Breaking the silence around sexual and reproductive health

Alexa Gabriella Mugisha spent years believing that the severe pain she experienced during her periods was normal. Doctors told her painful periods were common among women and that she simply had to manage the discomfort. She relied on painkillers and tried different ways of coping. It was not until she was 19 that she pushed for a scan, which revealed a three-centimetre fibroid. ALSO READ: What Rwanda’s new health law means for access to sexual, reproductive services “If it wasn’t for my excessive pushing, they would have never discovered that,” she said. Medication was used to shrink the fibroid, but the pain persisted. Mugisha continued seeking specialist care and was eventually put on hormonal contraceptives. She said the contraceptives regulated her previously irregular periods and stopped the pain. Now 22 and a third-year student at African Leadership University, Mugisha said the experience taught her the importance of women having adequate information about their bodies before health problems arise. ALSO READ: Teen pregnancy rises to 8% as experts warn of growing risks Her experience also inspired her to create “Our Sisu”, a women-led community project she founded in January this year. The idea began taking shape through bridal showers she attended with her mother from around the age of 20. Whenever conversations turned to marriage, sex or other personal matters, she was sometimes asked to leave because she was considered too young to hear them. “I felt this was not something that should be hidden from me. Young people need to have these conversations before they enter relationships, marriage or parenthood. Otherwise, they have no idea and can end up making mistakes,” she said. Our Sisu, whose name comes from a Finnish word associated with strength and perseverance, brings women together through workshops, mentorship and conversations about relationships, marriage, motherhood, sexual and reproductive health, and other major life transitions. Mugisha said some women have shared how they became mothers without enough information about childbirth, contraceptives or postpartum depression, leaving them unprepared for what followed. Such experiences, she said, illustrate how information gaps can be passed from one generation to another. Many women, she added, have found value in sharing their experiences with others going through similar challenges. Barriers to sexual and reproductive health care Sexual Health Awareness Month is observed annually in September to promote education, encourage open conversations and challenge stigma surrounding sexual and reproductive health. Access to sexual and reproductive health services continues to be affected by a combination of financial, social and health system barriers, according to Dr Gilbert Mbaraga, a medical officer at AIDS Healthcare Foundation (AHF) Rwanda. Mbaraga said the cost of seeking care can still discourage some people from accessing services, even with the expansion of Community-Based Health Insurance (CBHI), commonly known as Mutuelle de Santé. “Having health insurance does not always remove every barrier. Some people still have to meet transport costs and other payments, and for vulnerable households, those costs can be enough to delay care,” he said. Adolescents and young people face additional challenges. Some lack reliable information about contraception, family planning, HIV prevention and other reproductive health services, leaving them vulnerable to myths and misinformation, Mbaraga said. “Some young people have questions but do not know where to get accurate information. Misconceptions about contraceptives, cervical cancer screening and adolescent services can discourage people from seeking care,” he said. Social attitudes can also prevent people, particularly unmarried adolescents, from seeking these services. Mbaraga said discussions about sexuality and reproductive health remain difficult in some families and communities, while some young people fear being judged by parents, teachers, health workers or others around them. “For an adolescent, the fear of being judged can be a very real barrier. If they are not sure that their privacy will be respected, they may choose not to seek the service at all,” he said. He said health facilities therefore need to create environments where young people can ask questions and seek care without fear of stigma or judgment. “Services have to be confidential, respectful and non-judgmental. People need to feel that they can walk into a facility, explain what they need and receive care without being made to feel ashamed,” Mbaraga said. Closing access gaps Mbaraga said improving access requires bringing services closer to communities, particularly in remote areas, through outreach programmes and community health workers who can provide information and link people to health facilities. “Community health workers are already close to the people. We need to use that connection to provide accurate information and ensure that people are referred to the right services when they need them,” he said. He also called for greater use of social media by health professionals to provide reliable information, particularly to young people who increasingly turn to digital platforms for health information. Making services more accessible Mbaraga said health facilities need adequate supplies, trained staff and private spaces where adolescents and young people can feel comfortable seeking care. He cited shortages of contraceptives and HIV test kits, long waiting times, limited numbers of staff trained to provide adolescent-friendly services, and inadequate privacy among the challenges that can affect access. He said health facilities should have well-equipped youth corners and continue training health workers in adolescent-friendly communication and counselling. “Access is not only about having a service available. People must also feel comfortable using it. If a facility does not offer privacy or the provider is judgmental, the service may exist but people will still stay away,” he said. Mbaraga also stressed that reproductive health should not be treated as a responsibility for women alone. “Men have a role to play in decisions around family planning, pregnancy and the health of their families,” he said. He said government institutions, health facilities, schools, community organisations and development partners should work together to reach groups that face greater barriers, especially adolescents and young women. Mbaraga also called for more community education on family planning, HIV prevention, cervical cancer screening, HPV vaccination and the importance of starting antenatal care early.

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Breaking the silence around sexual and reproductive health