Men's Role in Adolescent Reproductive Health

Paul Kimumwe

On Wednesday July the 11th, the world commemorated the World Population day, with this year’s theme focusing on men’s involvement and participation in making a difference in women’s lives, with emphasis on the young people.

In her statement the UNFPA Executive Director, Thoraya Obaid, remarks that, "All over the world, young people want to be heard and involved. They possess the ideas, determination and energy to accelerate effective action to reduce poverty and inequality....

"It is clear that the Millennium Development Goals will not be met unless young people are actively involved in policymaking and programming, their voices are heard, their needs are met and their human rights are respected".

One area however that has been lacking in support to the young has been in their sexual and reproductive health. Many young people engage in risky sexual behaviours with little or no knowledge about how to protect themselves against the risks of infection or unwanted pregnancies.

A 2004 national survey of adolescents in Uganda by the Makerere Institute of Social Research and Guttmacher Institute revealed that in Ugandan, many adolescents are sexually active and are aware of the risks of unprotected intercourse.

The report further says that while many are interested in obtaining sexual and reproductive health information and services related to family planning, HIV and AIDS and other STIs, pregnancies, etc. from reliable sources such as the formal health care system, they express a number of problems with doing so under the existing health care system.

These include; fear, embarrassment, confidentiality of information shared, distance/ease of access to the facility, client handling, and affordability of services.

This year’s theme couldn’t have any timely. While the gender equality and equity crusade has come of age now, its effects are yet to take root, mostly because men, to the larger extent, have not yet been embraced as partners in this noble cause.

To borrow Obaid’s words, "We (need to) see men and women as partners in a relationship built on mutual respect, trust and commitment.

Partnering with men promotes the right of every woman, man and child to enjoy a life of health and equal opportunity."

Fathers (men) often decide whether a daughter will marry young or have a chance to complete an education.

They have the financial power to take their pregnant wives to health centres; often make the decisions on how many children they should have, the list goes on.

Addressing adolescents’ sexual and reproductive health needs is an important and urgent policy and programmatic concern in Uganda.

But to address young peoples’ needs effectively, it is imperative to have a better understanding of the various aspects or adolescent sexual and reproductive health and needs.

As family heads, fathers need to appreciate that adolescents face many huddles in the course of juggling with unfamiliar body changes, temptations, inaccurate or complete lack of information relating to sexual reproductive health, and the challenge of living in an era of HIV and AIDS, on top of other STIs.

It is therefore important for a countrywide campaign that promotes parental participation, especially fathers (or father figures), in ASRH issues and equips them with information to effectively deal with their children’s concerns.

This is because, while the mothers are making attempts to fill the gaps, in light of the new ASRH challenges, particularly those posed by HIV and AIDS, they need to be equipped with accurate information and appropriate skills to establish an effective dialogue with their children.

And of course, sensitise and persuade fathers to appreciate their roles and responsibilities so that they can become more proactive in the lives of their children.

Talking AIDS to the young: What works?

Paul Kimumwe

For all the achievements that there have been in the fight against AIDS, none has been more effective that communication. Simple as it is, it has been responsible for massive strides in the reduction of HIV prevalence.

At its basic, AIDS communication has been about telling people how AIDS can be spread, the symptoms, prevention methods, and where to seek treatment from. This is the stage of creating awareness.

The end result has to be behaviour change. Period! Any thing less of this, the efforts would be deemed wasted.

By its nature, AIDS was a myth to the world. Its emergence has been a challenge to all aspects of life. Responding to it required immediate and drastic actions, which the world was not prepared for at the time, even up to now. For some, the realities were too harsh to bear.

You could not talk about AIDS without talking sex. Yet talking sex at the time represented the highest level of immorality. It was taboo. More so, admission to having AIDS in your country meant losing out on revenues from the tourism industry.

Unfortunately, the rate at which it was obliterating communities demanded that it was time to face the music. There was little else left to do.

As researchers, clinicians, and herbalists grappled to find a cure, it was important that preventive measures are given priority. Up to until now, the AIDS cure is still elusive, infection rates are still high and prevalence levels have stagnated.

AIDS and young people
But one of the biggest victims of AIDS have been the children. Not only has it redefined the very meaning of childhood for millions, it has gone ahead to deprive many of their human rights; the care, love and affection of their parents; of their teachers and other role models; of education and options for the future; and of protection against exploitation and abuse.

According to a stocktaking report, “Children and AIDS” released by United for Children, United against AIDS early this year (2007), it is estimated that 2.3 million children under 15 years old are infected with HIV, 15.2 million children under 18 have lost on or both parents to AIDS, and millions more have been vulnerable.

The report notes that the risks inherent in these statistics are many, as children affected by AIDS may experience poverty, homelessness, school drop-out, discrimination, loss of life opportunities and early death.

The report further notes that “the Millennium Development Goals (MDGs) especially MDG 6, which is to halt and reverse the spread of HIV/AIDS by 2015 will not be reached without integrating approaches to children and AIDS with approaches to child health and survival”.

Talking to them about AIDS
For this to happen, it means that young people will, by themselves, have to make critical decisions regarding their sexual lives. Society can only do so much.

However, many young people still engage in risky sexual behaviours with little or no knowledge, skills and resources to have health sexual relationships and protect themselves against the risks of HIV and AIDS and unwanted pregnancies.

Studies done by the Guttmacher Institute in four African countries of Ghana, Uganda, Burkina Faso and Malawi show that young people are not getting the information they need to protect themselves against HIV.

Traditionally, aunties, uncles or grandparents, depending on the cultural area, played the role of providing sexuality education to adolescents within the family setting. However, this practice has been eroded by modernisation, leaving an information vacuum.

Adolescents particularly those who are out of school, now have no one to turn to – except perhaps their peers and siblings – to address their information needs and concerns on AIDS, sexual and reproductive health issues.

The Guttmachers studies show that some mothers are making attempts to fill the gap, but in light of the new adolescent sexual and reproductive challenges, particularly those posed by HIV and AIDS, they need to be equipped with accurate information and appropriate skills to establish an effective dialogue with their children.

Of importance also is the need to sensitise and persuade the fathers to appreciate their roles and responsibilities so that they can become more proactive in the lives of their children.

This is because, in the era of HIV and AIDS, where behaviour change is plays a key role, awareness creation is just a step in the process. For messages to take root and be acted upon, they must be simple, repeated and provide answers to the so what questions, which is always asked in any behaviour change communications. Why should I behave in a certain way? Why should I use a condom? Why should I abstain? The list goes continues…

Make Every Day A Day of the African Child

Paul Kimumwe

As the world marked the Day of the African Child on June the 16th my heart sank deep. Just a few days before that, there had been several Ugandan media reports about that really bothered me: child-headed homes were on the increase (The New Vision, Monday, June 11, 27), the worst districts being Kampala, Masindi, Iganda, Busia and Kabarole.

One the same page, there was a story of two children who were being looked after by the police after they had been abandoned by their parents, just on the next page, there was a story of a man who had just been sentenced for defiling a 15-year old girl. And this was just in one media outlet.

Since 1991, the world has been observing this day, which was created to honour the memory of innocent children in Soweto, South Africa when hundreds of them were wounded and killed during a match to protest the inferior quality of their education and to demand their right to be taught in their own language.

Looking at the situation now, I think these poor souls will never rest in peace. For all their courage and sacrifices of life, these children seem to have died for nothing.

The number of child soldiers in all African civil wars is simply unbearable. The number of street children is always on the increase; defilement and rape cases are heart breaking; and if poverty or AIDS had a human face, it is highly likely to be that of an African Child!

The day of the African Child is supposed to be a day for celebrating and acknowledging our children as Africa's most valuable asset. A day on which nations, families and communities should reflect on the challenges and threats that compromise the healthy growth and development of children, and their health and well being of their children.

It is also a day on which all of us, as adults, should assess opportunities for enhancing children's lives, individually and collectively, in the home, in schools, communities and other institutions that potentially make a positive difference in the life of a child.

This year’s them could not have been any better. “Stop Child Trafficking.” The rate at which children are being trafficked within and across the boarders is heart breaking.

In many a posh home, there are multitudes of children enslaving away as maids. Their only crime is being orphans, coming from poor families and dropping out of school, with rich relations in need of cheap labour.

According to a Rapid assessment report in trafficking of children into worst forms of child labour, including child soldiers in Uganda, conducted in the districts of Busia, Kalangala, Masaka, Pader and Kampala, as part of the International Programme on the Elimination of Child Labour Time Bound Programme by the ILO, child traffickers mainly target children who have lost their parents, mainly out of school and at the brink of poverty.

The report further says that most of the children are promised employment opportunities, a better life, making quick money and school fees. And in addition to the promises made to children, guardians are also enticed with sugar, alcohol and monthly remittances of income earned by the children.

With all these gruelling scenarios, it defeats thinking that we have to wait for June the 16th to think about our children.

On Wednesday the 13th June 2007, the African Network on Prevention and Protection against Child Abuse and Neglect (ANPPCAN –Uganda) organised quite a successful dialogue, during which the above report was launched. But while these efforts are commendable, the situation demands that there is still a lot to be done.

The driving factors of children into vulnerabilities are quite overwhelming. These cannot wait for June the 16th or thereabout to manifest. They are daily occurrences. Unfortunately, they seem to have become part of us.

Sparing at the bare minimum a minute each day to think about the African Child will do miracles, and brighten up the future of our children. You do not have to wait for June the 16th to make a contribution. All you need is a heart that cares for the children – all children!

Environment Sustainability Key to Sustainable Development

By Paul Kimumwe

During the United Nations Millennium Summit in 2000, 189 Heads of State and Governments pledged to work together to make a better world for all by 2015. On our behalf, they signed the Millennium Declaration, which promised to free men, women and children from the dehumanizing conditions of extreme poverty and make the right to development a reality for us all!

To this end, Eight Millennium Development Goals were adopted, committing both the rich and poor countries to work together to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women,reduce childe mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability and develop a global partnership for development – all by the year 2015.

While some progress has been made in the right direction in regards to all eight goals, with less than 10 years left for the deadline, goal number 7, which is, “Ensuring Environmental Sustainability,” still lags behind.

According to the Millennium Developmental Goals Progressive report that was released in May 2005, there should be drastic improvements in our efforts; otherwise, “sustainability will not be achieved with current patterns of resource consumption and use. Land is becoming degraded at an alarming rate. Plant and animal species are being lost in record numbers. The climate is changing, bringing with it threats of rising sea levels and worsening droughts and floods,” is warns.

“Environmental sustainability means using natural resources wisely and protecting the complex ecosystems on which our survival depends,” says the report.

Missing link
Unfortunately, the failure to make a linkage of all these eight goals has left gaps and uncoordinated strategies that have undermined the very essence of working for sustainable development.

“For most people, environmental protection means planting trees. They can not understand how their health, farming methods, means of income and feeding habits are important in protecting the environment,” says Mr. Maurice Bafirawala, the District Environment and Forest Officer of Kalangala District.

Howevr, “if people are poor, then chances are that they will resort to using any means in search for survival, and in a fishing community like ours (Kalangala Islands) that is when they start using poor fishing methods like fish poisoning, using small nets, and this has a negative impact on the state of our fish stocks and quality of fish products,” adds Bafirawala.

Dr. Peter Waiswa, the Deputy Director of Iganga District Health Services says that the interrelationship (among all these goals) is so great that it si becoming increasingly importantt to revise our approach to both health promotion and poverty alleviation strategies.

“When people live in a health environment with access to clean water, the chances of suffering from communicable diseases are lessened. In turn, the number of children and women, who are the main victims of these backward diseases, reduces greatly. Besides that, the high rate of school drop outs especially for the girls is highly associated with poor sanitation facilities at their schools,” he says.

Thus, by ensuring a health environment (goal 7), child mortality (goal 4) and maternal mortality (goal 5) would have been catered for, and so is goal 2 (achieving universal primary education) and promoting gender equality and women empowerment (goal 3) by ensuring more girls finish school.

No ones concerned
It is however sad to note that protecting the environment is a duty that no one has been willing to take upon his/her sleeves.

“No body seems to mind about the state of environment, especially in their day-to-day lifestyles,” Says Kayondo Titus, a field officer with Uganda Environmental Education Forum.

“People are so eager to get rid of water bottles, airtime cards, milk pouches, polythene (kaveera) bags and other wastes both at their homes and places of work without regard of where these wastes end up and their impact on the environment. It is frustrating to see grown up people littering everywhere without feeling guilty,” he adds.

The tendency however stems from the deep-rooted apathy within the population, and the failure to think beyond the self. There exits wrong thinking that issues to do with environmental protection are a responsibility of the politicians and other authorities.

Bafirawala however says that this apathy can partly be attributed to the chronic poverty that has been mistreating our people for so long, with the least opportunity of escape.

“When people are poor and not sure of survival the next day, chances are that they will cut the next tree for charcoal, clear a forest to get land for cultivation, poison the fish, and it is these unsustainable behaviours that have exacerbated the situation,” he says.

Challenges
The biggest challenge however has been the failure on the part of the development-oriented activists to include environment concerns in their search for prosperity. Unfortunately, the environmentalists have also been short sighted in their cause to conserve the environment with little or no regard at all to the prevailing political, social, cultural and economic concerns of the populations.

Secondly, the ever increasing population has systematically been exerting pressure and overwhelming the capacity of the support systems to recuperate from the shocks that are so often inflicted by natural disasters such as storms, droughts.

This population explosion has also been accompanied with its own evils, yet reversing the situation is more of a myth especially in developing nations, which have very alarming fertility rates. According to the MDG progressive report, by 2007, the number of people living in cities is expected to exceed the rural population in developing regions.

“Nearly one in three city dwellers — almost 1 billion people — lives in slums, in conditions characterized by overcrowding, little employment or security of tenure, poor water, sanitation and health services, and widespread insecurity, including violence against women. Not surprisingly, disease, mortality and unemployment are considerably higher in slums than in planned urban settlements,” says the report.

Yet these are just but two of thousands of environmental issues that must addressed.

ICT and Environmental Journalism

One of the newest breed of journalism that is slowly but systematically taking shape is Environmental Journalism. Though late by timing, at least it is refreshing that it has finally taken off.

And with the emergency of the ICT wonder, environmental journalism has a better future. This is because despite the richness and importance of this beat, there has been litttle interest from both the journalists and editor not to mention media owners to put some more time on environmental issues. "Because environmental issues are not sexy".

Secondly, reporting about environmental issues has been shallow, largely due to the difficulty in accessing the relevant information need to make a reasonable news story.

It is therefore my hope that with the availability of new ICTs, even with limited accessibility due to the high cost and other factors, journalists should be able to write comprehensive environmental articles that will catch the eyes of the editors.

More to this, the possibility of creating a blog or a website should be exploited so that these story can be published. You will get surprised at how much you can change the world.

But as it is always said, new ICTs can only enhance what is already there! If you are not good, do not expect to make miracles with ICTs.

Cheers and go start now. It is already too late!

Love for the Environment

My first time to interact with nature was not a good experience. It is almost 13 years ago, but it still seems like yesterday. It was so cold and i was practically freezing. But if i was to the family was to eat, then i had to go and fetch fire wood.
And so, i went. Two hours later, i had swelling all over my body, courtesy of mosquito bites. I vowed to cut down all the trees and bushes in which these vampires were breeding enmasse without.
Unfortunately for me, I was later to learn that these creatures had as much a richgt, an inherent ecological right to live just as i did. The question was, How do we co-exist?

Continues! Watch this space.

Profile

Paul Kimumwe:
Media Consultant in Health Communication, with special interest in Child and Maternal Health, Adolescent Sexual and Reproductive Health, HIV and AIDS, Human Rights, Health Economics, Gender and Environment.

I hold a Bachelors Degree in Mass Communication from Makerere University, Postgraduate Diploma in Environmental Journalism and Communication and pursuing a Masters of Science in Population and Reproductive Health - Makerere University.