Reproductive cancers and social media among emerging SRHR issues — ICRW report

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 SEXUAL & REPRODUCTIVE HEALTH 

From an early age, Rose had her life all figured out: finish school, get a job, start a family and live happily ever after. For a while, the pieces of her life's jigsaw puzzle fitted nicely into place — until one day, four years into her marriage, she packed up all her stuff and left her marital home, never to return, together with her two children.

It is nearly six years now since calling it quits and Rose, who has asked to keep her real name anonymous, harbours no regrets over her firm decision.

"That man nearly killed me in that house. In our marital home, imagine!" she says, visibly upset, referring to her now ex-husband and father of her two boys, who are now nine and seven.

"Any small issue would trigger a violent side of him that I had never seen before. 

"At the beginning of our marriage, we would hold healthy conversations. But with time, he turned into a monster and he would beat me regularly. I became his punching bag," remembers Rose.

'I will not marry again'

Having silently endured torment for years, she finally pulled the plug on a torturous marriage, relieving her of dark, violent episodes of physical and mental suffering. 

Rose, who has since been living in one of three family houses built by her late wealthy father in Entebbe, Wakiso district, is glad to have put her abusive marital past behind her.

"Right now I am focusing on my life as a single mother. I don't intend to marry again. I will do all it takes to see my boys grow up into responsible men. I don't want them to be abusive to their future wives like their father was to me."

A trained nurse but now running a thriving private clothing business in Entebbe town, Rose is aware that her story is not unique. Her older cousin endured a similar experience until she finally tapped out.

"Her husband was a heavy drinker and, especially when under the influence, he would often beat her along with their three children. Eventually, she decided enough was enough and left for good," says Rose.

Her cousin's decisive departure from an unsafe space darkened by domestic violence inspired the 34-year-old to also do the same years later.

Rose and her cousin are part of an unwanted, staggering statistic that has stood for a long time. The United Nations (UN) says that nearly one in three women and girls worldwide will experience physical or sexual violence during their lifetime.

Emerging SRHR issues

Gender-based violence (GBV), like the two women faced, is one of many longstanding sexual and reproductive health and rights (SRHR) issues in Uganda and beyond.

Similar issues stretch this list to include high persistence of maternal mortality and morbidity, unsafe abortion, female genital mutilation (FGM) and child marriage as well as high HIV prevalence.

But there are also emerging SRHR issues in the country, as a study conducted by the International Centre for Research on Women (ICRW) in 2024 reveals.

One of them is the rising HIV fatigue, with 1,000 new weekly infections. More worryingly, 70 percent of all new infections among young persons are in adolescent girls.

The researchers also found out that there is a rise in the number of SRHR exclusion-prone persons.

"Many people are moving into the city to live. Many of these are settling in slums, where they may not have access to the resources they may need to live quality and productive SRH lives," said renowned Nigerian researcher Dr Chimaraoke 'Chima' Izugbara (pictured below).

The vastly experienced director of global health, youth and development at ICRW was sharing highlights of their study during a dialogue on SRHR in Uganda's capital Kampala last Friday (March 21) at Kampala Serena Hotel.

According to the World Health Organization (WHO), access to sexual and reproductive health services is a human right and should be available to all people throughout their lives.

In broad terms, SRH encompasses services that cover access to contraception, fertility and infertility care, maternal and perinatal health, prevention and treatment of sexually transmitted infections, protection from sexual and gender-based violence, and education on safe and healthy relationships. 

In reality though, such services continue to remain out of reach for many people who need them.

Take, for instance, the growing prevalence of reproductive cancers, which was also highlighted as an emerging SRHR issue in the ICRW study.

At a similar dialogue on SRHR in neighbouring Kenya last Wednesday (March 19), doctors revealed to ICRW researchers that they are increasingly seeing people walk into health facilities with cervical cancer, many of them at a terminal stage of the disease.

"With research on this, you are able to tell who is at risk very early on and you begin to target those people with interventions and programmes, which may be low-cost — including [sensitization] information and screening," said Izugbara.

Then, social media has also risen into a juggernaut of communication and networking but with a double-edged influence on especially SRHR issues.

While social media platforms have done well to fuel, say, GBV with implications on mental health, the same platforms have also been useful in addressing social needs of people. 

"People can get information on where they can get social services, where they can report cases of sexual abuse, etc," said Izugbara.

In January this year, a house help in Uganda's central district of Wakiso was sentenced to 40 years in jail after she pleaded guilty to torturing a four-year-old child under her care.

Footage showing the 35-year-old Precious Tumuheirwe abusing the toddler was widely shared on social media, drawing a lot of condemnation and more importantly, leading to her arrest by Police.

Other similar incidents circulated on social media have led to the arrest and subsequent prosecution of the perpetrators.

Defiled by dad

The evidence gathered by the ICRW team points to a long list of data gaps. One area that needs more work in this regard is child sexual violence, which lurks around, somewhat invisibly, in homes and schools.

"We don't have very strong nationally representative data in terms of this prevalence. We don't also know effective mechanisms for addressing it," said Izugbara.

At the beginning of Friday's dialogue — moderated by health activist and lawyer Dorothy Amuron — one moving story briefly shared by CEHURD executive director Fatia Kiyange (pictured below) revealed just how real — and serious — SRHR issues are.

CEHURD is a non-profit, research and advocacy organization whose work revolves around pursuing social justice in health.

One of the cases they have been handling involves a 15-year-old girl who was defiled by her biological father during the COVID-19 pandemic. She was 10 at the time.

"He is on remand and he has yet to be sentenced," said Kiyange.

At the inaugural Uganda National Conference on Health, Human Rights and Development (UCHD) in 2023, jointly organized by CEHURD and the health ministry, funds were raised to put this girl back in school.

But she has since dropped out again due to lack of funds. According to Kiyange, the teenage girl's mother decided to integrate her into her food business in town. But even here, she faces similar struggles. 

"When she was telling me about this food business, she was crying, saying 'more men are taking advantage of me'."

Worse still, the lasting physical effects of being defiled at such a young age linger on.

"She told me the bones are still painful. She had a lot of things happening to her body at that time. We want to approach CoRSU [Rehabilitation Hospital in Kisubi] to see if they can help fix issues with her bones, etc," said the CEHURD executive director.

They also want to find a scholarship for to get back to school "because she wants to study, she is so brilliant, she is a beautiful soul".

'Older persons neglected'

Meanwhile, another poignant issue that came to the fore is SRHR for older adults.

"Nobody is talking about them. Nobody has evidence on them," said ICRW director Izugbara.

Dr Betty Kyaddondo (pictured below), a senior medical doctor and the outgoing head of the Family Health Department at Population Secretariat, agreed, saying they are a neglected demographic as regards SRHR.

"With most data and policies focusing on individuals aged 10 to 49, little attention is given to the [sexual and reproductive health] needs of older populations," said Kyaddondo on a five-strong experts panel.

"The lack of research, stigma surrounding ageing, and societal perceptions of menopause and andropause contribute to this exclusion. Addressing these gaps is crucial to ensuring comprehensive SRHR for all."

Speaking of menopause, one previous meeting that ICRW's Izugbara attended revealed a disturbing trend.

"One medical doctor said that people walk into her room saying they have been treated multiple times for malaria. But when she sits them down, she realizes [what they are experiencing] are instead the early onset of menopause," he said.

While some embrace this reality as a natural process of ageing, it hits others so hard to the extent of affecting them mentally.

There are many groups in Uganda — young and old — that are increasingly being excluded, whether in terms of voice or access to SRHR services. What are the mental implications of those deprivations? 

"We have little information about them," said Izugbara.

'Urgent reforms needed'

With SRHR being a multifaceted and multidimensional issue involving practitioners, researchers, implementers, policymakers, and community members, more obstacles are inevitably bound to come in the way of ongoing efforts.

Part of the concern is around policy.

Rose Wakikona (pictured below), the deputy executive director at the Women’s Probono Initiative and Advocate of the High Court of Uganda, said some of the policies on SRHR practice contradict the laws around it.

“Uganda’s SRHR policies promise protection for students, women, and children, yet weak enforcement and legal loopholes leave many at risk," said Wakikona during the session.

"Inconsistent implementation undermines progress, exposing vulnerable groups to GBV, inadequate reproductive healthcare, and systemic neglect. 

"Urgent reforms are needed to close these gaps and ensure laws translate into real protections."

Responding to this, Dr Allan Kasozi (pictured below) from the health ministry's Department of Reproductive and Child Health, said: "Policy will give the guidance, but there is no greater guidance than the law."

'No girl, woman should be left behind'

Kasozi, who was representing Dr Richard Mugahi, the commissioner in charge of reproductive and infant health at the health ministry, said there is need for more advocacy on this issue.

"In as much as policy informs law, we can only do so much. As a ministry, we shall always be ready and available to serve the need. Our services are in such a way that we respond to anyone who may need that service.

"We have a number of committees in Parliament. These are the people that we need to talk to and help them appreciate how law, especially those provisions on consent, affect access and utilization of SRH services."

Weighing in, Dr. Stella Bosire (pictured below), the executive director of the Africa Centre for Health Systems and Gender Justice, said addressing Uganda’s SRHR gaps requires more than just policies on paper.

"It demands sustainable healthcare financing, stronger legal frameworks, and inclusive solutions that prioritize neglected groups," said Bosire.

"No young woman or girl should be left behind."

Indeed, the "leaving no one behind" tone is a theme at the heart of the Sustainable Development Goals (SDGs).

Here, the emphasis is on prioritizing the needs of the most vulnerable and marginalized, ensuring everyone benefits from progress.

'Maternal deaths drop'

The Ugandan government underlined its commitment to benchmarking at least 50 percent of locally ring-fenced resources to providing SRH services to adolescents and young people.

"The progress on that commitment is that we allocated close to 31 percent of the entire health ministry budget for the benefit of young people — that is, providing family planning as well as SRHR services," said Dr Kasozi from the health ministry.

He also said that advocacy efforts have resulted in fewer mothers now dying giving birth (maternal mortality): from 336 deaths per 100,000 deliveries to 189 per 100,000 deliveries.The ministry is looking to push this statistic further down to around 70 per 100,000.

Positively, there has been a global decline in maternal mortality by about 34 percent in the last two decades.

However, the problem remains more prevalent in low- and middle-income countries, particularly in Sub-Saharan Africa, than anywhere else in the world, as you can see from this graph below:

'There is still work to do'

"Every maternal death and every prenatal death has to be accounted for. Every week, we have at least two meetings to review each maternal death in the country," said Kasozi.

"We need to sit and discuss and see how we can tackle these other determinants of poor health among mothers and other young people."

Every Friday morning, the health ministry holds a virtual discussion on issues such as teenage pregnancies, targeting the most burdened, geographically isolated districts.

"We want to account for each and every teenage pregnancy in the country. We know the picture is not yet so rosy, there is still much work to do," said Kasozi.

The health ministry official is right. Efforts around SRHR are already feeling the strain from all corners. 

Uganda is one of the countries that will be heavily affected by the freeze in USAID funding as directed by US President Donald Trump at the beginning of his new term at the helm of the world's largest donor country.

"That has implications for many lives that have been supported here by investments that USAID makes on many issues, ranging from reproductive health, HIV & AIDS, maternal mortality, child wellbeing, nutrition," said Izugbara.

"Those have implications not just on the future of the country but also the future of programming, policy, and research.

"It shows the importance of being ahead of issues in terms of the request for evidence on those issues as well as identifying what the priorities are, which we believe is becoming very key in shaping interventions, funding, programming and policy," he said.

Importantly, there is need for locally driven research agendas now that ever before. And because this is lacking, ICRW feels there is very little in terms of sustainable focus on critical SRHR issues.

Additionally, SRHR campaigners are coming up against the opposing force of the anti-SRH movement, which ICRW research shows is happening across the African continent.

The centre says there is need for information on the activities of advocacy groups and the strategies that they use to achieve some of the progress attained in the past.

"We prioritize sexual and reproductive health rights and gender not because it is funded or trending, but because the challenges in our communities demand action from those of us who are passionate and committed to these values," said Evelyne Opondo (pictured below), the director of ICRW Africa.

Meanwhile, in Entebbe, as divorced mother of two Rose prepares to retire for the day, she voices her determination to not let the memories of her recent violent marriage shackle her lofty ambitions.

"That is now in the past. The present is me and my boys. I am working hard to see my clothing business grow into a much bigger one," she says.

"I hope that one day I will own an arcade of only clothes here in Entebbe. That's my focus now."
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💬   WHAT OTHERS SAID 

'Integrate SRHR into economic policies'

Olabukunola Williams — Sexual and Reproductive Health and Rights Lead at Akina Mama wa Afrika

❝Women’s economic empowerment and sexual and reproductive health and rights (SRHR) are deeply interconnected. Without control over their bodies and reproductive choices, women face significant barriers to full participation in the economy. In Uganda, one in four married women lacks decision-making power over her health, finances, and mobility limiting her economic independence.

Unpaid care work, often invisible in economic policies, continues to subsidize economies, yet remains undervalued. Achieving true economic justice requires integrating SRHR into economic policies, ensuring that women can fully engage in and benefit from the marketplace ▪️

'Personal biases in policymaking'

Justine Balya — Director of Community Outreach Programme at Human Rights Awareness and Promotion Forum (HRAPF)

❝Policymaking in Uganda’s SRHR landscape is deeply influenced by personal biases, moralization, and shifting political agendas. Decisions on crucial issues like contraception access, abortion rights, and adolescent healthcare often reflect individual legislators’ personal experiences rather than evidence-based policymaking.

Additionally, policies can be abruptly shelved with changes in leadership, and SRHR discussions are frequently used to divert attention from political scandals. This unpredictability makes advocacy challenging, as technical expertise is often sidelined in favour of subjective and political considerations ▪️
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📸   IN PICTURES 

The East African SRHR Dialogue brought together key stakeholders in Uganda and Kenya to address progress, challenges, and critical gaps in sexual and reproductive health and rights (SRHR).

The Kenyan session took place on March 19, followed by the March 21 dialogue in Uganda, both aimed at shaping inclusive policies and amplifying advocacy efforts across the region.

In attendance were SRHR stakeholders, including policy makers, researchers, academics, programme implementers, advocates, NGOs, grassroots organizations, development partners as well as media practitioners.

Dorothy Amuron (pictured below), a health activist and lawyer, moderated the Kampala dialogue.

The session started off with around-the-room introductions, with participants particularly sharing their personal highlights of the women's month (March).

Then, renowned Nigerian researcher, Dr Chimaraoke 'Chima' Izugbara, who is also the director of global health, youth and development at ICRW, presented summarized findings from a study they conducted last year in Uganda on SRHR.

Here, the study explored the progress, challenges, and emerging evidence gaps as regards SRHR.

An expert panel then explored the key issues shaping the future of sexual and reproductive health and rights.

There was a question-and-answer (Q&A) session that saw participants weigh in on the insightful discussion.

And once all was done, it was time for group photos to wrap up a day of fruitful discussions and plenty of useful takeaways and much-needed reflections.