UNDERSTANDING THE SEXUAL &

REPRODUCTIVE HEALTH OF VERY YOUNG

ADOLESCENTS IN RURAL UGANDA

VIOLA NYAKATO, PHD, MPH; YOLANDE POKAM TCHUISSEU; TYLER ANN JOHNSON; RUTH
KAZIGA, MA; DORCUS ACHEN, MA; MARK RUMANZI ; RACHEL MCGLONE; CHRISTINE
KARUNGI; SUSAN KOOLS, PHD, RN, FAAN

THE PROJECT DESCRIBED WAS SUPPORTED IN WHOLE OR IN PART BY THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES OF THE NATIONAL INSTITUTES OF HEALTH UNDER
AWARD NUMBER T37MD008659. THE CONTENT IS SOLELY THE RESPONSIBILITY OF THE AUTHORS AND DOES NOT NECESSARILY REPRESENT THE OFFICIAL VIEWS OF THE NATIONAL INSTITUTES OF
HEALTH
SEXUAL AND REPRODUCTIVE HEALTH STATISTICS

• Young people aged 0 – 24 comprise roughly 70% of the total population of Uganda (2017)
• Of the 1.2 million total pregnancies recorded in Uganda, 25% are teenage pregnancies
• Furthermore, 43% of young mothers in Uganda reported having forced sex which lead to
• Increased number of teenage pregnancies among Ugandan girls
• Increased number of HIV infected young women

(Lori Heise et al. 1995, Birungi, Harriet et al. 2008)

RESEARCH QUESTIONS

• What are very young adolescent perceptions of the context in which they are growing up in
rural Uganda?
• How do these perceptions relate to their SRH?
• Our specific aims included:
• Describing VYA perceptions of the sociocultural context in which they grow up
• Analyzing how VYA perceptions of factors within their social context might influence
sexual development and behavior
METHODOLOGY

• Collaboration with Community Advisory Board

• Naturalistic Observation and Field Notes
• Key Stakeholder Interviews
• Five individuals were selected by the research team to be re-interviewed this year
• Photovoice and Focus groups
• The participants (n=20), of which 9 were males and 11 were females, were given a
camera phone and instructed to take 10-20 photos that impacted their
development as an adolescent
• Young adults were then placed in gender specific groups of 4-6
• They discuss their experiences as they reflected on their adolescence in the
community
ANALYSIS
• Transcription of the field notes, key stakeholder interviews and focus groups
• Coding of the transcriptions
• Themes
• Patterns
• This two-year research project was informed by two theoretical frameworks
• Socio-Ecological Model
• Holistic view of the influential factors
• Positive Youth Development
• Allows for a different and stronger approach in explaining the development of young
adolescents
 School and Staff Sex Education
and
Peer Influence
Communication

Parents/
Caregivers

Limited Resources
Gender
Lack and
Inequality impact
Accessibility of
on SRH outcomes
resources

Religion and
Media

Emerging Themes
LIMITED RESOURCES
• Education is a resource
• A Key stake holder also referenced a direct link between poverty and gender
violence
“The main reason is low household income. When income is low, even when
you get friends and they make you happy sometimes they make you drink.
They [parents] say that’s where you’re spending your money. Then you go
home and violence starts because you didn't bring anything [money]”
-Male participant in focus group
• Another reference made included the problem of young girls being unable to
acquire feminine products due to limited resources
“We give emergency pads that will help in the moment, but unfortunately,
when they get home they will have no money or facilities to buy and use
pads. In this case they will miss a couple of days of school”
-Key stakeholder interview
SEX EDUCATION AND COMMUNICATION
Different sources of information (especially related to SRH) and support( or lack thereof) impact
the growth and development of VYAs. These include
• Parents and Caregivers
• Peer Influences
• School and supportive organizations
• Religion and Media
SEX EDUCATION AND
COMMUNICATION
“So when someone starts feeling shy about their bodies, you know they’ve started adolescence. The teachers
would tell us not to engage in sexual intercourse with any girl because by doing so, you would automatically
impregnate her. He would tell girls to do the same when they started developing breasts”

-Participant from focus group

“Actually we learned about that from school, teachers would tell us about wet dreams are normal and of the body
changes. As for our parents, they didn't tell us about wet dreams.”
-Participant from focus group
“The first picture is the bible, it has helped me stay in spirit with God and I have managed to stay away from
ill manners. When I felt disturbed or depressed, I looked to God for solace and peace.”
-Participant from focus group
“If you meet good friends, you do good things. If it’s a bad group, you follow the practices they do like
drinking alcohol, betting, and others.”
-Participant from focus group
GENDER INEQUALITY

• Gender roles seem to have a large impact on SRH of VYAs in the rural Ugandan community
“Unlike his sister, he is much stronger. There is nothing that can scare him, so parents look at having
a son as a special thing because he will one day be the head”
-Participant from focus group
“ Girls have a difficult time growing up because at home, they don’t count as children”
-Key Stakeholder
GENDER INEQUALITY (CONT.)
• Outlook on ‘pulling’ and circumcision
“If you are not pulling then the man will leave you”
-Participant from focus group
“Circumcision for boys though is not embraced by most parents because it is
painful”
-Key stakeholder interview
• Forced married and transactional sex
“There are instances where some parents will force you into marriage before
you are of age because they want to get money and property”
-Participant from focus group
GENDER INEQUALITY (CONT.)
• Sexual harassment and assault affects VYAs

“ These old men beg for sex a lot especially from young girls like us”
-Participant from focus group
“ Employers will ask for sex or marriage… we girls suffer a lot”
-Participant from focus group
“There are instances where some parents will force you into marriage before you are of age
because they want to get money and property”
-Participant from focus group
FUTURE WORK
• Dissemination to the Community Advisory Board as well as the community as whole
• Provide data for an intervention that is:
• Community Driven
• Culturally tailored
• Strength based
• Developmentally appropriate
WORK CITED
• Benson, P. L., Scales, P. C., Hamilton, S. F., & Sesma, A., Jr. (with Hong, K. L., & Roehlkepartain, E. C.). (2006). Positive youth
development so far: Core hypotheses and their implications for policy and practice. Search Institute Insights & Evidence, 3(1), 1–
13.
• Birungi, Harriet, John F. Mugisha, and Juliana Nyombi. "Sexual and reproductive health needs of adolescents perinatally infected
with HIV in Uganda." Sexual and reproductive health needs of adolescents perinatally infected with HIV in Uganda (2008): n. pag.
Web. 19 July 2017.
• Heise, L., Moore, K., Toubia, N.,  "Sexual coercion and reproductive health: A focus on research." Reproductive Health Matters 3.6
(1995): 175. Web. 19 July 2017.
• Neema, Stella , Nakanyike Musisi, and Richard Kibombo. "Adolescent Sexual and Reproductive Health in Uganda: A Synthesis of
Research Evidence." (2004): n. pag. Web. 19 July 2017.
• Rimer, Barbara K, and Karen Glanz. Theory at a Glance: A Guide for Health Promotion Practice. Bethesda, MD: U.S. Dept. of Health
and Human Services, National Institutes of Health, National Cancer Institute, 2005. Web. 19 July 2017.