KAMPALA, UGANDA – Sarah Nagawa, 14, is a teen mom.
Crying as she recalls the event, she says a man she had never met raped her last year. After the rape, she says family members shunned her, forced her to leave school and sent her away to a teen pregnancy center in Kampala, Uganda’s capital city.
Her family took her back once her baby was born. But Sarah says her situation is difficult. Stigma for teen moms runs high. She says she does not know what the future holds for her.
Scovia Kebirungi, who just turned 20, is pregnant and HIV-positive. The father of her baby died in a car accident in November. She says another friend had promised to marry her, but only if she was HIV-negative. With nowhere to go, she is living at the Kampala teen pregnancy center and is on antiretroviral drugs. She says the medication, which she must take for the rest of her life, makes her nauseated and weak.
“The medicine makes me feel like vomiting and it gives me a headache,” she says.
Noeline Nakagwa, 14, is also pregnant. Noeline is an orphan. She dropped out of school when she was in primary school, and a relative brought her to the city to work as a housemaid. The family she worked for was embarrassed when she became pregnant, so a relative sent her to the teen pregnancy center. She is suffering from depression and is often listless and unresponsive.
Teen pregnancy rates are high in Uganda, where the culture considers it so taboo that many families send pregnant teens away. Yet despite the social taboo, there are few programs here that offer education or promote contraceptive use to prevent it. HIV/AIDS awareness also remains low among youth. As the government and local organizations aim to bolster sex education, one teen pregnancy center takes a different approach by caring for the pregnant teens who are shunned by their families.
According to the Ministry of Health, Uganda’s fertility rate, or number of children born to one woman, has decreased only slightly during the past decade. The country’s population growth rate remains one of the highest in the world, and the CIA ranked Uganda’s fertility rate in 2010 as the second highest globally. Although contraceptive use has increased and knowledge of contraceptives is high among adults, many Ugandans still don’t use them or don’t have access to them.
With women here having an average of seven children each, according to the Ministry of Health, pregnancies start at a young age. According to UNICEF, 16 percent of adolescents ages 15 to 19 have given birth, and 35 percent of women ages 20 to 24 have given birth before the age of 18. Pregnancy is among the primary reasons girls drop out of school. In all, just 7 percent of girls attend secondary school, according to the Ministry of Education.
In Uganda, having children out of wedlock is considered taboo, so many parents send pregnant teens away during their pregnancies, says Vivian Kityo, director of Wakisa Ministries, the nongovernmental organization that runs the teen pregnancy center that took in Kebirungi, Sarah and Noeline.
“Guardians and parents are embarrassed by their daughters because getting pregnant [while] living under the same shelter with the fathers is culturally unacceptable,” she says.
Kityo says that although traditional attitudes toward teen pregnancy haven’t changed, traditional activities for young people have changed, creating more opportunities for sexual activity among teens. She says pregnancy rates are particularly high after school holidays, when youth are idle.
“The traditional ways of life are giving way to the growth of the urban culture, where young people no longer utilize their energies in family fields tilling the land,” she says. “Instead, they spend time loitering in the city centers with friends, particularly at night.”
Socio-cultural practices and traditions also contribute to the low use of contraceptives among Ugandans, according to a joint action plan by the Ugandan government and the U.N. Population Fund, UNFPA. Only 38 percent of young women and 55 percent of young men in Uganda say they used a condom the last time they had sex, according to UNICEF’s most recent statistics.
“The young girls are also not informed of contraceptive use,” Kityo says. “Most of these girls are from rural areas. Sex education in schools is limited. The government really needs to do more.”
Condom distribution has increased in recent years – to 10 million per month in 2010 – according to the Ministry of Health. Yet there have been reports of consistent condom shortages at health centers, most recently in northern Uganda earlier this year.
Kityo says that HIV/AIDS is another major concern among teen mothers, who have engaged in unprotected sex. She says many teens are not aware of the dangers of HIV and, therefore, don’t know to find out the HIV status of their potential sexual partners.
Uganda ranks among the top 10 countries that have the highest number of people living with HIV/AIDS in the world, according to the CIA. Yet just 32 percent of young women and 38 percent of young men in Uganda have comprehensive knowledge of HIV, according to UNICEF.
Organizations such as the Infectious Diseases Institute in Kampala, a Makerere University center that focuses on care and treatment of HIV and related infectious diseases, are advocating for prevention strategies such as the ABC model – abstinence, being faithful and condoms – and safe medical circumcision, which they say has the potential to reduce the spread of HIV. Another organization, Young Empowered and Healthy, aims to equip youth with information and skills to encourage them to make responsible choices.
But local teachers say good choices are hard to make without proper education. Julia Mutebi, a secondary school teacher in Kampala, says that sex education is not in the official school curriculum. She says that Ugandan President Yoweri Museveni has initiated an independent program that focuses on providing HIV awareness to students, the Presidential Initiative on AIDS Strategy for Communication to Youth, but that it’s only being implemented in some schools.
According to the Ministry of Health, sexual and reproductive health core preventions have also been implemented through the Health Sector Strategic Plan, but have not yet met the plan’s target goals. UNFPA has also worked with the Ugandan government to provide programs aimed to reduce teen pregnancy rates and educate young people on life-planning skills.
For some, traditional measures and governmental options are not enough. Advocates say new action is necessary. A few local communities have begun encouraging teen counseling at home and in schools. Others have implemented community policing protocols and increased prosecutions of rapists. But many young victims don’t report rape because they are afraid or embarrassed, or even when they do sometimes perpetrators leave the area before they can be prosecuted.
Wakisa Ministries takes a unique approach. The staff looks after the girls during their pregnancies, then sends them back to their communities after they give birth if it is safe for them. The girls say they are loved, cared for, counseled and encouraged at the center after the shame and embarrassment they endured at home. They also learn a number of life skills to prepare them for motherhood, such as cooking, cleaning, reading and writing.
One of the girls, Winnie C., who declined to give her last name, writes in a poem that her family, relatives and even her best friend abandoned her when she got pregnant, but that Wakisa Ministries sheltered and encouraged her.
“My own people rejected me, but you accepted me,” she writes. “You lit for me the hope of life and a good future again.”
