Uganda’s staggering rate of teen motherhood can shatter life dreams

In this East African country, many young women’s dreams of earning a university degree and pursuing a career are being shattered because they can’t access the contraceptives they need to avoid getting pregnant before they are ready for that major life challenge. They are also dying at high rates while pregnant or from giving birth, especially in rural areas. The situation is emblematic of a broader problem affecting the futures of young women globally, especially in developing countries.

“If the services were closer to me, I would have accessed them, and I wouldn’t have had children at my age,” Jackline Kabugho, 19, said in an interview, in rural Uganda. “I might have become a schoolteacher, as that was my dream.”

Health experts emphasize that the low availability of family planning services in developing countries — and even richer ones — plays a major role in influencing fertility rates and population growth, leaving young women and adolescents out on a limb in not only obtaining an advanced education degree but also affecting their health and well-being.

Research released in July 2022 by the UN Population Fund (UNFPA), which focuses on women’s sexual and reproductive health rights, revealed that nearly a third of women in developing countries initiate childbearing at age 19 or younger, and almost half of the first births by adolescents occur among girls aged 17 or under. Despite an overall decrease in fertility rates between 2015 and 2019 globally, women who began childbearing in adolescence averaged almost five births by the time they reached 40.

The UNFPA report highlights the crucial effects of gender-based and income inequalities in driving teen pregnancies, resulting in increased child marriages, limited education, restricted career goals and inadequate health care and sex education. These factors impinge on a country’s ability to flourish and compete in the global economy.  

In Uganda, with a population of nearly 50 million, a staggering one-quarter of teenage girls aged 15 to 19 have begun childbearing. Rural areas are particularly affected by the high rate due to limited resources.

Across the world, approximately 295,000 women die annually from pregnancy and childbirth complications, primarily in low- and middle-income countries. According to the 2022 UNFPA “Motherhood in Childhood: The Untold Story” report, 218 million women lack access to modern contraceptives. These statistics reflect the need for comprehensive efforts to address sexual reproductive health and rights (SHSR) challenges on a global scale, expert say. The problem extends to domestic violence and poverty crises.

According to a July 2023 report published by the Guttmacher Institute, a research and policy organization promoting sexual and reproductive health rights globally, while worldwide maternal mortality dropped 38 percent between 2000 and 2017, standing at 152 deaths per 100,000 in 2020, maternal mortality rates in sub-Saharan Africa, including Uganda, remains alarmingly high, at 545 maternal deaths per 100,000 live births. The rate is the highest in the world and far above the Sustainable Development Goal target of less than 70 deaths per 100,000 live births globally by 2030.

Only half of partnered or married women in sub-Saharan Africa have their family planning needs met, and while some services are becoming more available, access to safe abortion, sexuality education, prevention of sexual and gender-based violence and counseling for sexual health and well-being are severely lacking.

Uganda’s maternal mortality rate, at 336 deaths per 100,000 births, is more than double the global average and continues to rank among the world’s highest, according to the Uganda Bureau of Statistics, despite a decline since 2011. Direct obstetric causes contributed to 73.8 percent of maternal deaths, with the most common being hemorrhage, sepsis, hypertensive disorders and complications of abortion; malaria and HIV/AIDS were the leading indirect causes.

In the mountainous region of Bughendera County-Bundibugyo District, in western Uganda, the scarcity of family planning resources profoundly influence fertility rates and population growth, hampering the aspirations of young women and adolescents. Remote villages can go weeks without contact from outsiders, and critical health services are often far away. Yet, young women there want to take charge of their reproductive health, as they repeatedly asserted in interviews last fall.

Agness Namara, for example, gave birth to her children at 16 and 19 years old, but because of the lack of family planning providers in her village, she had to walk long distances to the main hospital for care.

Health facilities in Bughendera County, however, are often understaffed and dealing with shortages of contraceptives. Winnierose Masika, who runs family planning services in the village of Harugale, said that most medical center in Bughendera County are not digitized and that village health teams are not motivated to computerize their work.

Jackline Kabugho, 19, has two children. She attributes her early motherhood to having minimal information on contraceptives as well as family poverty. She said that she feared going to the health facility in her area to get advice on how to prevent an unwanted pregnancy, wary of social stigma, lack of privacy and potential judgment from healthcare providers.

Sheila Hosana Muhindo, a social worker and human rights activist in the area, said that despite legal age regulations, child marriage persists; although the legal age for marriage is 18 in Uganda, individuals can marry at 16 with parental consent. Domestic violence was another pervasive problem faced by adolescent mothers in the region, she noted. Economic pressures and social norms intensify the mothers’ mental health problems, as they do for women around the world.

Racheal Kabugho had to sell her retail shop in the town of Ntandi after experiencing complications while giving birth in 2022. The 20-year-old, who became pregnant while enduring an abusive relationship, now lives with her grandmother as she struggles to raise her child.

“I never intended to give birth at 19,” she said. “But, as you know, men often take advantage of girls, and that’s what happened to me. I tried to get family planning, but our facility didn’t have short-term methods, and I feared the long ones because he could find out.”

At the Bundibugyo Women With Disabilities center, Sarah Kabagenyi, an associate there, said that women with such challenges especially struggle to find health care and are often sexually exploited by men.

The number of young mothers seeking sexual reproductive health care services also remains low in the region because of limited male involvement. Due to entrenched cultural norms, lack of education, stigma, health system challenges, communication barriers and traditional power dynamics, men are often collectively discouraged from talking about these matters, Peace Muhindo, a health care worker in the village of Bukangara, said.

Lillian Vumilia, who is from another village, Bugombwa, dreamed of becoming a nurse after she finished her education, but when she had an unwanted pregnancy and was abandoned by her partner at age 18, she was forced to work odd jobs to support her child.

“When I got pregnant, I was too scared to tell my parents,” she said. “I had to run away from home, gave birth at a friend’s place, and my boyfriend abandoned me.” With better access to sexual reproductive health and other medical services, she said, she could have pursued her dream of becoming a nursing staff manager.

The call for male involvement in family planning, echoed by health workers like Peace Muhindo, requires a broader need for cultural shifts and awareness campaigns both in Uganda and beyond.

Annah Kukundakwe, a senior program officer at the Center for Health, Human Rights and Development, an indigenous nonprofit group based in Kampala, the capital, said that because nearly a third of all women in Uganda become mothers during adolescence, the country is unwittingly jeopardizing the future of young women.

The country, she argues, is raising a population that is highly dependent, uneducated and lacks employable skills, which hurts the overall national development agenda.

“We need to be flexible and understand that in many cases, families have become dangerous spaces for young girls and women,” she said. “We need to support families and parents. We need everyone involved.”