Immaculate Akankwasa, 19, a resident of Karumere village in Kisoro town council, vividly recalls the day she went to hospital for a pregnancy test and it came back positive.
At the age of 14, Akankwasa had seen her dreams of becoming a nurse washed away with one pregnancy test. She could not be allowed to sit her Primary Leaving Examinations; so, she moved in with the man responsible for her pregnancy.
“My parents forced the man responsible for the pregnancy to marry me and take care of me. After giving birth, the man asked me to go back to school and that he would be paying my school fees. But when I reached S2, he told me he was tired of paying and suggested that I sit home as he takes care of me,” she says.
Akankwasa would later become pregnant for her second time. It was also unplanned; she had wanted to leave the marriage because the husband had started mistreating her.
“I had started doing petty jobs like washing clothes for people in the village and I was planning to go back to my parents when I realized I was pregnant again. Two months after giving birth, the man kicked me out of the house and I was left homeless with two children,” she recalls.
Akankwasa is just one of many girls that contribute to the statistics recorded by Kisoro hospital every month, of teenagers with unwanted pregnancies.
According to Annie Modesta Budongo, the in-charge of the women’s ward at Kisoro hospital, the hospital records an average of two such girls every month, who show up at the facility to get maternity services. She adds that every month the hospital records at least one case of a botched abortion.
“We get girls as young as 13 years who come for antenatal services, while others come seeking ways of getting their pregnancies terminated,” she says.
In July this year, Kisoro hospital recorded 250 deliveries, out of which 61 were mothers aged between 10 and 19, while 50 [teenage mothers] of a total of 256 deliveries were reported in September.”
Francis Munyarubanza, the Kisoro district education officer, notes that teenage pregnancies have increased the number of girls dropping out of school.
He notes that out of the 11,000 girls enrolled in P1 in 2010, only 2,234 sat for the Primary Leaving Examinations, meaning at least 8,000 girls had dropped out.
“We don’t know what to do when it comes to teenage pregnancies. Whereas some girls drop out because of finances, the general picture shows that the highest percentage drop out because of pregnancies,” he notes.
The situation is not unique to Kisoro district, as Kabale teenage pregnancy statistics are equally alarming. According to Immaculate Mandera, the acting district health officer, the district recorded 2,264 girls between the ages of 10 and 19 out of the 15,278 women who went for antenatal services, which is 14.8 per cent.
Mandera notes that 1,637 teenage girls delivered from the public health facilities out of a total of 10,510 mothers, which is 15.7 per cent.
In the same year 2015/16, 1,461 teenage girls sought family planning services out of the 18,723 clients registered at health facilities, which is 7.8 per cent.
Contraceptives a solution?
On September 29, the ministry of health rejected to launch revised guidelines that would see teenage girls access contraceptives from public health facilities on grounds that the ministry had not made enough consultations with the stakeholders.
Budongo notes that even in the absence of approved guidelines by the ministry, she still gets cases where girls seek emergency pills. These are pills taken within 72 hours after unprotected sex, to hinder conception.
She adds that although she issues the contraceptives, she fears she could be going against current guidelines.
“I am human too and a parent. I don’t feel comfortable when I deny such a girl in need of contraception to secure her future. But I know the ministry has no policy for that and the only explanation I can have in defense is that the family planning registration book has provision where we can record the teenagers.” she says.
However, Christopher Ruzaza, the health services coordinator at the diocese of Muhabura notes that the ministry of health officials should not pretend that they do not see what is happening in the country.
He notes that the longer government delays to launch the guidelines, the more girls will drop out of school because of unwanted pregnancies.
“Let us put other factors aside and allow the girls who cannot abstain from sex to have access to contraceptives, instead of letting them drop out of school. There is nothing as bad as a child growing up knowing that he/she was an unwanted child,” he says.
He adds that the health ministry only needs to package the information well so that the girls know the side-effects of contraceptives and how they risk getting infected with HIV.
Ruzaza, notes that the government needs to invest more in family planning commodities at health facilities if the policy is to be effective.
“We already have an unmet need for contraceptives as a nation. This implies that if we are to have that provision for the teenagers, we need to double the supply,” he adds.
Dr Stephen Nsabiyumva, the Kisoro district health officer, says the policy on contraceptives for teenage girls has been delayed.
He says the ministry of health has the mandate to ensure that girls are not impregnated by providing youth-friendly services, including contraception.
“Regardless of religion, culture and morality, we need the contraceptives urgently. We cannot continue looking at our girls dropping out of school and ending up in miserable lives and yet we can do something to prevent this,” he says.
However, his education counterpart Runyabuzanza disagrees, saying this is likely to lead to more moral decay among the girls.
“I think we need a comprehensive policy on parenting. Giving girls contraceptives will just worsen the situation. Yes, the statistics are alarming but contraceptives are not the solution. Let the ministry look at the other drivers of sexual promiscuity and address them as a whole.”