Young People’s Voices: Contraception in Uganda

Uganda held its 2nd National Family Planning Conference in Kampala last month. The conference was organized by the Ministry of Health (MOH) in collaboration with FP2020 donor focal points for Uganda (UNFPA, DFID, USAID), as well as World Health Organization, National Population CouncilUganda Family Planning Consortium and other development partners.

Reach A Hand Uganda took the time to talk to young people, both in and out of schools, about their views on family planning. We sought to understand their ideas about the most immediate and logical solution to demand and access to contraceptive information and services.

The demand is evidenced in the 2016 Demographic Health Survey. Among young, sexually active and unmarried women surveyed, 83% expressed that they wanted to have access to contraception. While it is plausible – based on national statistics – that 51% of those women already do have access, that leaves 32% with their demand unmet.

The youth we talked to were all in favour of universal access to both information and services around contraception and family planning. This didn’t surprise us, knowing the statistics mentioned above. With the high numbers of young people who turned up to talk to us, and the positive ambience, it was clear this topic is important to youth in Uganda.

In the video we recorded, the youth voiced a call for all those over the age of 18 to have full time access to contraception – especially condoms – because, as 20-year-old Mpagi Jamiru said, sometimes you relate with people whose lifestyles you may not know much about.

Mpagi is a mechanic, like many out-of-school young people in Uganda. He spends most of his day working at a garage in Nsambya with his friends. Beyond this, though, Mpagi is a young man who is taking his own health and safety seriously.

The best thing about using condoms is that you safeguard yourself from very many diseases”, he stressed. He urges his peers to get tested, know their status and live carefully.

We also spoke to Namara Judith, who hit the nail on the head when he said: We need family planning to help the youth because they over-play sex”.  

This is well backed up by the 2016 Demographic Health Survey which shows that those aged 15-24 are most likely to be having sex with multiple partners – at 2.7% of those surveyed (with that rate increasing to 3.3% in the sub age group of 20-24-year-olds).

Proscovia Alimo, a 19-year-old, argued that young people need extended access to other health services such as safe male circumcision on top of increased availability of family planning services.

We were delighted to find that all of the young people we talked to had heard of family planning before. It was even better to hear that some were already using different methods. This is proof that more young people than ever are making informed decisions with regards the safety of their lives.

We believe that it is only fair that a group taking their health so seriously ought to have access to the contraceptive methods and family planning information they need to keep themselves safe. 

At 25, I’m Finally Meeting my Cycle

I started taking the contraceptive Pill at 15. At 19, I had an implant inserted. Earlier this year, a decade after starting, I stopped using hormonal contraception.

My decision was mainly based on my growing disbelief at how little I knew about my own reproductive health.

At 15, at 19, at 22, all I’d known was that I did not want to get pregnant. And all I’d had to do was make an appointment with my doctor, pick my poison from the menu of contraception on offer, receive no guidance, ask no questions, fail to read the leaflet handed to me, swallow a tablet I knew nothing about once a day and get on with my life. Easy.

I’ve visited a doctor several times with concerns that my contraception might be adversely affecting me. Each time, I was reassured that whatever symptom I was worried about had another explanation. Anxious? Exam stress. Overly emotional? Family stress. No energy? Life stress. I once summoned up enough courage to tell a university doctor I was worried the Pill was the reason I had no interest in having sex with my long-term boyfriend. She laughed, asked me which magazine I’d read that in and told me it was common for people to grow apart at my age.

Hormonal contraception is the only medication we take without being sick. It impacts our emotions, mental health, quality of life and long-term fertility. Yet we are not educated about it.

As I learned more about the impacts of artificial hormones on emotional wellbeing, it started to frighten me to think of how regularly women say “I didn’t feel like myself” when describing contraception that didn’t work for them. I worried that if I’d been using artificial hormones since the age of 15, they could be affecting or even creating parts of what I thought of as my ‘self’.

I’d also been in the dark about the extent to which hormonal contraception affects body literacy. If you’d asked at any point over the past few years, I think I would have said that I knew my body quite well. I’ve never felt too terribly uncomfortable in my body, but never really consciously comfortable in it either.

I’ve learnt more about my own body in the past few months than in the rest of my 25 years combined. Since stopping hormonal contraception I feel connected to my body in a way that I never have before. I feel like I’ve woken up. It’s an incredible and a terrifying feeling, because I’m so horrified to realise that I didn’t know I was asleep.

As I’ve tried to educate myself about natural menstrual cycles – which I’m now experiencing for the first time in my adult life – I feel more alert to the signs and signals my body sends me. I’m working on building my knowledge of what’s happening at different stages of my cycle, and I feel more able to listen to and respect what my body wants and needs at each.

I find my emotions have far less power to stop me in my tracks now that I can better pinpoint the reasons I might feel the way I feel from one day to the next. I feel more energetic and less anxious. I’m more motivated to exercise, my libido is higher, I’m less easily overwhelmed. My hair is thicker and shinier. I feel more confident than I ever have in my life.

It is essential to acknowledge that the Pill and other forms of contraception gave women unprecedented freedom and equality in the past and continue to empower women all over the world today. Access to contraception is linked inextricably with feminism and the fight for gender equality. Having grown up in Scotland, I am in a massively privileged position to have the access that I do to contraception, information and services. I also know that for many women with certain medical conditions, the Pill and other hormonal contraception are absolutely the best options.

My point is that, despite the layers of privilege within my own life, I didn’t know I had a choice. I didn’t know there was choice as to whether or not to use hormonal contraception at all. If we each have a right to contraception then surely we each have a right to make an informed choice about it. It’s not about saying one way is best, or telling anyone what they should or shouldn’t do. It’s about the basic fact that you should never feel powerless over your own body.

In the 1960s, the Pill was incredibly liberating for women. In 2017, not having to rely on huge pharmaceutical companies or damaging the environment to prevent pregnancy, and to know how my own body works? That sounds liberating to me.

However you choose to prevent pregnancy is entirely your choice to make. Your body is yours alone. But knowledge is power. It feels like I have a whole world to learn about, and I’m excited to be at the beginning of a long road to better understanding and appreciating my body. I’m excited to take control of, understand and demystify this cycle taking place within me every single month, and to harness the power within it.

If you’ve had your own experience of shifting from hormonal to natural contraception, or if you have suggestions of things I should be reading/following/researching – please feel free to share in the comments below!

Shero Sara Conquers Kilimanjaro

At Kupona Foundation, we encounter incredible women every day. Today, we want to introduce you to our latest Shero. Meet Sara Safari.

Sara (left) carried a banner for Kupona Foundation to Kilimanjaro’s summit.

Sara is an author, engineer, professor, mountaineer, TedEx speaker, recipient of the 2015 Global Citizen Award from the United Nations, advocate for the empowerment of women and girls, and newest member of the Kupona community.

In 2015, Sara was climbing Mt. Everest to raise funds to empower Nepali girls who were trafficked or forced into marriage. On day 25 of Sara’s climb, Nepal was struck by a 7.8 magnitude earthquake. Sara survived the quake and the devastating avalanche that followed while clinging to the edge of the treacherous Khumbu Icefall by her harness and anchor.

Today, Sara continues working to empower women and girls. She aims to climb the highest mountain on every continent (The Seven Summits) to raise funds for seven organizations working for women’s empowerment. When she completes her challenge in July 2018, she will be the first Iranian in history to conquer The Seven Summits.

Last week, Sara summited Mount Kilimanjaro to raise funds and awareness, through Kupona Foundation, to empower women living with and recovering from obstetric fistula in Tanzania.

Her goal is to raise $19,000, $1 for each foot of Kilimanjaro’s elevation. Funds raised will support comprehensive treatment for women and girls at our partner hospital, CCBRT, as well as vocational training and socioeconomic empowerment for women recovering from fistula at the Mabinti Centre. You can show your support for Sara’s challenge here.

“Women living with obstetric fistula are often denied the opportunity to live to their fullest potential. Many are cast aside by family members and neighbors, and confined to their homes to avoid the stigma and shame associated with this debilitating childbirth injury. They cannot work, attend community functions, and are often susceptible to infections and disease.  I climb on behalf of all women who don’t have the opportunity to live fully self-expressed lives around the world.” – Sara Safari

Sara visiting the ladies recovering from obstetric fistula surgery at CCBRT.

Kupona Foundation is honored to be Sara’s charity of choice on the African continent. We were also thrilled to welcome her to CCBRT and The Mabinti Centre after her climb last week, where she visited the ladies she had been climbing for.

“I feel so honored that I met these women. They are so strong and resilient. They deserve a better life and I wish I could give them everything. As they were sharing their stories, I was so moved.” – Sara Safari

She was also able to meet the young woman whose picture she had carried to the top of Kilimanjaro.

“There is a huge difference between the women [on the ward] at CCBRT and [training at] Mabinti. At CCBRT, they are vulnerable but at Mabinti, they are empowered, strong, hopeful about the future. I can see how learning a new skill and making money can give them their confidence back.” – Sara Safari

Together, we can conquer fistula

Thanks to Sara’s incredible commitment, and the contributions of her supporters, we will be able to reach more women living with fistula, supporting their comprehensive treatment and rehabilitation, and their reintegration to their community as they rebuild their lives. The road to recovery is not an easy one, but like Sara’s climb to the summit of Kilimanjaro, their destination is within reach.

We’re excited to conquer fistula together, returning hope, health and empowerment to women and girls in Tanzania.

Are you inspired by Sara’s incredible efforts?

You can support Sara’s CrowdRise project today. You can also follow her journey on Facebook and Instagram.

 

Keeping Girls Healthy in DRC

October 11 is the International Day of the Girl, one of CARE’s favorite days of the year. In some ways, we celebrate girls every day. After all, empowering girls and women is the focus of CARE’s mission, and we believe they are the key to overcoming global poverty.

This year, International Day of the Girl is focused on the empowerment of girls in crisis situations. According to UNICEF, approximately 535 million children worldwide were living in countries affected by conflict, natural disasters, epidemics, and other emergencies last year. The Democratic Republic of Congo (DRC) is one such country.

DRC is located in the Great Lakes region of Africa and home to breathtaking scenery and vibrant people. Although civil war here officially ended in 2003, conflict between government forces and various armed groups has persisted and remains ongoing in certain regions. DRC is rich in natural resources, but it remains mostly poor in terms of infrastructure and economic opportunity for its citizens. Women and girls, in particular, face enormous challenges just to survive and provide for themselves and their families.

The health system in DRC is weak and unable to fully meet the primary health needs of the population, including sexual, reproductive, and maternal health needs. Tens of thousands of Congolese women and girls die each year from pregnancy and childbirth – many are only teenagers.

Adolescents and young people in DRC often find it difficult or impossible to access health care. Information and services related to sex and reproductive health (SRH) are especially hard to find due to cultural norms and expectations (such as abstinence before marriage) that prohibit young people from seeking them out. If a young person does manage to reach a health clinic or provider, it is not uncommon for them to be denied care because of their age or even shamed for seeking it out.

“Why do you need condoms? You’re too young to be having sex! Go home!”

Of course, teenage girls and boys in DRC (and around the world) are having sex whether or not adults approve. And without knowledge of sexual health or access to contraceptives, girls are accidentally getting pregnant. Girls like Claudine.

Claudine is 19 years old and lives in Goma, the bustling capital of the North Kivu province of DRC. Not knowing how to protect herself, she became pregnant and gave birth to a child at age 17. She has returned to school and is studying social sciences at the Uzima Institute.

Fortunately, SRH information and services are becoming more available to Goma teenagers through Vijana Juu (translates to ‘Stand Up for Youth’), a project implemented by CARE DRC and funded by the UK Department for International Development. Adolescents and young people partnered with CARE staff to identify barriers to accessing and using contraception, brainstormed solutions, and worked with community leaders and health administrators to change the situation.

They recognized that their peers did not feel comfortable going to local health centers because they might run into judgmental adults, so certain clinics responded by setting up discreet side entrances available to youth only and created adolescent-specific referral cards to improve access to health services. Open meeting spaces designed by young people were established next to health centers where adolescents could come to talk with their peers about issues related to SRH in a relaxed environment that belongs to them, and teenagers could volunteer to be trained as peer leaders, providing information and referrals to their friends and neighbors.

CARE is helping to train health providers to recognize and challenge their own values and biases toward teenage sex that could discourage youth from seeking services. CARE is also supporting health facilities to provide a full range of contraceptive options and reproductive health services to adolescent girls and young women.

Over 6000 adolescents received sexual and reproductive health counseling and services through this program, and many began using contraception for the first time. About 30% of these new contraceptive users are girls, and 65% of them selected a highly effective, long-acting and reversible method (implant or IUD).

After her child was born, Claudine visited one of the Vijana Juu youth-friendly health clinics for an IUD so she could finish school without the risk of getting pregnant again. She has become a vocal advocate for safe sex in her community, and advises her friends to use contraception. When we asked why, she explained:

“Girls my age forget that sex can lead to harmful consequences like unwanted pregnancy, sexually transmitted diseases, abortions, and even death. Young people need to be informed. Adolescent girls and boys have a right to sexual health to make a better future and realize their dreams.”