What adolescents want addressed about access to sexual reproductive services

More than 150 youth and decision-makers have concluded a two-day national conference where they met to discuss their challenges and offer practical solutions on “Adolescents’ Access to Sexual and Reproductive Health and Rights (SRHR)”. The conference, which gathered adolescents from four provinces and the City of Kigali, development partners, policy makers and stakeholders, including government institutions, was hosted under the theme, “Amplifying Voices towards Access to SRHR Services”. Although different topics were discussed, the issue of teenage pregnancies which have increased over the years was at the centre of each conversation. Below are some of the highlights of the recommendations made by the adolescents and other participants at the conference. 1- Equip parents with information Although there are no current statistics, the available data from the Ministry of Gender and Family Promotion says that a total of 19,701 girls from all over the country gave birth between January and December 2020. King David Academy International School’s Dan Shema says that such high numbers can be avoided if parents who are at the forefront of the protection of children are trained on how to talk to their children on issues surrounding sexuality and reproductive health early enough. “Getting this information in a timely manner and from a trusted source like your parents is definitely more helpful because most times, we rely on social media where we cannot make a difference between right, partially right or completely wrong information,” he said. 2- Train healthcare providers In its July 2020 survey among social and healthcare providers titled “Availability, Accessibility, and Quality of adolescent Sexual and Reproductive Health (SRH) Services in Urban Health Facilities of Rwanda”, the University of Rwanda (UR) says that sexual and reproductive health services in the country are available for the general population but are not specifically designed for adolescents. The university says that though the services are fairly accessible to adolescents, they are of insufficient quality as adolescents themselves do not get to be fully involved in service provision among other aspects of quality SRH as required by the World Health Organization (WHO). At the conference, Donatha Muyizere, from Kinyinya Sector, Gasabo District said that she had her baby when she was 14. She says her visit to the health centre in her area has discouraged her to seek information and as result, she also discourages her peers from visiting due to the pointed and sometimes discouraging questions asked by the personnel. “I went to seek an HIV test and the lady who attended to me started asking me if I had unprotected sexual intercourse the previous evening. Before I could answer, she started lecturing me about how this generation is uncultured. I excused myself and walked out. I have never gone back,” she said. Francine Uwayezu, a nurse at Remera Health Center, told participants that although sexual and reproductive health services are available, adolescents, who are the target, are not seeking them because there is little awareness and the quality of service. She also pointed out that many of those providing these services are older men or women who are not equipped with the skills to talk to young people about their sexuality. Uwayezu added that another challenge is that health centres do not have personnel that specifically deal with sexual and reproductive health services. This means that the services are provided like any other which in the process discourages many young people. “Young people don’t have time to wait in line, especially because they fear that they could meet someone that they know. It is important that there is a youthful person who is only at the health centre day-to-day only to deal with young people seeking these services,” she said. 3- Take SRHR services to rural areas Francoise Tuyizere, an adolescent from Karongi District, Western Province, said that there is a need to push for more information to be available for young people from rural areas. “When you go to town centres upcountry, you will find some information but when you move deeper in the rural areas, there is no information about sexual and reproductive health at all. This should change,” she said. Tuyizere called for a general countrywide audit to evaluate if the services are being given, or if they are being given to the right people and if there is impact. 4- Prioritize sexuality education in TTCs Tuyizere said that there is a need for Comprehensive Sexuality Education (CSE) to be introduced in Teacher Training Colleges (TTCs) and should be prioritised. “Teachers should have CSE as a principal course because without prioritising it, they are also not fully equipped with the skills and information that they require to impart the knowledge on sexual and reproductive health,” she said. Vital Gatoyi, a teacher at IPRC Kigali, said that there is still an issue of culture which limits how much openness one can exercise while talking about sexuality, making it challenging for both the student and teachers. He called for special training for teachers but also teaching materials that can be used to assist both the teacher and the learners of CSE. CSE is integrated in five subjects, two in Primary schools (Science and Elementary Technology, and Social Studies) and three in Secondary Schools namely; Biology and Health Sciences, General Studies and Communication Skills including History and Citizenship. 5- Scrap parental consent requirement For 16-year-old Bienvenue Heavens Mihigo, there is a need to revise laws that continue to block adolescents below 18 from seeking some sexual and reproductive services. “We find some laws inconvenient. For instance, requiring a young person below 16 to be accompanied by a parent when they are seeking these services can be discouraging. How do I tell any of my parents that I need a condom?” he wondered. 6- Involve adolescents Sandrine Muhimphundu, an adolescent from Bugesera District, Eastern Province, requested for sexual and reproductive health services that are friendly, accessible and appropriate for adolescents and youth including those with disabilities. They requested that the services are provided in the right place (not necessarily at health centres) and delivered by a service provider that is trained in adolescent-and youth-friendly services. They requested for their involvement in the designing of these services as well as enough space to not only give feedback, but have it responded to. The Assistant Officer in charge of Adolescent Sexual and Reproductive Health and Rights at Health Development Initiative (HDI), Ange Umutoni, said that there is a need for adults to begin seeing the value of young people being empowered to make their own decisions. When equipped with the right information and in a timely manner, they are capable of doing things right with a little guidance. 7- Put a stop on stigma against teen moms The adolescents touched on the issue of stigma that is directed at teenage mothers. They called for campaigns that will involve teachers, parents, church leaders and the entire community on how to deal with teenage pregnancy challenges. “When a teenage girl gets pregnant, she is subjected to lots of stigma yet this unwanted pregnancy does not concern her alone. This is a social issue and should be handled collectively by the entire community. Boys and men should not be left out,” Isai Nshimiyimana from Ndera Sector said. Organised by Health Development Initiative (HDI) in partnership with Plan International Rwanda and Norwegian People’s Aid, this is the second National Conference on Adolescents’ Access to Sexual and Reproductive Health and Rights (SRHR). The first was held in 2019.

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What adolescents want addressed about access to sexual reproductive services