Adolescents and young mothers at Kanara landing site, Ntoroko District, are experiencing significant barriers, including stigma and discrimination, in accessing voluntary family planning and reproductive health (FP/RH) services.
Although self-care interventions have been shown to reduce social barriers to family planning and reproductive health care, little is known about their effectiveness, particularly in low-resource settings. With district records showing teenage pregnancies at a staggering 25%, adolescents and young mothers believe that empowering them to take control of their health could significantly reduce cases of teenage and unwanted pregnancies.
Self-care is a significant initiative aimed at empowering individuals to manage their health, ultimately alleviating the burden on healthcare workers. Rehema Kabatoro, a resident of Kigungu village in Kanara Sub County, says that many adolescents at Kanara landing site experience fear and shame when purchasing contraceptive products, leading them to avoid healthcare facilities.
Kabatoro, who gave birth at 16 years old, believes that the lack of self-care awareness has led many young women to have unwanted pregnancies and contract sexually transmitted infections like HIV/AIDS.
“I am requesting awareness so that individuals can make decisions on how they can manage their sexual life. When self-care awareness training occurs here, it is conducted at the Health Center III, and most young girls fear going there,” says Rehema.
Bob Kuguma, a youth in Kanara Town Council, notes that many young people are not equipped with the skills and essential items needed to manage their health. He mentions that the condom box at the town council has not been refilled for the last year. For him and his peers, self-care is an option for reducing discrimination and improving the user experience.
Sarah Sandra, who gave birth to twins at 16 years old, recounts how she was lured into sex by her boyfriend, who convinced her that she was on her “safe day” and wouldn’t get pregnant. Both didn’t understand how the menstrual cycle works. She now advocates for integrating self-care awareness on family planning into routine health awareness campaigns.
Fred Kyotumu, the youth chairperson for Kanara Town Council, says that due to the significant challenges faced by families, notably those staying in camps, many young girls are engaged in commercial sex without basic health information.
Jessica Bahati Balikatura, a VHT at Stella Maris HCIII and a counselor at Ntoroko Hospital, agrees that educating young people about self-care can reduce the risk of costly non-communicable diseases. She notes that many sexually active youth fear seeking open medical services due to cultural barriers and a lack of women-controlled products like the Caya diaphragm, the Woman’s Condom, and a self-injectable contraceptive.
Due to this lack of knowledge, the sub-county alone recorded more than 100 teenage pregnancies during and after the COVID-19 lockdown.
Patrick Byaruhanga, the Ntoroko district health educator, agrees that the lack of self-administered contraceptives among sexually active girls has negative effects on their lives and reduces their economic potential. However, he mentions that the district is undertaking self-care awareness campaigns among adolescents and parents to improve health literacy, promote autonomy, and support women and girls in participating directly in their health care. Despite these efforts, limited funding and partnerships affect outreach programs.
Fatia Kiyange, the Executive Director of the Center for Health, Human Rights, and Development (CEHURD), stresses the need for programming around sexual reproductive health information to help young people make informed decisions. She noted that denying young people sexual education is denying them a life-saving intervention.
Kiyange emphasized the need to present evidence regarding the impact of not having reproductive health information so that sexuality education can be socially accepted.
Roseline Achola, Technical Specialist for Sexual Reproductive Health and Self-Care at the Ministry of Health, mentions that self-care empowers individuals to make informed decisions about their health management through information provided by health workers.
However, Dr. Olaro Charles, the Director of Clinical Services at the Ministry of Health, argues that while self-care is connected to the health system, it should not include self-medication. He agrees that there is a need to empower the community, especially mothers, to appreciate self-care.
According to the World Health Organization (WHO), there is an expected shortage of approximately 10 million health workers by 2030. WHO advocates for self-care interventions as vital components in achieving universal health coverage (UHC), promoting health, safeguarding the world, and serving vulnerable populations.
In May this year, the Ministry of Health, in partnership with the Uganda Healthcare Federation, established a structure to oversee efforts by various stakeholders to promote self-care in the public and private sectors.