The emergence of COVID-19 has not only disarrayed the day-to-day operations in the lives of individuals but also brought to light the inequities within the healthcare delivery systems, especially the essential health services and information on the sexual and reproductive health of young people.
One of the most affected population categories has been the young people, who are currently out of school and have had little or no access to maternal health services as a result of the pandemic containment measures – closure of schools, ban on public, private transportation, and curfew among others.
With the suspension of public transport, many Ugandans seeking health services were unable to reach health facilities, with ambulances in short supply. As a result, reports indicate, some pregnant mothers developed complications in deliveries which were not handled by professional midwives while and several new bornes didn’t make it past the neonatal window.
It is also important to note that the 2016 Uganda demographic health survey indicated that 25% of adolescents aged 15-19 in Uganda have begun childbearing, 19% of those in the same age group have given birth, and another 5% pregnant with their first child.
The same survey revealed that adolescent childbearing is more common in rural than in urban areas (27% versus 19%, respectively) thus creating a regional variation with the Teso sub-region with the highest proportion of adolescents who have begun childbearing and the Kigezi sub-region having the lowest (31 and 16 percent respectively).
Likewise, child mortality has seen a steady decrease from 38 deaths per 1000 live births in 2011 to 22 deaths per 1000 live births in 2016. Adolescent death is 44% of maternal mortality in Uganda.
Closing the gaps to address Maternal and Neonatal Health
Mr Joshua Thembo, the Advocacy Officer at Naguru Teenage Information and Health Centre (NTIHC) confirmed that adolescent pregnancies in Uganda are mainly due to limited understanding of sexual reproductive health and rights.
Thembo notes that this ignorance, coupled with the low quality of sexual and reproductive health services, limited capacity of health care providers to deliver youth friendly services; inadequate supply of essential medicine and commodities and, lack of basic infrastructures, high exposure to early and multiple sexual relationships, and low utilization of contraceptives hinders maternal and adolescent health.
He further said that parents and caregivers have not done enough to empower the young people on their reproductive health, noting that despite the pandemic, adolescent, maternal and neonatal health ought to be prioritised.
“At Naguru Teenage Information and Health Centre, we believe that mother’s and baby’s lives matter even in the toughest situation. As a best practice youth-friendly centre, observing the Ministry of Health COVID-19 standard operating procedures, we have continued to implement the pillars of safe motherhood including family planning where young mothers and their partners receive adequate information and services regarding family planning,” Thembo explained.
He revealed that maternal health talks are conducted both at the centre and in communities through outreaches, radio talk shows, print material, and distribution of information and educational materials including flyers, t-shirts among others.
“Also over the years, we have been providing antenatal care (ANC) services to the young mothers including routine check-ups at the Kiswa-based health facility. Our experienced youth-friendly midwives detect complications early and support them as soon as possible, providing pregnant young women with vitamin supplements, iron tablets, and vaccinations so that they can have a healthy and safe pregnancy,” he added.
Throughout the implementation of the safe motherhood pillars, the centre has ensured that young people remain at the forefront of their programming through a peer to peer approach.
“We, therefore, have a vibrant team of trained peer mothers that is charged with mobilization and reaching out to young mothers receiving services from our centre. The peer mothers understand the needs of fellow young mothers, as a result, the young mothers find it easy to open up and interact with their fellow peers at the health facility and in communities during health outreaches,” Thembo said.
A voucher system where young people are referred for antenatal and family planning services within community clinics has been put in place and it has, Thembo noted, increased the uptake of Antenatal Care and family planning services within the community clinics.
According to the 2019/2020 report by NTIHC, a total of 5,670 young women got maternal health services including routine check-ups during ANC visits 3,772), post natal care (230), FP (1,633), 35 got Post-abortion care (PAC) services, and a number of them got service to reduce or prevent congenital infections including ART for prevention of mother to child transmission of HIV, (MTCT), syphilis, chlamydia, and hepatitis B.
Among those that attended ANC, 1,158 visited the facility at least 4 times. Overall, 357 young men escorted their women for ANC, offering opportunity for partner STI screening services including HIV testing.
A total of 1,633 clients obtained family planning services or contraceptives. Injectable contraceptives were the most commonly used contraceptives, accounting for 83.5%. Long-acting contraceptives mostly Implanon and Jadelle were utilized by 123 clients and 3 clients utilized copper T, 39 clients took condoms specifically for use as contraceptives.
Role of Peer Mothers
Mr Thembo said that the magic bullet to the increased demand for Ante Natal Care and Family Planning services at the centre has been due to the presence of peer mothers at the facility to provide peer support.
These have ensured delivery of maternal services to young mothers who need support in the community and could not access the health facility because of the transport restrictions during the lockdown.
“We ask the government, development partners, and civil society actors to consider the integration of young people into the mainstream health-service delivery to reduce maternal morbidity. This can be achieved by having peer mothers identified, trained, and attached to health facilities and in the communities to complement the role of VHTs in the mobilization of young people for maternal services,” Thembo said.
He also pointed out that equally, service delivery structures at local government’s including Health Unit Management committees should have young people representation.