Sophia Nangobi sits quietly under a huge muwafu (African canarium) tree, a few feet away from the labour ward of Mayuge Health Centre III. It seems she is bored because she plucks a piece of grass, puts it in her mouth, and begins to chew on it.
Everything about the bare-footed girl, including her shyness when I approach her, is girlish. But, it remains just that – impressions. Rooting around in the grass, as if searching for something precious, is Nangobi’s eight-month-old daughter, Shuleya Nabirye. At 17, Nangobi has so far spent three years in marriage. She is also unemployed.
“I’m happy in my marriage,” she says quietly, probably wondering why I should ask. Her husband, Sadat Muwanika, 20, is a boda boda rider in Mawumu Parish, which about 11km from Mayuge town. For riding a customer this distance, a boda boda rider earns Shs1,000.
“I’m the last born of eight children brought up by a single mother,” Nangobi says. “When I got to Primary Five, my mother could not afford the Shs20,000 for school fees, so I dropped out of school.”
When Muwanika approached her for a relationship, there was nothing stopping her. With her mother’s blessing, Nangobi became Muwanika’s wife at 14.
It is school or marriage
There is a general agreement that attending school stands as a buffer between rural girls and child marriage. However, Universal Primary Education (UPE) is no longer free in rural areas because parents – who are often living under the poverty line – have to pay for school requirements such as pens, exercise books, uniforms and lunch. Girls like Nangobi fill up the statistics of the number of girls dropping out of school every year. But, unlike others who would jump at the chance to resume their education, Nangobi is comfortable with her lot.
“I do not want to return to school even if someone offered me money,” she says, adding, “I want to give birth to four more children and look after our home.”
As we are talking, a heavily pregnant woman emerges from the labour ward. From a distance, she looks like she could be above 30 years old, but that is probably due to that special way in which a nine-month pregnancy can sap the liveliness out of a woman. The woman is Jennifer, Nangobi’s sister. At 20, this is her third pregnancy.
“The nurses say I’m due to deliver any day now,” she says, as she struggles to sit on the ground. She is married to a farmer and they had their first child two years ago. The girls came to the health centre without an emergency bag of delivery items such as gloves and a Macintosh sheet. Since they are returning home, it is likely that Jennifer may give birth from home before they have time to return to the health centre.
To the rescue
Olivia Kawuma Aliyenka, a retrenched nursing assistant, encounters pregnant teenagers on a daily basis. The 56-year-old is a member of a Village Health Team (VHT) and moves around villages offering basic health education to different families. Of late, her duties include urging first-time mothers – who can be as young as 13 years old– to deliver in a health facility.
At about midday, she rides her bicycle into Mayuge town and parks outside a church where a man is setting up a small table, two chairs and two benches under a mvule tree. The mobile vaccination team is scheduled to spend the entire day in this location. Aliyenka has come to offer a helping hand.
“This is a town and there are a lot of things for young girls to admire,” she says, adding, “Some parents send their daughters to school without anything to eat, yet they are at an age where they crave so many things.
Then, there are the boda boda men who entice them with little money. I can only compare these boda boda men to a plague when it comes to young girls. In my experience, many of these teenage girls suffer obstetric complications during delivery and are usually recommended for C-section deliveries, which at Shs300,000, are expensive.”
Aliyenka, therefore, also sells them vouchers cards under the Uganda Reproductive Health Voucher Project (URHVP). These vouchers, sold at Shs4,000, enable pregnant girls to receive antenatal care, medical help during delivery, postnatal care and free C-sections when referred by the doctor.
“I ride more than 5kms out of town every day and over the years I have witnessed a big attitude change in rural women. They are now more eager to deliver their babies at health facilities instead of their homes or in the homes of traditional birth attendants.
In fact, towards the end of last year, 15 women gave birth at the health centre in a single night. Previously, there would be only two women on any given night.”
Searching for a way out
There are many brick huts in the compound where Sauda Nkoma lives with her husband. The compound belongs to her husband’s clan. It is easy to see that Nkoma is not happy with her situation in life. The 19-year-old got pregnant at 17; her husband was three years older.
Now, they have a one-year-old son, Asumani Musaku. “I regret getting this ‘accident’ at a young age,” she says, adding, “In fact, I do not want to get pregnant again, maybe in the next three years. I’m now using inject plan. My parents were very angry with me. I think they hated me at the time. There is nothing good about getting married when you are young.”
Nkoma got pregnant after she had completed Senior Four at Delta High School. The yearning to return to the classroom is evident in the girl. Teenage mothers in the rural areas in most cases face more obstacles in their ability to pursue educational opportunities than young women who delay childbearing.
Nkoma’s husband does not have a steady job and he takes on whatever job comes his way. “Life was not good for us. We had no hope of getting a way to earn a living until I enrolled for a training opportunity with BRAC.”
In December 2016, BRAC Uganda in Mayuge District, with funding from UNFPA, offered a three-day livelihood training to a number of teenage mothers and girls who had dropped out of school. The trainings, as a grassroots intervention, are offered with the hope that economically empowered girls (and their families) are less likely to become victims of child marriage and teenage pregnancy. From the training, Nkoma received two goats.
“If this female goat keeps on producing, with five healthy goats, I can sell each at Shs60,000 and buy a cow. I would then sell the cow and buy a piece of land. I wish BRAC could give us cows, seeds and land.”
Children born to young mothers are at increased risk of sickness and death, while teenage mothers are more likely to experience adverse pregnancy outcomes.
Also because these girls get pregnant before the right age, child marriages and teenage pregnancies have huge implications on the maternal health of the country.
Besides, most of these girls get married to older men so there is a high likelihood of domestic violence in the marriage.
“These marriages have implications on education of the girl-child and the country as many girls are now dropping out to get married,” adds Peninah Kyoyagala, Programme Analyst, Adolescent Health – UNFPA.
World Bank research on Uganda shows that teenage marriages account for about 36 per cent school dropouts.
Since government developed the National Strategy to end Child Marriage and Teenage Pregnancy, an inter-ministerial committee was formed to provide guidance on the interventions around child marriage.
Government is also mobilising civil society organisations to invest in the area of ending child marriage. There is also the Youth Livelihood Fund, which was formed to reach out to girls who are at risk of child marriage due to poverty.
On June 16, 2015, on the Day of the African Child, the government launched the National Strategy to end Child Marriage and Teenage Pregnancy. The strategy outlines approaches and interventions that will end child marriage and teenage pregnancy in Uganda.
According to the Uganda Demographic and Health Survey (UDHS) 2016;
• 25 per cent of adolescents aged 15-19 have begun childbearing and 19 per cent of women aged 15-19 have given birth. Adolescent childbearing is more common in rural than in urban areas (27 versus 19 per cent, respectively).
• Teso sub-region has the highest proportion of adolescents who have begun childbearing and Kigezi sub-region the lowest (31 and 16 per cent respectively).
• Teenagers in the lowest wealth quartile tend to begin childbearing earlier than those in the highest quartile (34 versus 15 percent, respectively). This is due to poverty which makes it easy for young girls to be lured into sex, parents’ mindsets to child marriages, and low education attainment.
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