A missed opportunity for adolescent sexual reproductive health
Adolescent sexual reproductive health (SRH) is a hot topic in international development today.
According to the WHO, “For many adolescents who need sexual and reproductive health services, such as appropriate information, contraception and treatment for sexually transmitted infections, these are either not available or are provided in a way that makes adolescents feel unwelcome and embarrassed.”
Many organizations have recognized that even when the healthcare is available, young people often don’t take it up.
Thus, many projects focus on addressing the power and voices of young people, especially in countries where parents greatly influence the lives of young people or just call the shots.
The idea is that if we can reduce the stigma perpetuated by the older generation and give more power to young people to make their own choices, young people will take up SRH services as they need.
On one such project, I facilitated a design workshop in Uganda with a local team. They were focused specifically on the youth in the Kalangala Islands.
In Kalangala, there are many islands, sparsely distributed communities, and few health facilities. The geographical structure of the islands make it difficult for people to access to both information and services.
In diving into the team’s research and experiences, we uncovered an important barrier to better contraceptive choices.
Young people had many beliefs around what prevented pregnancy - and many were inaccurate or misleading. One myth that shocked us all was the belief that that drinking paracetamol with warm milk would do the trick.
But how did we get here? What was really behind these myths and misconceptions?
The team began to recall stories and perspectives of the people in Kalangala, with the help of two team members having grown up in Kalangala.
One person shared that there was a time, years back, in Kalangala that health workers were sent out on outreaches with contraceptive quotas. This might have been around the time of HIV/AIDS prevention in the 90s.
To put bluntly, they had a set number of contraceptives they needed to put in women.
Contraceptives are quite intrusive on the body, and women needed to consent to this, of course. The strategy that made the most sense, then, was to “sell” the benefits of contraceptives and omit the possible side effects of using contraceptives.
So what happened?
Women took up contraceptives, the health workers filled their quotas, and everyone went home.
From here, we can track the story.
Contraceptives are a foreign object in the body. The body naturally reacts - bleeding, cramps, weight gain, headaches, nausea - the list goes on. It’s not fun stuff. I can tell you from experience.
Many of the women who took up contraceptives didn’t have the information to know why their body was reacting and there was no where to go to ask for help.
If a woman didn’t want the contraceptive anymore, there were no health facilities available or equipped to remove the contraceptive.
If a couple experienced infertility or if a woman got sick, there was no clarity on what was caused by the contraceptive and what wasn’t. Perhaps herself, her partner, or her family, not having enough information on contraceptives, would have blamed the thing that was put in her by a stranger.
Fast forward to today.
The generation that had gotten contraceptives in this way became parents or aunties or older sisters.
Now, the next generation is being approached by organizations with information about their sexual health and about contraceptives. However, the organizations are not family members and they have (kinda) obvious intentions.
The youth are probably going to look for validation in their trusted circles from those who have actually experienced contraceptives.
How likely do you think their parents would recommend modern contraceptives?
Out of their care for the younger generation, they may find ways to discourage contraceptives with alternate beliefs. These are the beliefs that have morphed into the myths and misconceptions we uncovered in the research.
Here’s what we heard from the older generation:
“Because they [health workers] don’t teach us the advantages and disadvantages of the contraceptives.”
“They [health workers] don’t examine our bodies before putting those contraceptives in our bodies.”
“Due to the high side effects, we think our children would die in the near future yet we rarely see health workers this side.”
“Yes, we believe they [contraceptives] cause barrenness so if at all our children start it early, they might not give birth in the future.”
This is the missed opportunity.
If we want to address current needs, we need to make up for the past hurts.
If we want to help the youth of today, we need to help the youth of yesterday understand what happened to them and do the post-care that they should have gotten years ago.
The reality of the collectivistic culture in Uganda is that generations within families and close circles influence each other.
In the pursuit of supporting young people, is it right for us (I’m speaking for individualistic cultures where this comes from) to focus on youth circumventing their parents and breaking relationships in the process?
Should we be “individualizing” people or can we leverage the strength of relationships instead?
This project ultimately decided not to focus on caring for the older generation. After all, it had a defined scope that was limited to empowering and advocating for youth.
I hope that someone, somewhere finds it in their scope to do this important work. Please take me with you!