Harm reduction in adolescent sexual and reproductive health

Young people in Uganda face a high burden of sexual and reproductive ill-health. This includes a high risk of acquiring sexually transmitted infections (STIs), high burden of unintended pregnancy, sexual exploitation, and gender-based violence. Sexual and reproductive health (SRH) issues are stigmatized, especially for young people. This leads to low awareness about risk factors and consequences and limited access to services, especially where parental or guardian permission is required. The Ugandan government banned comprehensive sexuality education in 2016 and issued guidance which focused on abstinence. As a result, adolescents experience unwanted pregnancies, STIs, stigma and a lack of support when accessing contraception or safe abortion care.

What is harm reduction?

Harm reduction refers to strategies or services aimed at lessening harms associated with behaviors or practices that are socially, legally or morally prohibited. For example, sexuality education and contraception to prevent unplanned pregnancy among minors, or safe abortion services to prevent morbidity and mortality from complications caused by unsafe abortion. While acknowledging that potentially hazardous behaviors or practices may continue, the focus of harm reduction is on reducing risk, and lessening the harms associated with the consequences of such behaviors or practices. For example, accepting that while young people will always engage in sexual activity and experimentation, they may need help to limit the risks (of sexually transmitted infections and unplanned pregnancy) which may result.

Harm reduction strategies have the potential to promote health, improve quality of life, reduce morbidity and mortality, and promote equitable access to SRH services. They are applicable to prevention of HIV infection, prevention of cervical cancer through pre-adolescent Human Papilloma vaccination, prevention of early child marriage and high-risk sexual behaviors, reduction of child sexual exploitation, prevention of mortality from unsafe abortion, and management of gender-based violence.

How does harm reduction apply to unplanned pregnancy and abortion?

Unsafe abortion complications contribute to the high maternal mortality rate in Uganda. These complications can also lead to infections or genital trauma, and carry long-term consequences such as infertility and chronic pelvic pain. Complications from unsafe abortion threaten adolescents’ health, quality of life and wellbeing, and pose a big burden to the healthcare system.

Harm reduction can promote self-care in SRH as well as access to equitable services for marginalized populations. It can reduce the burden of unsafe abortion depending on women’s ability to access appropriate and timely information on SRH services (including contraception, safe abortion and management of sexually-transmitted infections), and on a functional supply chain that ensures availability of contraceptive services and safe abortion medications.

How do we work to reduce the burden of unsafe abortion through harm reduction?

Access to abortion care is affected by lack of information, unavailability of abortion care services, abortion stigma, cost of the procedure, and unclear legal context. Adolescents are subjected to additional restrictions, such as the requirement for parental consent to access services. On top of this, misinformation about the correct administration, dosage, and timing of medical abortion are widespread. Through our work, the Association of Obstetricians and Gynecologists of Uganda (AOGU) builds the capacity of healthcare providers in abortion care and family planning using the abortion harm reduction model. Through our call centre, we provide information on SRH issues, including contraception and safe abortion. Women empowered with information can then access abortion medications. Our call centre provides information and emotional support for those self-managing their abortions, as well as technical support for service providers who may need to provide post-abortion care and counseling to clients.

By Dan K. Kaye, Project Manager at the Association of Obstetricians and Gynecologists of Uganda, a SAAF grantee partner.

Photo credit: Jonathan Torgovnik/Getty Images/Images of Empowerment

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