The emergence of COVID-19 has not only disrupted the day-to-day operations in the lives of individuals, but has also brought to light inequalities within health care delivery systems, especially essential health services and information about the sexual and reproductive health of young people. people.
One of the most affected population categories have been young people, who are currently out of school and have had little or no access to maternal health services due to pandemic containment measures – school closures, ban on public and private transport, and curfew among others.
With the suspension of public transport, many Ugandans seeking health services were unable to reach health facilities as ambulances were scarce. As a result, according to reports, some pregnant women have developed complications during deliveries that have not been treated by professional midwives while several new milestones have not passed the neonatal window.
It is also important to note that the Uganda Demographic Health Survey of 2016 indicated that 25% of adolescent girls aged 15-19 in Uganda have started childbearing, 19% of those in the same age group have given birth, and 5% of those in the same age group have given birth. % are pregnant with their first child. child.
The same survey found that teenage motherhood is more common in rural than in urban areas (27% vs. 19%, respectively) thus creating regional variation with the Teso sub-region with the highest proportion of adolescent girls who have started to procreate and the sub-region of Kurezi. -region with the lowest (31 and 16 percent respectively).
Likewise, infant mortality has declined steadily, from 38 deaths per 1,000 live births in 2011 to 22 deaths per 1,000 live births in 2016. Adolescent mortality accounts for 44% of maternal mortality in Uganda.
Filling the Gaps to Address Maternal and Newborn Health
Mr. Joshua Thembo, Advocacy Officer at Naguru Teenage Information and Health Center (NTIHC) confirmed that teenage pregnancies in Uganda are mainly due to a limited understanding of sexual and reproductive health and rights.
Thembo notes that this ignorance, coupled with the low quality of sexual and reproductive health services, limits the ability of health care providers to provide youth-friendly services; insufficient supply of essential drugs and commodities and lack of basic infrastructure, high exposure to early and multiple sex, and low contraceptive use hamper maternal and adolescent health.
He further said that parents and caregivers had not done enough to hold young people accountable for reproductive health, noting that despite the pandemic, the health of adolescents, mothers and newborns should be a priority.
“At Naguru Teenage Information and Health Center, we believe that the life of mother and baby matters even in the most difficult situations. As a youth-friendly center of good practice, following Ministry of Health COVID-19 standard operating procedures, we continued to implement the pillars of safe motherhood, including family planning, where young mothers and their partners receive adequate family planning information and services, ”Thembo explained.
He revealed that maternal health talks are being conducted both at the center and in the communities through awareness campaigns, radio broadcasts, print materials and the distribution of information and educational materials, including flyers, t-shirts.
“Over the years, we have also provided antenatal care (ANC) services to young mothers, including routine check-ups at the Kiswa health center. Our experienced and youth-friendly midwives detect complications early and support them as soon as possible, providing young pregnant women with vitamin supplements, iron tablets and vaccines so they can have a healthy and safe pregnancy, ” he added.
Throughout the implementation of the pillars of safe motherhood, the center ensured that young people remained at the forefront of their programming through a peer-to-peer approach.
“We therefore have a dynamic team of trained peer mothers who are responsible for mobilizing and reaching young mothers receiving services from our center. Peer mothers understand the needs of other young mothers, therefore young mothers find it easy to open up and interact with their peers in the health facility and in communities during health interventions ” , Thembo said.
A voucher system where young people are referred for antenatal and family planning services in community clinics has been put in place and, Thembo noted, has increased the use of antenatal care and family planning services in community clinics. .
According to the 2019/2020 NTIHC report, a total of 5,670 young women benefited from maternal health services, including routine examinations during antenatal consultations 3,772, post-natal care (230), FP ( 1,633), 35 received postabortion care (PAC), and a number of them obtained services to reduce or prevent congenital infections, including antiretroviral therapy for prevention of mother-to-child transmission HIV (MTCT), syphilis, chlamydia and hepatitis B.
Of those who attended antenatal care, 1,158 visited the facility at least 4 times. Overall, 357 young men escorted their wives for antenatal care, providing the option for partners to benefit from STI testing 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, mainly Implanon and Jadelle, were used by 123 clients and 3 clients used copper T, 39 clients took condoms specifically for use as contraceptives.
Role of peer mothers
Thembo said the silver bullet to the increased demand for antenatal care and family planning services at the center was having peer mothers in the facility to provide peer support.
These ensured the delivery of maternal services to young mothers who need support in the community and were unable to access the health facility due to transport restrictions during the lockdown.
“We call on the government, development partners and civil society actors to consider integrating young people into the delivery of traditional health services in order to reduce maternal morbidity. This can be achieved by having peer mothers identified, trained and attached to health facilities and communities to complement the role of VHTs in mobilizing young people for maternal services, ”Thembo said.
He also stressed that service delivery structures within local governments, including health unit management committees, should also have youth representation.