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.

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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.

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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.

Join us LIVE at ICFP2018!

We’re excited to announce that Girls’ Globe will be part of the 2018 International Conference on Family Planning in Rwanda next week.

From Monday 12 – Thursday 15 November, we’ll join thousands of advocates, young people, political leaders, scientists, policymakers and researchers from within the global family planning community. And we want you to come with us!

If you are interested sexual and reproductive health and rights you can attend the conference from wherever you are in the world through the ICFP Hub, and by joining the Virtual Conference on Facebook.

You’re invited to join Girls’ Globe’s LIVE events and reporting!

There are loads of ways to engage with Girls’ Globe online during the conference and you can catch everything on our  ICFP2018 LIVE page. Here’s what you don’t want to miss next week – make sure to RSVP to each event and follow us @girlsglobe on Instagram, Twitter & Facebook.

Monday 12 November 

Welcome to #ICFP2018: The Girls’ Globe team on the ground in Kigali, Rwanda welcome you to the International Conference on Family Planning 2018. While we say hi to people arriving for the opening ceremony, we will start a conversation with you about expectations for this year’s conference. We will talk to you about the ways you can engage online during conference – and what you don’t want to miss this week! 

Tuesday 13 November

Family Planning Commitments for Young People: In this episode, we will highlight young people’s priorities in sexual and reproductive health and rights, and we will shine the spotlight on the family planning commitments being made for young people around the world. You will have the opportunity to interact and to ask your question and share your priorities in a live Q&A.

Wednesday 14 November 

Stories at the Heart of SRHR (in partnership with sayitforward.org): In this episode, we will highlight a more personal side of sexual and reproductive health and rights, and we’ll shine a spotlight on women’s stories of overcoming challenging norms, stigma and taboos in their work with family planning. You will have the opportunity to join this conversation LIVE by sharing your own story and connecting in solidarity as others around the world share theirs. 

Thursday 15 November 

A Global Movement of Action: In this episode, we will highlight the actions that people are taking around the world to advance family planning and sexual and reproductive health and rights. We will shine a spotlight on YOU and some of our partner organizations in the studio and discuss the actions they are taking in the next year, the needs that they have to advance their work, and the change that they want to see in 2020. You can join the conversation LIVE by adding your perspectives and inspiration in a livestreamed Q&A.

Providing family planning services to urban migrant workers in Bangladesh garment factories: In this segment, Girls’ Globe will interview Dr. Jewel Alam Azad of CARE to discuss access to quality sexual and reproductive health information and services for urban garment workers in Bangladesh. You’ll be able to join the conversation by asking your own questions to Dr. Jewel Alam Azad.

Join Girls’ Globe’s #ICFP2018 conversations by sharing your voice, your perspective and your story with us throughout the week. We’ll see you there! 

“A world of hope for adolescent girls” – Olive’s story

This is the fourth and final blog in a series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from HawaParmila, and Oun Srey Leak.

Rwanda has made significant strides in empowering women and girls and ensuring they have access to affordable healthcare, including access to family planning.

Access to contraception has steadily increased from 17% in 2005 to 53% in 2015.

The government has decentralized and subsidized healthcare to ensure the most remote areas are reached and the most vulnerable communities can access services. However, the biggest unmet need for family planning is predominantly among young and unmarried women. In 2016 alone, 17,000 girls reportedly became pregnant before turning 18!

In 2016, the Government of Rwanda began providing comprehensive sexuality education in schools, however there is still a long way to go to ensure teachers are equipped with the skills and information needed to engage in age-appropriate, open and honest conversations with students.

I work for CARE in Rwanda, where I advocate for increased access to age-appropriate, integrated sexual and reproductive health services, rights, and education for in-school and out-of-school adolescent girls. Although the country has made notable progress in promoting women’s and girls’ rights in recent years, teenage pregnancies have continued to rise, leading to dire socio-economic and health consequences for Rwandan girls.

A few weeks ago, I attended an information session for young women in Kigali where a medical doctor explained available methods of contraception. I realised then that there is a lot young people do not know. But it made me wonder…

If the youth of Kigali don’t know how to prevent pregnancy or to take care of their sexual and reproductive health, what about women and girls who reside in rural areas where access to information and services is still a challenge – even a luxury?

In my time at CARE, I have seen the tremendous work the organisation is doing around the world to increase demand for sexual and reproductive health information and services, including contraception. Much of our work focuses on addressing underlying causes of poverty and vulnerability and helping communities to challenge harmful and negative socio-cultural norms that hinder women and girls from enjoying their rights and reaching their development potential.

Two weeks ago, I met a group of adolescent girls in Karongi District, Western Rwanda, where CARE is implementing the Better Environment for Education (BEE) project to increase chances of girls staying in school. During my visit, the girls talked to me about the various problems that they faced, including unwanted and early pregnancy. As I listened to their stories, I wondered whether we are doing enough to address these issues.

One particular 17-year-old stood out to me. As she narrated her story with teary eyes, she recalled the difficult time she went through when she found out she was pregnant, and described how she was abandoned by her family. She felt she had failed them and failed herself. At some point she was forced to quit school to raise her infant. But when the BEE project began, she decided to join one of the clubs and suddenly found hope. According to her, the clubs have provided a space and a voice for girls to talk and to get accurate and comprehensive sexuality education.

Although the local health centre is just a few metres away from the school and provides condoms and other contraceptive methods, young people in Karongi told me they feel judged and shamed when they go there to seek services that they are entitled to. The BEE project aims to address this as well by giving adolescent girls a platform to dialogue with the school administration and local leaders to express their needs.

Studies have shown adolescents are increasingly becoming sexually active before they turn 18 and this is a reality we should not ignore. Too often, in countries like Rwanda, adolescent girls do not have information regarding their changing bodies or sexuality in general.

Adolescent pregnancy undermines a girl’s ability to exercise her rights to education, health, and autonomy. It’s not only a health issue, but a human rights and development one too. 

I believe that CARE’s integrated approach to empowering adolescent girls, including economic empowerment through savings clubs, sexuality education, addressing gender-based violence and engaging power holders such as parents, boys, school administration officers, and local leaders is powerful in ensuring the problem is addressed from all sides. I have no doubt that this will bring about transformation in the lives of girls and their communities.

We have no more time to lose.