By MUNYARADZI CHIMWARA
“Almost everyone in the world will need access to sexual and reproductive health services (SRHS) at some point in their life. The demand for SRH services is higher among adolescent girls and young woman (AGYW). Adolescence (ages 10–19) is a critical time period in life during which people undergo extensive biological, psychological and social changes. Sexual and reproductive health (SRH) plays an integral role during adolescence and can affect many aspects of a person’s life during and after this time. Adolescents face a multitude of risks and challenges related to SRH, including those related to early pregnancy and sexually transmitted infections (STIs).”Fatusi and Hindin 2010; Dick and Ferguson 2015 89 girls in Makoni District dropped out of school after falling pregnant.
The school girls fell pregnant between January and September 2019 prompting most of them to miss writing their end of year examinations. Of the 89 girls, the youngest is 13 years and only two are 18 years old. This highlights the gaps that exist in the provision of sexual and reproductive health services to adolescent girls and young women in Zimbabwe.
Health services provision encompassing interventions addressing sexual health education, family planning, HIV and STI prevention, safe abortion, menstruation, voluntary medical male circumcision has the potential to affect a wide range of outcomes in an adolescent’s life. With more adolescents in the world than ever before, this is an important part of the population that will have a direct impact on the wider community and economy. SRH issues pose serious concerns for adolescents.
Second only to young people aged 20–24, adolescents 15–19 years old have the highest rates of contracting sexually transmitted infections (STIs), including HIV. (Dehne and Riedner 2005). According to the WHO, pregnancy related complications are the second leading cause of death among girls aged 15–19 in Sub-Saharan Africa.
Furthermore, adolescents have less access to information and services. In a 2014 report, the UNFPA noted that twenty-two per cent of females 15–24 years old worldwide have access to contraceptives, compared to 60 per cent of women older than 30.to undermine the welfare and wellbeing of adolescent girls and young women (AGYW).
In Zimbabwe, the legal framework regulating access to reproductive health-care services continues to restrict AGYW’s access to much needed SRH services. Policy inconsistencies in the implementation of the ARSH strategy across the country for adolescents continues to create inequity blocking AGYW’s access to vital services.
Section 76 of the Zimbabwe constitution guarantees access to health services for all citizens and non-discrimination based on age. In spite of such constitutional provisions, the National HIV Testing Guidelines of 2014 and the Public Health Act of 2018 limit the age to accessing Reproductive Health Services to 16 years.
This has created one of the biggest barriers to the access of Reproductive Health-care Services leading to new HIV infections, unplanned pregnancies and unsafe abortions. UNICEF reports that more than 70 000 illegal abortions are carried out in Zimbabwe every year, with Zimbabwean women at 200 times greater risk of dying.
The need to address legal and policy barriers is urgent. Access to SRH services for women of all age groups brings gender equality. Gender equality is a human right. AGYW like all women are entitled to live in dignity and in freedom from want and fear, without discrimination. Gender equality is also vital to sustainable development, peace and security. It’s not just a women’s issue. It’s an issue for all of humanity.
Zimbabwe has an obligation to advance the new agenda for sustainable development, which enshrines gender equality as one of its goals. The ability of women and girls to exercise their basic human rights, including their right to sexual and reproductive health, is a prerequisite for achieving the Sustainable Development Goals.
Studies have demonstrated clearly that family planning is the best investment countries can make for human development. Ensuring universal access to voluntary family planning means putting the poorest and marginalized girls at the forefront of our efforts.
Studies show a general lack of comprehensive information and knowledge about RHS among adolescents and according to Zimbabwe Demographic Health Survey, 2015 (ZDHS 2015) only 41% of boys and girls in the 15-19 age groups have sufficient knowledge or information on reproductive health.
Religious and Cultural Practices in Zimbabwe limit space for easy access to RH information and services by this group, providing alternatives that are not scientifically approved. This hinders uptake of RH services at public health service delivery points. Furthermore, adolescents or young people require parent’s or third party’s consent when faced with an RHS need.
Minors would rather forgo competent medical treatment than to divulge such information to their parent or guardian. It is for this reason that Access to Healthcare for all should be prioritized as reflect in the Constitution.
The law must also promote accurate and balanced sex education for adolescents and young people, including information about their sexual and reproductive health lives as a basic human right for adolescent and youths. Such education helps young people to develop healthy relationships, consequently reducing their risk of potential negative RHS outcomes, such as unintended pregnancies and sexually transmitted infections (STIs).
Such education can also help adolescents and young people to enhance the quality of their relationships and to develop decision-making skills that will prove invaluable for life.
The Access to SRHS Services objective is premised on the need to reconsider policies on the requirements for consent to promote effective RHS access by adolescents and young people whilst maintaining a balance with parental oversight and rights as well as affording third parties sufficient legal protection when adolescents seek RHS.
When policies, frameworks and laws are ambiguous or restrictive in nature and application, barriers are created for both adolescents seeking the service and the health provider delivering the service. Adolescent girls and young women (AGYW) must be given the legal right to access SRH services at will.
According to the UNFPA women and girls who can make choices and control their reproductive lives are better able to get quality education, find decent work, and make free and informed decisions in all spheres of life.
Their families and societies are better off financially. Their children, if they choose to have them, are healthier and better educated, helping break the spiral of poverty that traps billions and triggering a cycle of prosperity that carries over into future generations.