Like 220 million other women and girls in developing countries, Stella lacks access to the contraceptives, information and services she needs to prevent unintended pregnancies.
At the age of 14, Stella* is already a mother of two and is expecting her third child. Like 220 million other women and girls in developing countries, Stella lacks access to the contraceptives, information and services she needs to prevent unintended pregnancies.
For Stella, from Kamuli district, Uganda, the lack of access to contraceptives is just one of many challenges she’s already faced in her young life.
“It seems that losing my parents to AIDS and acquiring the virus from them was not bad enough for my relatives who I thought of as my parents and protectors,” says Stella. “They forced me to marry a man fit to be my grandfather.
“I had to succumb to the pressure of leaving home. I was tired of being beaten by my uncle who wanted money and cows so badly, even at risk of my life.
“It was a Friday morning when four men dressed in kazu (white tunics) and two women came. All of a sudden I saw my uncles gathering, ready to hand me over for a long time suffering. The threats were so much that I could not say no.
“The ugliest night was sleeping with this big man of 46, I did not even know what to do, I was taken to a hut and ordered to remove my clothes and sleep with him. That is a night I will never get out of my memories.”
Secrecy about HIV at home
Stella is not aware of the HIV status of her co-wives and husband. When she talks about her HIV status, her husband beats her saying that she will cause his wives to divorce him. She is denied the chance to get antiretroviral therapy thereby increasing her risk of succumbing to opportunistic infections.
“Before, I was taking my drugs, but since I got married I have never gone back to the hospital to pick them up. I now fall sick more often than before. It is getting worse now that I am pregnant,” she says.
Stella has never attended antenatal care and when told that there are contraception methods that would prevent her from conceiving, she says: “You mean I can stop producing? Are there drugs to stop getting pregnant? Please kindly help me and give me money to buy them?”
Lack of access to family planning services
For many women like Stella in rural areas of Uganda, there are huge barriers which prevent them from accessing services for sexual and reproductive health and HIV.
One in three married women are not using contraceptives even though they do not want to get pregnant and according to the 2012 survey conducted by Uganda’s Ministry of Health more than 900,000 of the country’s annual 2.2 million pregnancies are unintended and unplanned. About 400,000 of these end in abortion.
According to Mary Nankya, Kamuli district health assistant, only 13 per cent of the women of reproductive age in the district have access to family planning services.
“Access to family planning services is still inadequate and the situation is worse in the rural areas. Most people still have a negative attitude while other women opt to have many children in order to compete with their co-wives because in Busoga you can hardly find a man with just one wife,” she said.
Health activist speaks out
Rosette Mutambi, the executive director of the Coalition for Health Promotion and Social Developments (HEPS- Uganda) – a health rights organisation that advocates for increased access to affordable essential medicines for the poor and vulnerable – described Stella’s situation as the worst kind of human rights and child abuse.
“This is abuse of the highest order,” she said. “First and foremost, this is a kidnap case, defilement that needs all of us as stakeholders to intervene and save her from more traumas. She is also facing child labour being the youngest wife – the chances are that the older women are also making her work hard.”
Mutambi went on to say that there is misinformation and misuse of family planning products among women due to lack of counselling. “A lot of self-medication leads to unnecessary side effects because women are not using the right products that fit their individual needs. This leads to discontinuation then unwanted pregnancies, then to unsafe abortion but mostly to a high population growth rate.”
What needs to be done
The permanent secretary in the Ministry of Health Dr Asuman Lukwago said that the government will increase the availability of family planning products at lower level so that mothers can easily have access to them.
Dr Lukwago added that the ministry is also working closely with village health teams to identify expectant mothers so they can counsel them to have babies they are able to look after.
“We will use the opportunity of mothers who are turning up for antenatal care to sensitise them on the good use and the benefits of family planning. When you have mothers in the health facilities, you are sure they will receive family planning information and education including preventing mother to child transmission of HIV.”
* not her real name
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Photo credit: Nell Freeman/Allianced