Ahead of the International Conference on Family Planning, Hope Mafaranga reports on the lack of information and access to contraceptives which is leading to many girls in Uganda having unwanted pregnancies.
Angela Tweheyo, 17, from Mbarara District, says she had no idea about condoms when she was impregnated at age 15 by a teacher at her school, who later denied responsibility for the child.
In Uganda, 25 per cent of girls between the ages of 15-19 have given birth and more than half of young women aged 15-19 who are sexually active are in need of contraception, according to the Ministry of Health.
Lack of information and access to contraceptives
"Lack of information about contraceptives landed me in trouble of getting pregnant. As if this wasn't bad enough, the first time I went for my antenatal visit, I tested HIV positive," Tweheyo says.
In 2013, HIV prevalence among young women aged 15-24 in Uganda was estimated at 4.2 per cent (AVERT).
To address these pressing sexual and reproductive health needs among young women, the government needs to ensure a tailored and targeted response to preventing unintended pregnancies, reducing maternal mortality, and ending AIDS.
Teen mother living with HIV
Tweheyo later found out that her "sugar daddy" had lost two wives to HIV. But when she confronted him, he told her to abort and said he would not be responsible for the baby. "I went to a traditional birth attendant to remove the pregnancy but the herbs she gave me did not work. I almost died," she says.
"It is true I am now struggling to ensure we survive but I am grateful that I am a mother. When my child calls 'mum', I feel good, though sometimes I feel guilty for my prior attempt to abort her. Thank God the herbs did not work.
"You have no idea how it feels to be a teen mother living with HIV as a result of unplanned pregnancy. My baby is also HIV positive. But I have decided to go public about my HIV status so that girls can learn from my experience and don't fall into the trap like me."
Ensuring healthy lives for all
In September 2015, heads of state and government met in New York and decided on the new global sustainable development goals, to be achieved by 2030. One of the goals focuses on ensuring healthy lives and promoting well-being for all at all ages.
As part of this goal, governments committed to reducing the global maternal mortality ratio to less than 70 per 100,000 live births and ending preventable deaths of newborns and children under five years of age. All countries will aim to reduce the neonatal mortality rate to 12 per 1,000 live births, or lower, and the mortality rate for under-fives to 25 per 1,000 live births, or lower.
Professional doctors fear to perform abortion, which is only legal under certain conditions, such as to save the life of the mother. As a result, the Ministry of Health estimates that 26 per cent of preventable maternal deaths are caused by unsafe abortion in Uganda.
According to Dr Asuman Lukwago, permanent secretary in the Ministry of Health, over 300,000 abortions occur annually, with the vast majority of these being unsafe. He says: "6,000 women die every year due to pregnancy or child birth, 15,200 women die from unsafe abortion and a further 85,000 women are treated for complications resulting from unsafe abortion."
Moses Mulumba, executive director of the Center for Health Human Rights and Development, says there is need to put in place a law to regulate the termination of pregnancies. This law has not yet been developed. Yet Uganda spends over 7.5 billion Ugandan shillings (about USD 2.1 million) from its national budget on treating women who have suffered complications due to unsafe abortion.
Sex education vital
Rosette Kyomuhendo, a mother from Tweheyo's village, said parents should start talking about sex and the dangers of early pregnancies to their children in order to prepare them for adolescence.
"The more we stay away from telling our children the truth about sex, the more they will end up with unintended pregnancies and carrying out unsafe abortions," she says.
Dr Julius Mugisha, a senior gynaecologist at Mbarara Referral Hospital, said 40 per cent of admissions for emergency obstetric care in Uganda are a result of unsafe abortion.
He believes revising messages on contraceptives and use of condoms to prevent unwanted pregnancies, HIV, and other sexually transmitted diseases is vital.
"We need to scale up campaigns to promote the goodness of family planning and also revamp messages on the use of condoms. This is the only way we will be able to control new HIV infections and prevent unwanted pregnancies," he said.
As they say, knowledge is power. For Tweheyo this is certainly the case. With an impending marriage and new found knowledge on family planning, she and her fiancée are busy planning for their future. "I am not focusing on HIV status because I am now informed about prevention of mother to child transmission of HIV. I am dating an HIV positive man who I met at the health center and we are planning to have two more children," she says with a smile.