A study conducted in Western Province between July and September this year by CLADHO (Collectif des ligues et associations de défense des droits de l’homme au Rwanda), revealed a rise in teenage pregnancies, with an average of 25 girls being impregnated every day. CLADHO is a well-established human rights organization in Rwanda, active in human rights promotion, economic governance, socio protection, education, and citizen participation. It found that a total of 2,233 schoolgirls in the same region were found to be pregnant. However, the issue has been largely blamed on parents’ failure to discuss reproductive health with their teenagers. And studies have shown that many Rwandan adolescents are involved in early sexual activities. For instance, Youth Survey done between 2011 and 2012 showed that one in six young people aged between 15 and 24 have been involved in risky sexual practices; and almost 13 percent had premarital sex while only 46 percent had used contraception by the time of their first intercourse. According to Kenneth Ruzindana, a gynecologist and obstetrician at University Teaching Hospital Kigali of Kigali (CHUK), these statistics are worrying, noting that even though contraception and contraceptive methods are widely available across the country, their use among the young and adolescent is still limited. He says this is very risky, as they are exposed to sexually transmitted infections and unplanned pregnancies. A CLOSE LOOK AT THE NUMBERS The 2014/15 Rwanda Demographic Health Survey shows that seven percent of women become pregnant between the ages of 15 to 19. The Ministry of Gender and Family Promotion reported that Rwanda registered over 17,500 pregnant girls aged 16 to 19 in 2016. In the first six months of 2018, approximately, 9,172 teenage pregnancies were recorded in health facilities. Ruzindana says the uptake of modern contraceptive methods amongst sexually active young people is not yet sufficient enough. Statistics from the Ministry of Health reveal that last year alone, 17,444 teenagers had unwanted pregnancies across the country and many eventually dropped out of school or suspended their education for a period of time. In Rwanda, family planning, being one of the priority programs of the government, modern contraceptive methods are freely available to all people of reproductive age through the public health system. The main aim of the national family planning program is to ensure that individuals and couples are able to fulfill their reproductive needs by using appropriate contraceptive methods. Despite this, Ruzindana notes that there are still some barriers in accessing contraception services among youth and adolescents, including restrictive laws and policies, especially regarding the provision of contraceptives based on age and marital status. However, the number of teenage pregnancies in various parts of the country shows how government and parents need to put in more effort to contain the issue which leads many young girls to drop out of school. Ruzindana says health workers being biased and the outright lack of willingness to acknowledge young people or adolescent sexual health needs, is also a challenge when it comes to young people accessing these methods. Another challenge, the medic goes on to say, is young people’s own inability to access contraception because of lack of knowledge or financial constraints. Whereas he adds, some of them face barriers that prevent them from using correct methods, despite their accessibility. “There is also a lot of stigma surrounding non-marital sexual activity, contraceptive use and the fear of side effects,” Ruzindana observes. In other studies, it reveals that teenage pregnancy has slightly decreased since 1992 when 11 percent of young women were mothers or pregnant with their first child. According to Rwanda Demographic Health Survey (RDHS), trends in teenage pregnancy of young women aged 15 to 19 who are mothers or pregnant with their first child in the year 1992, 2000, 2005; the percentage was at eleven, seven and four respectively. Whereas, from 2007 to 2008, the percentage was at six, which remained the same in 2010, but rose to seven percent in 2014 and 2015. Meanwhile, the government plans to avail access to contraception among teenagers, aiming at ending rampant teenage pregnancies. EFFECTS Adolescent fertility covers a certain percentage of total fertility. It is linked to certain health problems and socio-economic problems. Aflodis Kagaba, the executive director of Health Development Initiative (HDI), says adolescent fertility contributes to population growth and can influence socio-economic development and the level of mortality risks among reproductive-age women and their children. Although Rwanda has among the lowest levels of teenage fertility in the East African region, 2014/15 Demographic Health Survey (DHS) indicates that the teenage fertility rate increased from 40 to 44 births per 1,000 girls aged 15 to 19 years, and the proportion of women aged 15 to 19 who had started childbearing increased from 6 percent to 7.3 percent. Felix Sayinzoga, the division manager of maternal, clinic and community health at Rwanda Biomedical Centre (RBC), says adolescent or teenage pregnancy remains the major contributor to maternal and child health, and to intergenerational circles of between health and poverty. Globally, pregnancy and childbirth complications are the leading cause of death among girls aged 15 to 19, with low and medium-income countries alone accounting to 99 percent of global maternal death of women aged between 15 to 49 years. He says adolescent mothers face higher risks of preeclampsia, post-delivery, pelvic infections, and systemic infections compared to women aged 20 to 24 years. Additionally, Sayinzoga says, when young people get pregnant, they are most likely to have an unsafe abortion, and worldwide, this is also one of the leading causes of maternal death in these age groups. Besides, Ruzindana says the psychological, emotional and social needs of pregnant adolescents can be greater than that of older women. He adds that babies born to these young girls face the risk of low birth weight, preterm delivery, and severe neonatal conditions. “Babies born by these mothers are at greater risk of low birth weight with long term potential effects,” Ruzindana says. ACCESSIBILITY Experts insist that there are still significant socio-cultural and legal barriers limiting access to contraceptives for adolescents, despite some efforts to rectify this. Rwanda has ratified Maputo protocol and developed the National Family Planning and Adolescent Sexual and Reproductive Health (FP/ASRH) Strategic Plan (2018-2024), which provides access to youth-friendly reproductive health information and services including contraceptives, antenatal and postnatal services to adolescents. Kagaba points out that some legal provisions related to sexual and reproductive health and rights (SRHR) make it complicated for adolescents to access SRHR information and services, including access to contraceptive methods. Article 11 of the Medical Professional Liability Insurance Law stipulates that health professionals must obtain prior consent from parents, representatives, or guardians before providing healthcare to minors or disabled people. Whereas Article 7 of the Human Reproductive Health Law states that every person, having attained the majority age, has the right to decide for oneself in relation to human reproductive health issues. Ruzindana says in Rwanda, family planning, being one of the priority programs of the government, modern contraceptive methods both long and short-acting reversible contraceptive services, is freely available to all reproductive-age men and women through the public health system. The main aim of the national family planning programme, he says, is to ensure that individuals and couples are able to fulfil their reproductive needs by using appropriate contraceptive methods. Concurring with Kagaba’s sentiments, Ruzindana says there are still some barriers in accessing contraception services among youth and adolescents, including restrictive laws and policies, especially regarding the provision of contraceptives based on age and marital status. However, the number of teenage pregnancies in various parts of the country shows how government and parents need to put in more effort to contain the issue which leads many young girls to drop out of school. WHAT SHOULD BE DONE? Kagaba says there should be the availability of quality youth-friendly FP/ASRHR services. He says that there is a need to ensure youth corners and centers are equipped with up-to-date and appropriate IEC materials and have counseling tools that support providers is based on the client’s age and life stage, particularly older versus younger adolescents. He explains that providing appropriate youth-friendly services at different levels of the Ministry of Education structures, organizing ASRH activities that include not just information and awareness-raising, but the provision of comprehensive ASRH services, could help curb the problem. There is also a need to empower and create opportunities for inclusion and participation of adolescents and youth designing, validating and monitoring ASRH programs and services. “Increasing demand for ASRHR services to Strengthen Comprehensive Sexuality Education (CSE) curriculum implementation in schools and out of schools is important,” he says. Sensitising communities to enhance acceptance and support from teachers, parents, community and religious leaders for adolescents and youth to use contraceptives, and strengthening initiatives to prevent SGBV for women and girls, are some of the things that should be done to rectify the problem, Kagaba says. Also, he says amending the existing human reproductive health and medical liability insurance laws to address issues of consent, and removing the requirement of parental authorization for adolescents prior to accessing ASRHR services, will help a lot when it comes to curbing teenage pregnancies. editor@newtimesrwanda.com
