Wednesday morning was a day of long queues for Margaret Bako (not real name) who walked into Mungula Health Centre III to find treatment for her two-year-old daughter. Bako got pregnant when she was a 14-year-old primary four pupil of Mungula primary school in Itirikwa sub county, Adjumani district.
Speaking through an interpreter, Bako told The Observer on July 10 that the 20 year-old father of her child was briefly detained before their parents agreed to a marriage.
"My parents accepted a cow from him as bride price and he took me to his house," Bako said.
Itirikwa sub-county has the highest number of teenage mothers on record in the West Nile district. Dennis Mayamba, a midwife, said the situation has improved.
"In a month, we could get more than 30 cases but the numbers have reduced to about 10," Mayamba said.
Speaking at parliament last week, David Bahati, the state minister for Planning, said; "The teenage pregnancy rate has stagnated at 25% for the last ten years. This means that in Uganda, one out of every four teenage girls is either pregnant or has had a baby before reaching 19 years old."
Speaking on July 11 at an event to commemorate World Population Day, Alain Sibenaler attributed the high maternal mortality to teenage pregnancies.
Cultures have been singled out for blame for the high teenage pregnancy rates and Bahati said they are an issue of national concern. Among the Madi of Adjumani for instance, when a man is seen talking to a girl the two can be forced into marriage.
"If you are seen talking to a girl, no matter what your discussion is about, the girl's family will look for you and force you to pay dowry and take her," Mayamba said.
Reversing this has been a focus of organizations such as Danish Refugee Council (DRC), the United Nations High Commission for Refugees (UNHCR) funded Medical Teams International (MTI) and United Nations Population Fund (UNFPA) funded Lutheran World Federation (LWF).
"Besides engaging the communities, they also go for the perpetrators and get them prosecuted. I have personally been to court to testify in cases involving underage pregnant girls I had examined," Mayamba said.
The problem in the West Nile sub-region is worsened by the high influx of refugees from South Sudan and the DR Congo since among some refugee communities, it is normal for an adolescent girl to be married off. With authorities getting strict on enforcing the law, the refugees are running back to their home countries.
"In South Sudan, there is no prohibition for early marriages, if a girl gets pregnant, instead of waiting to be apprehended by the law enforcers, her parents send her back to South Sudan," Mayamba said.
Adjumani Woman MP, Jessica Ababiku said not much is being done to stop children from engaging in sex at an early age. Ababiku is opposed to the exposure of teenagers to contraceptives.
"The best form of family planning is keeping the children in school," the legislator argued.
Due to cultural sentiments, uptake of family planning methods is very low according to a study conducted by Makerere University School of Public Health in the 13 West Nile districts. The study shows that the contraceptive prevalence rate stands at 24.1 per cent compared to the national average of 41.8 per cent.
The resultant effect is a growing population. Government estimates put Uganda's annual population growth rate at 3 per cent leading to the current figures that put the country's total population at 40.3 million up from 34.6 million in 2014. About 78 per cent of this population is predominantly youth-- below 30 years while about 49.3 per cent are young people under the age of 15.
The implication of this, Bahati said, "This big proportion of young people has resulted in a high dependency ratio of 103 dependents per 100 working adults, indicating a heavy burden on the economically productive population."
In a speech read for him by Vice President, Edward Kiwanuka Ssekandi, President Museveni said, this is the very reason Uganda has not achieved the middle income status.
"If our population had grown at a slower rate, Uganda would already be a middle income economy. However, we don't regret the high population because it is an important resource," Museveni stated.