LILLIAN BANDA, Lusaka
ONE of the targets of the Sustainable Development Goal (SDG) 3
is that by 2030, the world should ensure universal access to sexual and reproductive healthcare services, including the integration of reproductive health into national strategies and programmes.
One of the proposed indicators of this target is that the proportion of women of reproductive age 15-49 years- should have their need for family planning satisfied with modern methods.
Increased access to Sexual and Reproductive Health (SRH) information and services is key to reducing the number of girls becoming pregnant, leading to a reduction in the number of unsafe abortions among this age group, which according to expert reports, is mostly affected by unsafe abortions.
Studies have shown that empowering adolescents and young people with information pertaining to SRH significantly reduces the number of unwanted pregnancies, Sexually Transmitted Infections (STIs), as well the proportion of unsafe abortions.
Contraceptives prevent unintended pregnancies, reduce the number of induced abortions; both safe and unsafe, and lower the incidence of death and disability related to complications arising from unsafe abortions.
However, adolescents continue to face barriers to accessing reproductive health information and services. These barriers range from cultural beliefs and practices to lack of infrastructure and long distances to health facilities.
“Sometimes, youth-friendly corners are manned by elderly people, thereby making it difficult for young people to access information and services. I once went to a facility to get condoms. When I got there, I found two elderly women in a youth friendly corner.
“I felt uncomfortable to go ahead and request for some packs of condoms, so I pretended to have been looking for someone instead and walked away,” explained 19-year-old Chanda Mwaba of Chibombo district.
And another youth contends that reducing the number of unsafe abortions among this population requires practical and realistic solutions that take into account needs of today’s young people.
“We need to devise better ways of reaching out to young people, including those that are out of school and those that are hard to reach. Programmes should be designed to respond to the challenges young people face with regard to reproductive health,” asserts 22-year-old Lister Mulenga, a Lusaka resident.
A Mufulira resident, Cecilia Chabala, 18, suggests that counselling programmes for adolescents should be introduced in schools.
“A lot of adolescents struggle with a wide range of issues around
their reproductive health sexuality. There is also need for counselling, increased services particularly for adolescent girls.
Schools can also partner with institutions that offer counselling
services. Such arrangements can help girls that are going through difficult situations,” Mulenga says.
But what is the role of men and boys in ending unsafe abortions among adolescent girls and younger women?
“Currently, many stakeholders are investing a lot in changing attitudes and behaviours rather than addressing the primary drivers of unsafe abortions among adolescent girls.
“Issues of gender inequality, sexual violence and coercion and poverty are often not given that much attention. Many efforts also fail to recognise the role of men and boys in addressing unsafe abortions among adolescent girls,” explains 22-year-old Robert Mumba, a peer educator and youth rights advocate.
Mumba, who has worked with renowned youth centred organisations, notes that vulnerable girls are often sexually abused by older men who later abandon them upon realising that they are pregnant.
“My interactions with adolescents who are survivors of unsafe abortions point to the fact that many of them were victims of sexual violence. The majority of them indicated being involved with older men. Having no-one to turn to, most of girls resorted to using unsafe and illegal methods of terminating a pregnancy.
“There is urgent need to reach out to men and boys through programmes that help to bring about a sense of responsibility and make them accountable for their actions,” says Mumba.
It is important to note that access to SRH services also entails access to post abortion services even for persons that may have had an unsafe abortion. To this end, a medical specialist has called on the public to desist from condemning survivors of induced unsafe abortions but instead encourage them to seek professional help.
“Post-abortion care should be provided to every girl or woman in need of such services. That is not to say one is encouraging young people and women not to take preventive measures. The idea is to ensure that any complications that may come about as a result of the unsafe abortion are averted or managed.
“Complications from unsafe abortions can cause infertility or other long-term illnesses and death in tragic instances,” explains Zambia Association of Gynaecologists and Obstetricians Theresa Nkole.
Dr. Nkole pointed out that prevention measures, which include the provision of contraceptives to adolescents, should be encouraged.
She observes that while abstinence is the sure way of preventing unwanted pregnancies, some adolescents are unable to abstain, hence the need to ensure they access contraceptives.
Reverend Leonard Lukula of Kamwala South Assemblies of God church has, however, implored the Church to step in and address reproductive health issues affecting young people.
Rev Lukula said the Church should do so by supporting or initiating programmes that focus on giving information to enable young people to make sound decisions.
“Let us bear in mind that adolescence is a very crucial stage of a person’s life. It is can be both challenging and confusing. It is at
this stage many young people start to explore their sexuality and a lot of mistakes are made along the way. There is therefore need to provide them with proper tools and guidance.
“It is our responsibility as faith-based entities to provide our young people with guidelines not only pertaining to Christian walk, but also information for their daily practical application. Ideally, parents should be a primary source of information and guidance on sexuality, but others such as school authorities, faith and community-based entities should also step in,” rev Lukula said.
His congregation is working with experts who have been giving talks and facilitating discussions on reproductive health, including abortion, during meetings for young people.
“We are losing young people as a result of unsafe abortions. Most of them resort to having unsafe abortions to avoid stigma and discrimination. There is need to address matters of reproductive health as much as we address matters of righteousness. Let us have programmes that respond to the needs of young people,” Rev Lubula said.
The introduction of Comprehensive Sexuality Education and the creation of youth-friendly health facilities are some of the measures that Government and other stakeholders have put in place to address SRH needs of young people.
As a result, there are a number of initiatives aimed at encouraging parents, guardians and children to engage in conversations about sex and related issues.
Globally, about 3 million girls aged 15 to 19 undergo unsafe abortions annually. Community studies around the world indicate a higher magnitude of unsafe abortions than do health statistics. Unsafe abortion is estimated to account for 13 percent of all maternal deaths globally; this is according to a report by the World Health Organisation (WHO).
In Zambia, it is difficult to know the number of deaths resulting from unsafe abortion, as much as it is to know the number of survivors.