The App Empowering Young Women in Uganda

In Uganda, young women and girls face many sexual and reproductive health and rights (SRHR) challenges. For example, a high unmet need for contraception leads to dire consequences like unplanned pregnancies and sexually transmitted infections.

Challenges that limit provision of SRHR services to adolescents and young women include lack of privacy and confidentiality, knowledge gaps, cultural and social stigma, biased service providers, and inconvenience in accessing SRHR services despite their availability. Although there have been improvements in creating a youth-attractive environment for SRHR services and access to tools, more work is needed.

We are constantly reminded of the need to provide avenues where young people – including women and girls – can access sexual and reproductive health and rights services that are equitable, appropriate and effective.

At Reach A Hand Uganda, we help to address this need through our youth empowerment centres, and now, we have introduced the SAUTIplus app.

The SAUTIplus app is an innovative part of the SAUTIplus ecosystem,  helping to fill existing gaps in information. Uganda is experiencing a smartphone boom, with over half the population now owning one, and this number is increasing day by day.

Internet penetration in Uganda is at 41.6% – with 19 million Ugandans connected to the internet. In 2017, the Uganda Communications Commission recorded that the total number of mobile phone subscriptions was 23,529,979, up from 21,039,690 the previous quarter.

The SAUTIplus app was revamped two months ago to further engage Uganda’s high youth population and, at the time of writing, has 1,600 downloads on Google Play Store. The iOS version is in its final stages of going live.

On the app, information is available day or night. With a few taps of their phone, young women and girls can quickly find answers to their burning questions about sexual and reproductive health.

It’s the young people at Reach a Hand Uganda producing the content for the app and answering the questions – with support from the Programs and Communications departments. We understand the needs of the young women and girls and can craft our responses to reach the users in a relatable manner.

Users are able to see answers to questions other young people have asked and read tailor-made stories addressing issues faced by girls. Questions can be submitted on the website (hopefully soon to be added to the app) and the questions and answers can be viewed on either the app or website. The questions can be anonymous to maintain a safe and confidential space.

The app provides accurate information on SRHR, rather than simply promoting abstinence, which has proven an ineffective method of protecting young girls in Uganda.

The section named ‘Senga’ is a reference to a trusted relationship between a woman and her father’s sister (auntie). This relationship is commonly one where information regarding sexual and reproductive health and rights is passed on, but there can be a gap in appropriate or accurate information. This is where the SAUTIplus app comes in.

‘Senga’ provides an opportunity to view answers to questions you may have had yourself, smashing the common myths and misconceptions surrounding SRHR in Uganda. “My boyfriend says we don’t need contraception because he will pull out at the last minute. Is this a good idea?” is an example of one of the questions asked by a young girl on Senga.

The SAUTIplus app is providing a platform for women and girls to take charge of their sexual health. The knowledge the app provides is giving power to young women.

With power comes increased agency and the ability to negotiate within relationships – for example, with regards to contraceptive use to prevent pregnancy. No topic is taboo on the app. This includes menstruation and menstrual hygiene, a key SRHR challenge Reach a Hand have identified among young women in the country.

The for-the-youth attitude of the SAUTIplus app means it is an engaging platform for young people to access reliable information. Multimedia content, including photos, videos and blogs, provide a plethora of youth-friendly, easily digestible resources on SRHR.

The app is in continuous development, striving to meet the changing needs of young women in Uganda. It aims to create a positive relationship between young people and SRHR information, showing that information is a tool of power and not something to be dismissed. 

Women’s Reproductive Health is Under Attack

The medical device ‘Essure’ is an implantation method of sterilization that came to the market in 2002. The device received patient backlash from the outset and has since come under extreme scrutiny.

Over the years, women have reported serious complications from Essure and thousands have filed lawsuits against the medical device’s manufacturer, Bayer AG. Some of the complications women have reported are unintended pregnancies, tears and perforations of the uterus and other surrounding organs, as well as the sudden development of autoimmune disorders.

In summer 2018, Bayer announced the discontinuation of Essure. The company cited business reasons and stood by the safety and efficacy of the product. Sales of the device have declined significantly since April of 2018, a factor Bayer claim contributed to the decision to pull it from the market in the United States.

Essure has stood out as the only implantation method of sterilization approved by the Food and Drug Administration (FDA). But researchers estimate that nearly 10% of women who undergo the procedure could become pregnant within 10 years of implantation. This rate is nearly four times higher than traditional methods of sterilization, such as tubal ligation.

The device consists of metal coils which are inserted into a woman’s fallopian tubes to block sperm and prevent it from reaching the eggs.

It’s expected to be fully effective after three months following implantation. The procedure is done in-office, with the expectation that women return to normal daily activities the same day. Many women report mild to moderate pain or discomfort immediately following the procedure.

It is estimated, however, that nearly 10,000 of U.S. Essure patients required additional operations after their original procedure. This is due to anything from severe side-effects, the device traveling to different areas of the body, or perforations and tears requiring medical procedures.

Dr. Katy Moncivais, PhD, Medical Writer tells me: “Essure fails every test – it’s less safe, less effective, and more side effect prone than most other methods of birth control.”  

Side-effects include – but are not limited to – pain with sex, back pain, abdominal pain, severe menstrual cramps, and severe pelvic pain. There have also been many reported cases of unintended pregnancies while the device was implanted. Some women carried the child healthily to term, but many experienced ectopic pregnancies, stillbirths, or miscarriages.

In the years since the device came to market, the FDA stepped in several times to regulate the product. The first steps to regulating were to enforce label changes on the device and to include a boxed warning to advise physicians and patients of the potential dangers. After these regulations were enforced, sales began to decline.

The United States was the last country to stop selling Essure to the public. Other parts of the world, including Canada, Europe and the United Kingdom, either chose to discontinue the device themselves or had it pulled from their markets by Bayer.

Activism has been central in the story of Essure.

Thousands of affected women are part of a Facebook group called Essure Problems. Last year, Netflix released The Bleeding Edge, a documentary on the medical device industry which features a section on Essure’s risk to women. A week after the documentary’s release, Bayer announced their voluntary discontinuation of the device.

Women’s health and bodies must not be compromised in the name of innovation, business or profit.

Essure was marketed as an easy method of sterilization for women who no longer wish to get pregnant. But from perforations in organs, development of autoimmune disorders, and unintended pregnancies, it has proven to be dangerous, or even life-changing, for far too many.

Like this post? Try these…

Sex Education is Everyone’s Right

Sex education is the teaching of knowledge and understanding of our bodies in their natural sexuality. It’s important for many reasons. Many privileged sectors of society have access to this knowledge and understanding, but in many parts of the world, it can’t be taken for granted.

There is a huge problem with sex education worldwide.

In the United States, a survey showed that of 1000 participants between 18 and 29 years, only 33% reported having had some sex education. In the United Kingdom, a similar poll proved that from the same number of participants, 16-17 years old, only 45% felt confident to define their sex education as ‘good’ or ‘very good’.

Meanwhile, in South Africa, the adolescent pregnancy rate is 30%. Mexico has the highest rate of teen pregnancies among the 34 member countries of the Organization for Economic Co-operation and Development (OECD).

Sex education simply means teaching young people to know how their bodies work and how to take care of them.

A sex education of quality provides us with the tools to respect our own bodies and the bodies of other people. It enables us to be conscious of the respect sexuality deserves, to prevent sickness, and to value the importance of open, shame-free dialogue.

Sex education should be part of every education. Sadly, many cultures still think that sex education is not a priority matter. Many people believe it shouldn’t be included in basic education because for them, talking about sex is a synonym for shame.

Consistent, high-quality sex education must not be only an option.

The importance of the subject goes beyond the individual. It matters deeply because a correct education can actually save lives. According to The United Nations Educational, Scientific and Cultural Organization (UNESCO), sex educations is:

“[…] teaching and learning aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to realize their health, well-being and dignity; develop respectful social and sexual relationships…”

Sex education can:

  • Prevent sexually transmitted diseases
  • Provide knowledge of how to use contraceptive methods
  • Prevent unwanted pregnancies
  • Create understanding of the menstrual cycle
  • Reduce stigma and shame

A thorough sex education also gives young people an understanding of the boundaries of their body’s intimate space. This helps them to identify sexual abuse.

With the correct information, people are more able to make responsible decisions.

Sex education must be a right. It is about more than just sexual life. Education helps young people to take decisions about their bodies, health and lives in their own hands. This can, in turn, create a better lifestyle for all.

It’s important to visualize the body as the natural thing that it is. If parents and textbooks would teach about the naturality of our bodies, it would be easier for people to demand respect over their own.

In the world I envisage for the future, everyone will receive high quality sex education. They’ll understand what sex is about, and there won’t be more fear or taboo. No child, woman or man will be limited in speaking about sexuality as a personal and social priority.

If you enjoyed this post, we think you’ll like these too!

Women in Rural Zimbabwe are Being Left Behind

Being a young woman living in a rural or remote community can be very daunting. You have to fight tirelessly to loosen yourself from the grip of sociocultural stigmatization to have any sense of autonomy over your sexuality.

The situation is worsened by the absence of easy access to modern family planning methods. The problem lies in the fact that when coming up with sexual and reproductive interventions for women and adolescents, our governments still rely on ‘a one size fits all’ approach.

But women in rural areas have different lifestyles and challenges than women living in urban communities.

When it comes to sexual and reproductive health, one size fits all really makes no sense. One size fits all isn’t good enough.

In Zimbabwe, the fact that young women and adolescents in rural and remote communities are still struggling to access modern family planning methods – or even comprehensive sex education – is overlooked. These issues are still regarded as taboo, and in my community you can’t talk openly about them.

It’s a different scenario for women and adolescents in urban communities within Zimbabwe. In urban areas, it’s possible to access both information and services through youth friendly centres, Non Governmental Organisations and other diverse forums.

I believe that women can only enjoy their sexual and reproductive health and rights if they have access to relevant services and supplies – including access to contraceptives and accurate information on how to use them – regardless of geographical area or socioeconomic status.

The government of Zimbabwe is committed to ensuring improved availability of and access to quality integrated family planning services for all women irrespective of age, marital status and their geographical location by the year 2020.

A sizeable number of interventions have been made. For example, we now have an ambassador for Family Planning to advocate for family planning. This is a great initiative, but in rural areas this ambassador is not visible, and so issues are misrepresented! This type of intervention is relative – it primarily benefits the adolescents and young women in urban areas the brand ambassador is engaging with – which makes it an unfit approach for women collectively.

I believe that this kind of intervention leaves a lot of women behind. 

A large percentage of Zimbabwean women are in rural communities. Adolescents and young women in rural areas need interventions they can relate to – services that resonate with their particular reality and their existing level of understanding.

As much as there have been family planning and contraceptive outreach services, it is still absurd that in rural areas adolescents and young women continue to have unwanted pregnancies and new cases of HIV infections. The reason behind this is a lack of positive and affirmative approaches towards women’s sexuality.

From my experience in a rural area, the healthcare service providers are not youth friendly and they tend to have a negative perception of young women trying to access family planning. As a result, adolescents and young women shy away from these health centres as they don’t trust the service providers.

This is very disturbing, as trust should be one of the core values health service providers should strive to uphold at all times. I believe that it would be a great idea for genuinely youth friendly centres to be established in rural and remote areas. This would encourage adolescents and young women to seek out sexual education and feel comfortable asking questions about the family planning methods that will work best for them. It would also help conservative rural communities to recognize family planning as not only a priority, but also a right.

Sexual and reproductive health and rights of women and adolescents in rural communities should be prioritized in Zimbabwe, and the government must be held accountable for delivering meaningful and diverse approaches in tackling the family planning challenges our country faces. Without this, achieving the FP2020 targets will not be possible.

If truth be told, rural women and adolescents have had enough of being left behind.