Research conducted to understand the SRHR-related factors affecting Female Adolescents & Young women’s development in Luuka district, East Central Uganda

1. Gender-based influences on Sexual and Reproductive
Health and Rights outcomes among Adolescent and
Young people in Luuka district, Uganda: Key learnings for
Nigeria.
Presented at the 7th Nigerian Family Planning Conference
2022
By
Sande Slivesteri
Dec 2022

2. Contributors
• Rachael Arowolo & Yetunde Omotosho - Wapa Africa
• Sande Slivesteri - MRC/UVRI and LSHTM Uganda Research Unit
• Tobias Kisoke - Luuka Local government

3. Background
• Globally there are over 7.9 billion persons, of which 16.7% are Adolescents
and Young People (AYP)
• 90% of whom live in low developing countries, with 40% from Africa
• Sub-Saharan Africa has the highest pregnancy rate (218 per 1,000 women)
and about 33 abortions occurring per 1,000 women aged 15-49 years
annually
• This study aimed to understand the gender-based influences on SRH
outcomes among AYPs in Luuka district, Uganda.

4. Study Site: Luuka District Uganda
• Luuka District is located in the East Central
Region of Uganda
• Boarders with Iganga, Buyende, Jinja, Kaliro,
and Kamuli districts.
• Luuka is one of the ten districts that form
Busoga Kingdom
• The district has 7 sub-counties and one
town council

5. Purpose of this Study
To understand the SRHR-related factors affecting Female Adolescents
& Young women’s development in Luuka district, East Central Uganda.

6. Objectives
• To assess the SRHR needs of Female young people and adolescents in Luuka district
• To understand the typical growth life timelines of female adolescents and young
women and their implications on their SRHR outcomes
• To understand the key growth, social, and livelihood events that occur in the growth
path of female adolescents and young people in Luuka district.

7. Study design
A prospective study comprising both qualitative and
observational data collection methods

8. Study population
Adolescent and Young people ages 15 – 24 years

9. Methods
• FGDs – Between June and July 2022, we conducted 8 Focus Group
Discussions (FGDs)
• Purposively selected AYP 8-12 per each FGD between the age of 15-24
years
• Four FGDs in Ikumbya sub-county consisting of 2 male groups and 2
female groups among 15-17years in-school AYPs
• Four FGDs in Bokooma sub-county, 2 male groups, and 2 female groups
among 18-24years of out-of-school AYPs.
• Assent and consent was obtained from the participants.

10. Methods – Cont’d
• Examined typical growth timelines for female AYPs and the key growth social and
cultural critical events that occur in the AYP’s growth pathways in Luuka District
• We explored the SRHR needs of AYP.
• Interviews were audio-recorded, transcribed, translated, and data analyzed
thematically.

11. Results
Key Timeline Growth Events
• Unwanted/teenage pregnancies
• Forced marriages
• Unsafe abortions
• School dropout (15 years)
Barriers to Contraceptive Access and Utilization
• Low female self-esteem
• Societal norms, Household duties exclusive to
females
• Females regarded as sex objects and source of
income for parents.
• Negative myths on family planning (male mainly)

12. Unwanted/Unplanned Teenage pregnancies
“When she is 14 years, there are body changes. That the one without
breasts, the breasts start coming, and then she starts going into
menstruation periods, she starts experiencing them, and then she gets
a sharp voice. Then there, she does not listen well to her parents, and
she becomes stubborn, then out of that, boys start seeing her because
at that stage she starts looking nice and attractive, then after she trusts
the boys and in the end, she gets pregnant”
- FGD with 15-17 years in out of school adolescents

13. Forced Marriages
“Then the father will say that since you have gotten pregnant and
you have been in school, you have wasted my money for school fees
but since you are pregnant, go and marry the man who is
responsible for the same, and the father will force her that she has
to go and marry, she has to leave her parents home. So, I say that
the most important decision-maker is the father. He is the decision-
maker in the girl’s marriage”
FGD, 18-24years male/out of school

14. Unsafe Abortions
“Because abortion is a crime, so she might go to the health facility and
the healthcare worker will ask how did this come to happen that you are
bleeding, Remember for the healthcare worker, for them, there are
learned people you cannot deceive them. You cannot tell them a story
that you have been just there and you started bleeding, you can be
examined immediately because even after the abortion, your body
indicates that you are pregnant each time they make medical tests on
you. So, you may be tested, and it points out that you are pregnant yet
you have nothing in the stomach then you are asked how this came to
happen. So the healthcare worker might instead go and report a case
and this turn out a crime to you that you did an abortion something that
is illegal. So it is not easy to go and seek post-abortion care, you go
when you are worried”
- FGD, 15-17years, male in school

15. Dropping out of school
“When the girl goes into adolescence and the
situation overburdens her, and she reaches 17,
18, 19 years and she starts getting closer to the
boys, she stops school at 17 or 16 years and
those are the ones that you see getting married
at 17 years or 18 years”
- FGD male, 18-17years, out of school

16. Societal norms
“ Me as respondent 1, the typical girl of our community her daily
activities are many, she wakes up in the morning and goes to the
garden, she comes back, and sweeps the house, goes to fetch water,
goes to the kitchen and cooks at times even fetching firewood. So her
activities are many and at times she is harassed in a situation where
the mother might be harsh, or the father might be harsh on her.
At times, depending on how she is being treated in the community or
at home she goes into early marriage”
- FGD, 15-17years, male, in school

17. Family Planning Decision Making
“The one of this (showing the hand/family planning method), then she might fear
that the one the implant the man might discover that she has put in on the arm
when he touches her arm and feels. So, she might choose to go for an injection”
- FGD/Male, 18-24 years, out of school
“When she reaches the health facility and sees the health care worker, and she
explains her problems, and the health care worker gives her a family planning
injection, or she is given pills. When she reaches home, she has to keep it a secret
because she does not want the man to discover that she has taken on a family
planning service because the man will not say yes to family planning”
- FGD/Female, 15-17years, in-school

18. Challenges
• The concept of SRHR is still viewed as not African.
• Parents and guardians to give consent for the below 18years study
participants to participate in SRHR related research was not easy.
• Getting female participants to participate in the FGD demanded on the
approval of the male (husbands) regardless of the age.

19. Key Learnings for Nigeria/ Recommendations
• SRHR policies and programs should aim at addressing comprehensive mindset
change with deliberate intentions of breaking negative societal norms and
stereotypes.
• Deliberate gender-sensitive interventions on family planning will go a long way in
ensuring equitable access and utilization of the same.
• Unpacking SRHR to the relatable day to day life will go a long way sensitizing
people not to shy away from their SRHR needs.

20. Acknowledgments
• Wapa Africa – Coordination and funding the research activities
• Luuka Local Government - Administrative approvals
• Our participants -accepting to take part in the research.

22. @wapa_africa
@wapaafrica