of all expecting mothers in May.

“Very few girls below 20 years manage to deliver [naturally] since their bones are still weak and this has encouraged us to sensitise them to deliver in the hospital to avoid risks of overbleeding while delivering at home,” she said.

The Chief Administrative Officer Davis Dembe Beyeza said, although Ngora is a new district, it has been previously registering bad performance in Primary Leaving Examinations (PLE) due to the high number of girls dropping out of school to become mothers.

“Our survey found that many girls have been fighting to complete primary school but drop out due to early pregnancy,” he said.

The District Chairman, Ben Eumu, said many girls who get pregnant early end up on the streets and become thugs or prostitutes, after many are also shunned by their disappointed families.

“We have a weak justice system which is often bribed by defilers, and if they are not charged, many girls will continue to be defiled and suffer [the consequences of] early pregnancy,” he said.

According to the World Health Organisation, at least 16 million girls aged 15 to 19 years and two million girls under the age of 15, give birth every year. One in five girls has given birth by the age of 18, which figure rises to over one in three girls in the poorest regions of the world.

In Uganda, teenagers make up 25 per cent of the country’s population and of these, 25 per cent are pregnant or have had a child before 19 years. Achom may be in Ngora, but her dilemma is shared by countless girls nationwide, many of whom lack support from their families and from the man responsible for the pregnancy.

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