As more young people are becoming sexually active early, many are being exposed to the dual risk of unintended pregnancies and sexually transmitted diseases (STDs).
Among unmarried adolescents, sex is sporadic. According to Richard Kibombo, a researcher with Makerere Institute of Social Research, the vast majority (93% of females and 98% of males) of 15 to 19-year-olds who have ever had sex have attended school.
“A considerable proportion of 15 to 19-year-olds are sexually experienced and have fallen prey to teenage pregnancy and because of its social unacceptability, many resort to abortion,” Kibombo says.
However, Uganda’s official position on sex education remains undefined and there is no official estimate of the number of schools that provide sex education courses. In March 2003, President Yoweri Museveni introduced a set of teachers’ manuals containing a chapter on safer sex to avoid abortion and its after effects by using the condom and being faithful, among others.
However, these were strongly criticized by conservative and religious advocacy groups because of the section on condoms and safe sex and by the end of 2003, they were withdrawn from the curriculum.
According to the 2006 report titled ‘Unintended Pregnancy and Induced Abortion in Uganda: Causes and Consequences’ by the Guttmacher Institute, the Uganda school system is inadequate in educating school boys and girls about healthy sexuality.
“School children rely on self-education from peers without adequate and professional guidance and counselling,” reads the report.
The report also revealed that 44% of boys and 50% of girls aged 15-19 had never participated in a classroom discussion about sexuality. While parents consider discussion of sex a taboo, deliberate programmes to train teachers on sex education do not exist. Little wonder, that an estimated 297,000 induced abortions are performed in Uganda each year with a yearly abortion rate of 54 per 1,000 women aged 15-49.
Those who resort to abortion, research revealed, do so because of lack of access to sexual reproductive health and services, which limits their capacity to address sexual and reproductive health issues.
Adolescents' sources of information
The report says young people have frequent access to the media; radio being the predominant one and many confess having received their information on sexual and reproductive issues from public information messages. Almost one half of women and two thirds of men aged 15 to 19 years listen to the radio every day.
“Radio stations often carry health information programmes and talk shows giving advice on people’s families and love life,” reads the report.
Also, specialized non-governmental organisations like the Straight Talk Foundation hosts programmes on radio and television targeting adolescents and young adults, directing them to avoid early pregnancies and develop skills such as assertiveness, confidence and proper decision-making. Substantial proportions of youth obtain sexual and reproductive health information from teachers.
For example, two thirds of 15 to 19 years olds who know about abortion obtain information from a teacher or a healthcare provider.
“Family members do not seem to play a major role in youth’s sex education. Only about half (52%) of 15 to 19-year-old females report that a family member has ever talked to them about sex related matters,” Enid Mwebaza the Assistant Commissioner of Nursing, says.
She adds that when parents talk to their children about sex, it is often to scare rather than instruct them about the consequences of sexual activity. Despite overall broad levels of awareness and knowledge about unwanted pregnancies, adolescents continue to have substantial unmet sexual and reproductive health needs.
“Many youths have unanswered questions about abortion risks and some have not had any sexual education in school or at home,” Kibombo says.
According to the Health Professional Survey and Community Abortion Morbidity study, these are some of the abortion methods used in Uganda:
Surgical and medical methods
Dilation and curettage (doctor uses mechanical dilators to open the cervix and scrape the uterine walls), manual vacuum aspiration (uses a tube inserted into the uterus to suction out contents of the uterus; an electric pump can be used in this procedure) and saline instillation.
Omujaaja, coral bean (ekiko), poke weed (oluwoko), kamunye, water grass (ennanda) and tealeaves among others.
Smoking cow dung, tying the stomach, wearing herbs, drinking laundry detergent, bleach or gasoline, insertion of catheter, clothes hanger, stick and cassava into the vagina and taking oral hormonal drugs.
Action needed to reduce unsafe abortions
According to the Guttmacher Institute report, education in schools as well as through the mass media is needed to emphasize the dangers of abortion and there is need for community leaders to improve knowledge about access to and use of effective contraception which can lower rates of unintended pregnancy and induced abortion.
Poor women and those with little education often have little say in when they will marry, when to become mothers, the number of children they will have and when they will stop child-bearing. Moreover, lack of contraceptive use among these women puts them at an increased risk of unwanted pregnancy and in turn unsafe abortion.