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.”

#InvestInUGchildren Media Tour: Teenage Pregnancy in Arua District, Uganda

It’s a humid Saturday morning when we arrive at Bondo Health center in our air-conditioned land rovers to have a meeting with health workers, teenage mothers and community members. I enter the stuffy metal tin roofed meeting room a little late, and find everyone settled on concrete benches.

All eyes are on a young pregnant woman in the corner, I realise as the discussion is going on that she is not really a full grown adult woman, she is a pregnant teenage girl. Her hands are shaking, she can barely get a word out of her mouth. Her eyes keep darting around the room looking for help. Anyone would feel nervous too, imagine sitting in a room full of strangers while they ask you, “How could you allow yourself to get pregnant?” “Will you be returning to school once you’ve had the baby?”

It must be too overwhelming for a young girl like her, and I doubt she ever considered the consequences of her pregnancy. We continue to ask our questions as though we understand (with our NGO jargon) what it means to be a girl like her. We ask our questions as though opportunities in this area are growing and falling off trees like unwanted over-ripe mangoes.

At first she refuses to answer the questions and others decide to answer for her, They say “Her father died, Her mother went mad, there is nobody to guide her…..” Finally my boss asks, ” What happened to the man who made her pregnant?” There is some mumbling among the participants which dies down immediately and then the question is forgotten, and silence returns. Again my boss insists, “What happened to the man who made her pregnant?” To which there is silence until one brave middle-aged man stands up and says, “You see if she lived closer to me I would have advised her like a daughter to stay away from men, but the children of these days they are different. What can we do?” He shrugs his shoulders and sits down. He seems proud of himself thinking he has said what the NGOs want him to say. But they have still failed to answer the question.

This man who impregnated her has quite simply and quickly been absolved of all responsibility. By now the young girl has already made her way to the back of the room. Unrecognizable among the crowd, she can relax and let them talk as though she isn’t there. Eventually my boss asks another question, “What would the women in this community like to see happen so that girls are better protected from defilement?” He kindly gestures towards the women in the room as he talks to the translator. First there is silence, except for the children playing outside. My boss asks his question again and some smiles appear on the women’s faces. Can you imagine a man actually ignoring what the men have said and now seeking the women’s opinions? Then finally one woman is brave enough to stand up and say, “Here we have no voice. In our community it is the men who make all the decisions. Even if it is our hardwork that brings in the income, it makes no difference, for it is the men who decide how to spend the money, some days you can even fight with your husband to pay school fees for your children.”


The #InvestUGchildren campaign was initiated by UNICEF Uganda in 2014. It aims to highlight the many issues affecting children across Uganda that need to be addressed as part of the vision of becoming a modern, competitive and prosperous, upper middle income country by 2040. According to the Situation of Children in Uganda Report, 1 in 4 teenage girls are pregnant or have a child and 15% of  women were married by the age of 15 years.  During the recent media tour that took place in December 2015, UNICEF Uganda traveled with journalists from a range of national media houses to 6 districts (in Northern and Eastern Uganda) for a period of five days. This blog post was inspired by a community discussion that took place in Arua district.

Featured Image: UNICEF Uganda. A nurse comforts a 16-year-old pregnant girl in Arua Saturday 5 December 2015. After her mother died, her father suffered mental breakdown and she had to drop out of school. She was impregnated by a man who abandoned her.

Teenage Mothers in Developing Countries Need Support

As I was reading the blog entry “Teenage Pregnancy: What to do about it”, I was brought back to a familiar place, a time when I became a young mother. Although I got pregnant with my son at 18 and was a junior in college, I still faced the same stigma and shame as Brianna. As a young woman born and raised in a developing country, though living in the United States, the social consequences of getting pregnant became real.

According to the World Health Organization, the vast majority of births that occur worldwide to girls aged 15-19 years old occur in low and middle income countries. The average global birth rate is 49 per 1000 girls among 15-19 years old with country rates ranging from 1 to 299 per 1000 girls. Often times, girls drop out of or are barred from school and are kicked out of their homes because of the stigma associated with becoming pregnant. Far too often teenage mothers are ignored and left to raise children by themselves with no support. Not being able to go to school leaves young mothers vulnerable to poverty, low self-esteem and lack of economic growth.

So, what do teenage mothers need?

Support – I was able to complete college and further my studies because of the support that I received from my family, friends and church. Support can come in different forms such as watching the baby while the mother does her homework or goes to school. They also need mentors who are willing to give their time to help in the development of themselves as adolescents and parents.

Advocates – Individuals and organizations that will increase the public’s awareness about the issues teenage mothers in developing countries face. They need people who will challenge existing policies that do not support them furthering their education.

Love – Teenage mothers need to know that they are still loved and that they matter. Girls in general already face many challenges and when a baby is added, the challenges become greater.

As a community, we must support our girls by encouraging them to reach their full potential. I urge you to increase awareness by reading more about this topic, finding ways in which you can help and sharing this information on your social media platforms. When we support our girls, we support our communities and our world!

Featured image: A portrait of Massa Foley and her daughter, Kona Taylor at the Liberia Government Hospital in Tubmanburg, Liberia on June 24, 2015. Photo © Dominic Chavez/World Bank

Teenage Pregnancy: Still a Great Killer of Teenage Girls in Kenya

Reproductive health and rights have been conceptualized under several human rights instruments that Kenya has ratified. These instruments seek to entrench gender equality by stemming out discrimination against women and guaranteeing comprehensive rights to women including to control their reproductive health and to put an end to female genital mutilation. In spite of these instruments, abortion is restricted in Kenya and only applies in very limited situations, that is, where the continuation of the pregnancy poses a threat to the life of the woman.

All human beings are born free and equal in dignity and rights and thereby every human being has a right to life. This right is safeguarded by the Universal Declaration of Human Rights (UDHR) which states that no one shall be subjected to torture or cruel, inhuman or degrading treatment or punishment.

Teenage pregnancy remains the biggest killer of teenage girls in the developing world.

Young women aged 15 to 19 are twice as likely to die from complications in pregnancy as compared to older women. The chances of death in the first year of life for a baby born to a woman under the age of 18 is 60 per cent greater than that of one born to woman aged 19 or older. Teenage pregnancy has been on the rise in Kenya for many years and the situation is likely to get out of hand if nothing is done. Several factors, including peer pressure, rape, cultural practices, lack of sexual awareness and abuse of alcohol and drugs have been attributed to teenage pregnancies, but the biggest association is with poverty.

This explains why teenage pregnancies are more usual in the rural parts of Kenya, especially among poor households. In the northern parts of Kenya for instance, early marriages are very common especially in times of crisis, a trend that has been referred to as drought bridesViolence against women also exposes many young girls to unwanted pregnancy and its various consequences.

The high mortality rate in the country can be linked to insufficient availability of comprehensive reproductive health services, lack of availability of safe abortion services and high rate of teenage pregnancy.

Considering that early marriages are more prominent in areas where poverty is high and education levels are low, awareness campaigns, as well as, initiatives that could raise the living standards of those affected could go a great way in alleviating cases of teenage pregnancies. Sex education is also critical to teenagers especially as most parents shy away from discussing sex with their children.


In the Kenyan culture, sex is still a taboo subject and any issues related to sex are meant to be discussed in the married couple’s bedroom. It is rarely discussed in public although some communities offer sex lessons to brides-to-be, but in isolation. However, the society in general has changed, and sexual activity is frequently shown through the media with children as young as 10 years old being exposed and the internet is the least controlled media.

The confusing absence of discussion by parents and educators, yet the seeming promotion of sexual activity on TV and the internet and indeed advertising, could well be a factor in promoting teenage experimentation, and eventual pregnancy. Increased levels of knowledge about modern methods of contraception, as well as, making them available and affordable is very essential.

If teenage pregnancy is to be controlled and reduced we must realize that the solution lies in a shared responsibility that incorporates communities, the government and other stake holders and the teenagers themselves.

The Kenyan government should recognize and respect and raise awareness on Article 14 of the Protocol to the African Charter on the Rights of Women in Africa (the Maputo Protocol), which calls upon state parties to to ensure that the right to health of women, including sexual and reproductive health, is respected and promoted. And also the Africa Health Strategy developed and adopted during the 3rd Ordinary Session of the AU Conference of Ministers which provides in Article 86 that,

The health system should mainstream gender into health policy, seek elimination of all forms of violence against women, amongst other factors, recognizing the morbidity and mortality from unsafe abortions, safe abortion services should be included, as far as the law allows.

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Image credit: Nelly Lukale