A row has broken out in Uganda over proposals to extend sex education to 10-year-olds and give some 15-year-olds access to family planning services.
The Ministry of Health has refused to endorse the guidelines, which were designed to tackle the country’s high teenage pregnancy rate, objecting that they are morally wrong and would encourage promiscuity and abortions.
Activists condemned the decision as a “failure of leadership”.
Uganda’s first lady and minister for education, Janet Museveni, has also waded in to the controversy, calling the distribution of free contraceptives an “erosion of morals”.
At an event to mark International Day of the Girl last week, she said: “We no longer have pride to say no. People are given contraceptives to use them and do what they want, have sex, take pills, conceive and abort. This is not our culture in Africa.”
The revised national guidelines were drawn up by the health ministry’s own reproductive health division, with support from civil society organisations. They outline the need for “age-appropriate” sex education for 10- to 14-year-olds, promoting “information focusing on growth and development, life skills, proper nutrition and personal hygiene, abstinence, delay of sexual debut, staying in school”.
A broader range of services – including access to family planning and contraceptive services – were recommended for sexually active females between the ages of 15 and 49.
More than a quarter of 15- to 19-year-old girls in Uganda are pregnant or have given birth. Women have an average of five children, a figure the government wants to reduce, but just 24% of women use a modern form of contraception.
“There are certain provisions in the … guidelines that we don’t agree with, [we find] uncomfortable and can’t accept,” said Joyce Moriku, health minister. “How can you teach [sex education] and provide family planning services to children below 18? The civil society organisations should feel ashamed.”
But activists said the guidelines were “entirely appropriate”, considering the average age of first intercourse in Uganda is 16.
“The guidelines do not recommend family planning for 10-year-olds. The ministry is blocking guidelines they themselves contributed to,” said Asia Russell, of the Health Gap project.
Russell said the refusal to launch the revised proposals was symptomatic of a far greater problem. “The Ugandan government is resisting evidence-based interventions to respond to the crisis of teen pregnancy in the country – a crisis that has gotten no better over the last decade.
“By repeatedly obstructing tools that work, such as school-based sex education and these guidelines on family planning for health workers, government leaders are burying their heads further in the sand.”
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Simon Richard Mugenyi of Reproductive Health Uganda said abstinence-only messages had not curbed teenage pregnancy, but pointed to the success of sex education programmes that promoted contraceptive use among sexually active young people.
The Ugandan representative of the UN population fund, Alain Sibenaler, said the ministry needed to clarify its policy. He said the agency was concerned about the 10-year stagnation of Uganda’s teenage pregnancy rate, despite the country’s progress in reducing maternal deaths.
Having withdrawn guidelines to prevent unsafe abortion in 2015, the government last year banned sex education. The education ministry is finalising new guidance that could reverse the ban.
“I know our morals, religions and cultural norms are very important to us. But as long as we continue to pretend that our young girls are not having sex and not getting pregnant, we shall be doing a disservice for them,” said Justine Balya of the Human Rights Awareness and Promotion Forum.