In Uganda, Sexual and Reproductive Health Services and Information Fall Short for Adolescents
The ability to achieve sexual and reproductive health and rights, including being able to decide when and whether to have children, is critical for the health and well-being of all women. Yet new data from the Guttmacher Institute show serious gaps in sexual and reproductive health services for adolescent women in Uganda. For example, an estimated 648,000 women aged 15–19 in Uganda are sexually active and do not want a child in the next two years. However, among this group, more than 60% have an unmet need for modern contraception, meaning that they either use no contraceptive method or use a traditional method of contraception.
Approximately half of all pregnancies among women aged 15–19 in Uganda are unintended, totaling an estimated 214,000 unintended pregnancies each year. The overwhelming majority (88%) of these pregnancies occur among adolescents with an unmet need for modern contraception.
"Greater investment is essential to ensure that young people have access to age-appropriate, comprehensive sexuality education, as well as high-quality sexual and reproductive health services," said Patrick Segawa of Public Health Ambassadors Uganda. "Young people must be empowered to make informed sexual and reproductive health decisions in order to achieve their full potential."
The authors of the study also found that many of the 249,000 adolescent women who give birth each year do not receive the essential components of maternal and newborn care recommended by the World Health Organization and the Ugandan Ministry of Health. For example, half do not receive the recommended number of antenatal care visits and one-third do not give birth in a health facility.
Taking a comprehensive approach to the provision of sexual and reproductive health services for adolescents would yield immense health benefits. If all unmet need for modern contraception among adolescent women in Uganda were met, unintended pregnancies among this group would drop by 72%. Additionally, if full provision of modern contraception were combined with adequate medical care for all pregnant adolescents and their newborns, adolescent maternal deaths would drop by 76% per year.
Investing in meeting the need for both modern contraception and maternal and newborn health care would also cost less compared with focusing on maternal and newborn health care alone. This is because the cost of preventing an unintended pregnancy through use of modern contraception is far lower than the cost of providing care for an unintended pregnancy. In fact, fully meeting the need for maternal and newborn health care in conjunction with fulfilling the modern contraceptive needs of adolescent women in Uganda would save approximately US$26 million annually compared with the cost of meeting the need for maternal and newborn health care alone. This dual investment translates to a cost of $2.19 per person per year.
"Too often, the various components of sexual and reproductive health are treated as separate issues, but they are all interrelated," says Taylor Riley, research associate at the Guttmacher Institute and coinvestigator of the new estimates. "Addressing adolescents’ unmet need for modern contraception along with providing all pregnant adolescents and their newborns with recommended levels of care are both critical to save lives and improve young people’s health and well-being."
The authors recommend taking a coordinated and multifaceted approach to improve adolescents’ sexual and reproductive health in Uganda. For example, youth-centered health programs must be nondiscriminatory and medically accurate, as well as developmentally and culturally appropriate. Approaches should include improving access to and quality of comprehensive sexuality education as well as sexual and reproductive health services, both in and outside of the school setting.