In Adjumani district of northern Uganda young people cannot access safe and reliable sexual and reproductive health care.  Young people are sexually active and unwanted pregnancy is a common problem. Services must be tailored for young people and health professionals have to be more welcoming and understanding of their needs. Myths and stigma around sexual behavior and prevention should be tackled in an integrated approach.

Researchers from the UK Medical Research Council's Social & Public Health Sciences Unit, and Department of Public Health, University of Glasgow, UK examine the relationship between different kinds of health service provider and young people.  Their intention is to identify approaches that best meet the sexual and reproductive health care needs of adolescents.

The study was conducted in 2001 among young people aged 10-21.  Written questionnaire responses were included, as were in-depth interviews with eleven young people and service providers.  The interviewees were four randomly selected young people, two trained health workers, two traditional healers, two drug shop owners and a nurse assistant working in a doctor’s private clinic.  The results indicate that young people are generally well informed about the spread and prevention of sexually transmitted diseases (STDs) and about ways of avoiding pregnancy. However, further findings suggest that:

• lack of confidentiality at health centers made visits to drug shops and traditional healers preferable
• on failing to treat certain conditions, drug shop owners and traditional healers send patients to health centers for diagnosis
• health seeking behaviour depends to a large extent on feeling confident and relaxed with the person consulted
• pregnancy is not uncommon among both primary and secondary school pupils
• health professionals from every sector are unsympathetic to young peoples’ needs for contraception and abortion
• reasons why young people did not use condoms or pills include disapproval from health professionals, belief that contraception methods are unsafe or unreliable, and lack of money to purchase condoms
• many health service staff do not know how to work with young people.  Aggressive or rude behaviour discourages young people from attending clinics, as does the risk of being seen by parents.

The existing delivery of sexual and reproductive health care does not fully meet the needs of young people in the district.  This situation requires new approaches to the training of health workers and guidelines on adolescent reproductive health. More specifically:

• how myths about condoms and contraceptive pills arose must be understood in order to counter it effectively and prevent any future hindering of sexual and reproductive health programmes in Adjumani 
• knowledge of STD and pregnancy prevention methods does not mean that young people will practice safe sex.  Efforts to promote changed behaviour should include making health services more welcoming and integrated, improving access to condoms and oral contraception, and community-wide education programmes
• confidentiality and privacy are important. Formal health care professionals must learn from the approach of traditional providers
• Further training and integration of traditional care providers into formal systems is essential, as they already play a key role in providing care and information to young people.

This study finds little evidence of community participation in the delivery of health services for young people in the district.  Involving local beneficiaries in planning their health services can create a sense of ownership and increase the uptake of services.  Such an approach in Adjumani could help make adolescents less vulnerable to HIV/AIDS and STD infection. 

Current debates on HIV in sub-Saharan Africa centre on providing antiretroviral drugs for those living with the disease.  By effectively meeting the sexual and reproductive health needs of young people, prevention of infection can become an achievable goal and must remain the highest priority.

Source(s):
‘The sexual and reproductive health of young people in Adjumani district, Uganda: qualitative study of the role of formal, informal and traditional health providers’, AIDS Care 16(3), by L. Kiapa-Iwa and G.J. Hart, 2004

id21 Research Highlight: 12 October 2004

Further Information:
Graham J. Hart
MRC Social and Public Health Sciences Unit
University of Glasgow
4 Lilybank Gardens
Glasgow G12 8RZ
UK

Contact the contributor: g.hart@msoc.mrc.gla.ac.uk

UK Medical Research Council, Social and Public Health Sciences Unit

Department of Public Health, University of Glasgow, UK

Other related links:
'Realizing rights: transforming approaches to sexual and reproductive well-being'

'Misconceptions, denial and folk beliefs - obscuring the risk perceptions among young Zambians'

'Ask your aunty: sex education in rural Uganda'

'Community participation and sexual health – is there a relationship?'

'Behaving badly? Young men and sexual health'

'Meeting their needs? Discussing young people’s sexual health'

See id21's collection of links relevant to sexual and reproductive health.