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Saturday, February 4, 2023

COVID-19: Impact on access to ASRH services by young people

Adolescent Sexual and Reproductive Health and Rights (ASRHR), has generally been overlooked for decades despite the high risks that countries face for its neglect.

There are still barriers hindering access to Adolescent Sexual and Reproductive Health (ASRH) services globally, and in Ghana, access to appropriate information on contraception and treatment for Sexually Transmitted Infections (STIs) for many adolescents, are either not available or are provided in a way that makes them feel unwelcomed and embarrassed.

The 2017 Ghana Maternal Health Survey, reports the contraceptive prevalence rate for any type of method to be 31 per cent among married women, with 25 per cent of this group using modern methods.

However, the corresponding figures for sexually active unmarried women are 38 per cent and 31 per cent respectively and indicate that with the country’s total fertility rate standing at 3.9 per cent at the time, it shows that 20 per cent of married women still have an unmet need for family planning, in spite of the steady increasing prevalence of contraceptive use over the years.

The Survey also shows that 14 per cent of women aged 15 to 19 years were either mothers or pregnant for the first time, and that modern contraceptive prevalence rate among this age group was 6.9 per cent, while about 24 per cent of married women in this age bracket, modern contraceptives.

The statistics may not be the same as now, but there are undocumented evidence of increases in teenage pregnancy across the country especially during the COVID-19 lockdown, and the neglect of ASRH services, amounts to the gross violation of the Fundamental Human Rights of adolescents, as enshrined in Ghana’s 1992 Constitution which demands that quality access to healthcare be provided to all.

The World Health Organisation (WHO), however, notes that adolescents are likely to face a range of health and social challenges, such as the initiation of sexual activity while they lack adequate knowledge and skills for protection, which places them at a higher risk of unwanted pregnancy, unsafe abortion and sexually transmitted infections including HIV and AIDS.

Furthermore, the high prevalence of early marriage and childbearing in some of its Member States, are associated with higher maternal mortality and morbidity, as well as neonatal and infant mortality in adolescents, because pregnancy during adolescence is associated with a higher risk of health problems like anaemia, sexually transmitted infections, postpartum haemorrhage, and mental disorders like depression.

The WHO also notes that pregnant adolescents often bear negative social consequences and have to leave school, which can reduce their employability leading to long-term economic implications, and aside these challenges, unmet needs for family planning, especially for spacing are high among adolescents.

Mercy (not her real name) is 19 years old and a young mother of a nine-month old baby girl and a resident of James Town, a popular fishing community in the city of Accra, has to discontinue her education because she became pregnant, but she is now a peer educator in her community after benefiting from a capacity building programme by the United Nations Population Fund (UNFPA). She now supports her peers with fruitful and lifesaving advice on the uptake of Family Planning (FP).

Speaking to the Ghana News Agency under the “Mobilizing the Media for Fighting covid-19″ project being implemented by the Journalists for Human Rights in collaboration with the Ghana Journalists Association (GJA)”, she says; “living in James Town is very challenging because of the pressure from our society concerning childbearing at a certain age because of poverty, as most of the youth here have no jobs”.

“I wish I can tell you a different story about my life, but no, this is my life, and I was afraid to go to the clinic at mt the early stages of the pregnancy because my friends told me that I can be infected with COVID-19 and even die if a go to the clinic, so I did not have any antenatal care until my pregnancy was seven months old,” she said.

As Mercy makes great efforts to remain calm throughout her narration of her sexual encounter with her teenage fiancée on that faithful day, a clear picture is painted about the existing negative socio-cultural attitudes and believes regarding contraceptives use, is the result of the low level of knowledge and acceptance of these life-saving interventions among especially, young adolescents in the community, leading to high teenage pregnancy during the COVID-19 pandemic lockdown in Accra.

Studies by the Ghana Health Service (GHS), also shows a rising teenage pregnancy rate among some deprived communities in the city, and this is confirmed in an interview with Naa Kaaley (not her real name), also a teenage mother who lives at Chorkor Chemuena, another deprived fishing community in Accra.

She says; “here, nobody cares about stigma, because it is not strange for a girl of my age to get pregnant or give birth. At 18 years, I am a proud mother of a set of twins, but life has not been easy at all because my babies were delivered through a caesarean section”.

“It has not been easy for me at all since I became pregnant during the COVID-19 lockdown in Accra, and because my boyfriend also rejected me, I now depend on my mother who is self-employed,” she said in a shaky voice almost breaking down in tears.

Like most of the reproductive health indicators, the state of ASRH in Ghana is far from ideal, as high adolescent birth rates and unsafe abortions continue to be issues of social and public health concern.

The COVID-19 pandemic is also posing considerable challenges for Ghana in maintaining the provision of high quality, essential child and adolescent health services, because the attention of the government and development partners have shifted towards fighting the virus, leaving other programmes and interventions such as ASRH service provision to suffer.

In the heat of the spread of the pandemic in Ghana, for instance, the government as part of its interventions imposed a lockdown on high-risk communities in areas including Greater Accra, and Greater Kumasi regions respectively, while shifting focus on health service provision, to COVID-19 care with the majority of health care professionals reassigned to duties related to providing such services, an arrangement, which has disrupted other health intervention programmes and activities.

Besides the 1992 Constitution of Ghana, which guarantees the rights of citizens including women and children, the country is a signatory to key international documents and treaties including the UN Convention on the Elimination of all Forms of Discrimination against Women, the 1994 International Conference on Population and Development (ICPD) Programme of Action (PoA), and the 2030 Agenda for Sustainable Development which seeks to improve SRHR for all.

Although some improvements have been made towards improving ASRHR and ensuring access to SRH, especially for adolescents in deprived communities after adopting the ICPD 1994 PoA, and subsequently, the ICPD 25 commitments in Nairobi, Kenya by countries globally, they are not enough to address the impending problems.

At the ICPD 25 for instance, governments made commitments to uphold the reproductive health rights of women while empowering young people especially girls to achieve their full potentials.

The Government made a commitment to reduce the maternal mortality rate of 70 per 100, 000 live births by 2030 and enhance access to all adolescents and youth to culturally sensitive and age appropriate information and education as well as quality and responsible reproductive health services.
Other international and regional human rights laws such as the 2003 Protocol to the African Charter on Human and Peoples’ Rights, on the Rights of Women in Africa, enshrine states’ obligation to provide adequate, accessible and acceptable health care, which includes sexual and reproductive health services.

Article 25 (1) of the United Nations Convention on Human Rights, enjoins everyone to have access to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The same Article 25 (2) also talks about motherhood and childcare, which are entitled to special care and assistance, therefore, the lack of access to ASRH services is a violation of their human rights.

Ms Vicky T. Okine, the Executive Director of the Alliance for Reproductive Health Rights (ARHR), indicates from her desk in the First Edition of the Reproductive Health Watch Volume (1), states that although reproductive rights are human rights that are protected by Ghana’s Constitution, many are denied these rights on daily basis.

She said despite government health policies and commitments, progress in SRH in Ghana has been rather mixed, explaining that though antenatal coverage has improved, deliveries and the level of contraceptive use are still not encouraging.

“No wonder Ghana still has high rates of preventable deaths and injuries related to pregnancy, childbirth and AIDS. Furthermore, there are glaring inequalities in the health sector. More than half the population do not have access to services that are proven to reduce maternal deaths, such as access to deliveries by medical personnel, well-functioning health facilities, and emergency obstetric care,” she said.

Ms Okine said although Ghana has scarce resources, leading to inadequate health sector funding, the inefficiencies and inequalities in the system has produced devastating health outcomes, especially among poor and rural populations.

The United Nations Children’s Fund (UNICEF) reports that although the full extent of COVID-19’s impact on economies, societies and health is still unknown and unfolding every day, yet, if life-saving interventions are disrupted, many more children and adolescents could die from treatable and preventable conditions.

Therefore, adequate investments in health systems must be made to respond to the pandemic and ensure the continuity of critical child and adolescent health services and supplies.

Mr Niyi Ojuolape, the Country Representative of the United Nations Population Fund (UNFPA), Ghana, at the 2021 SRH Summit in Accra, called for urgent actions, prioritisation, and increased funding for ASRH services, saying, the world would be sitting on a time bomb that is waiting to explode if it fails to act now.

He indicated that the world is facing a greater pandemic than COVID-19, with the alarming increases in teenage pregnancy, and said giving ASRHR the deserved priority on the national agenda is very critical for the achievement of Universal Health Coverage (UHC) and the UN Sustainable Development Goal (SDG 3.7 and 5.6) targets, because it is the foundation for good health for women and children, impacting all aspects of development.

He said current studies show that the COVID-19 pandemic, has aggravated the economic plight of most underprivileged families, causing parents to desert their homes and children in search of funding, thereby creating a gap in supporting their adolescent children and exposing them to various forms of abuses.

Mr Ojuolape, however, said amid a pandemic that is straining even the most robust of healthcare systems, there is a real risk that these rights of adolescents will move even further from reach.

Experts say expanding access to Sexual and Reproductive Health (SRH) services is one of the key targets of the Sustainable Development Goals, and the extent to which these rights targets will be achieved largely depends on how well they have integrated within Universal Health Coverage (UHC) initiatives.

Dr Leticia Appiah, the Executive Director of the National Population Council says reproductive health, family planning, and education combined, is a social vaccine against poverty, and without focusing on these, it would be difficult to solve the existing problems, leaving societies caught up in a cycle of poverty.

She called for deliberate investment and advocacy towards ASRH services, arguing that if the global community within a year of the COVID-19 pandemic, can agree to fight the virus through simple and inexpensive interventions like basic hygiene, mask-wearing, social distancing, interventions, and vaccination while taking steps to develop health infrastructure globally, then, the same interventions can be adopted for other health challenges.

She called for stakeholder commitment, political will and increased investment to holistically address ASRHR issues, while adopting innovative technologies to improve access to a safe and supportive environment, with appropriate information and services, including counselling on mental health, nutrition, sexual and reproductive health, and ensure the active participation of young people in programmes affecting them.

The health and development of adolescents and young people are crucial for the development of every country, as they form the nation’s most valuable resource, stakeholders including the media, must devise innovative and compelling ways to support duty-bearers to reduce funding and mind-set, keeping the country on the more expensive and unsustainable path, because the economic, social, and healthcare burdens are enormous.

Source: Christabel Addo|GNA.

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