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Teen pregnancies in Gomba

02:43 Dec 15 2011 Gomba district, Uganda

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Sarah Nakagero has just had her sixth child. The 32-year-old resident of Degeya village in Maddu sub-county, Gomba district had her first child when she was 16, a year after she was married.

Nakagero has faced a number of complications during childbirth. Her most vivid memory is when she almost bled to death during her first pregnancy. “I almost died. I did not want to have any more children, but I did not know how to prevent it. I now want to stop since the nurse told me there is a way it can be (medically) done,” Nakagero comments while avoiding eye contact. But she conceived again and again and has become so worn-out with every child she bears that she looks much older than her age.

Like Nakagero, many teenagers are suffering this horrendous experience in Gomba where early marriages are the order of the day. Marrying off young girls is a common practice, especially among the Muslim parents, says Gomba MP Rose Najjemba.
Najjemba says this exposes girls to teenage pregnancies with all the consequences that come along – which at times might be death. “Many parents look at their children as a source of wealth at the expense of their lives, which is unfortunate. A recent study showed that Gomba has the highest number of early marriages in Uganda,” Najjemba reveals.

Out of 10 mothers who report for antenatal care, at least seven are teenagers, observes Beatrice Nakabiito, the Maddu Health Centre IV labour ward in-charge. By 30, most mothers in Gomba have on average seven children, she adds. Nakabiito says the situation is worsened when teenage mothers deliver from home instead of a health centre. “Out of the 20 mothers who come for antenatal, only seven return when it is time to deliver. This is why they die when they get complications,” she points out.

But teenage mothers talked to say they do not go for skilled births due to the high transport costs involved. Travelling from villages like Kasambya and Kyayi, which are over 30km from Maddu Health Centre IV is costly, notes a teenage mother only identified as Salima. But the situation turns ugly when these young mothers get complications. They are not only affected by delays to health centres, but also lack of enough facilities to handle the complications.

In case an operation is recommended, Maddu health centre IV is the best facility in the district with a theatre, but it is not operational due to lack of a doctor, says Dr. Moses Bemba, the acting district health officer. If a case need for an operation arises at Maddu health centre IV, it has to be referred and the nearest alternative is Gombe Hospital, which is about 65km from Gomba and it costs sh100,000 in a salon car to travel there. As a result, the expectant teenagers with complications stand a high risk of dying on the way. They mainly suffer from obstructed labour and postpartum haemorrhage (severe bleeding after birth), according to Nakabiito. With 19 health centres, Gomba has a population of 143,173 people of which 32,930 are women of child-bearing age.

Since teenage pregnancies are a result of early marriages, the Gomba district leadership led by the chairperson Abdul Kyabangi and chief administrative officer Esau Ekachelan has resolved to involve the Police to stop the practice. “When I was in Iganga, we would arrest those marrying off young girls at the wedding. We can also start it here to save our girls,” Ekachelan suggests.

Reproductive Health Uganda (RHU) programme coordinator, Annet Kyarimpa, says besides involving Police, there is need to sensitise the community about the dangers of teenage pregnancy and encourage teenagers to use contraceptives.

RHU spokesperson Martha Songa hopes that they will benefit from the $30m (about sh86b) reproductive health loan that the Government got from the World Bank to fight teenage pregnancy in not only Gomba, but also in other parts of the world. She notes that they need to equip health centres in Gomba with supplies like contraceptives, which are usually out of stock. Uganda needs $244,476,913 (about sh698b) to ensure that the country has all the reproductive health supplies it needs over the next five years, Songa says.

The Ministry of Health also has a reproductive health commodity security strategy whose goal is to accelerate reduction of maternal and neonatal morbidity and mortality. The strategy is also aimed at meeting Millennium Development Goal (MDG) number 5 – reducing maternal deaths by three quarters by the year 2015.

There were over 500 maternal deaths per every 100,000 live births in 2000 when the UN set the goal, but it has since reduced to 435 deaths as of 2006, according to the Uganda Demographic Health Survey 2006. According to the 2010 MDG progress report for Uganda that was launched at Hotel Africana recently, many women do not go for antenatal care, the reason why reducing maternal mortality is still slow. The report says maternal deaths have reduced to about 350 per 100,000 deaths.

Songa argues that if all the money is got and the contraceptive prevalence rate increases from 24 to 50% countrywide, budget allocation for reproductive health is raised, and the unmet need goes down from 41 to 5%, maternal mortality will automatically become history.

Besides, Songa says the Government would save $112m (about sh320b) by investing in contraceptive commodities and services to fill the entire unmet need. Unmet need refers to the percentage of women who would like to be able to either space their children or stop having children but are not using contraception.           

- By Chris Kiwawulo
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