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Sexual health barriers persist for women

by Sunday Express
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Pascalinah Kabi

WHEN 15-year-old T?ebeletso* (not her real name) complained of sharp stomach pain, her teachers at Bochaletsane Secondary School in Thaba Tseka did not think it was a matter warranting much concern. After all, similar complaints were common among adolescent girls at the school.

However, this case was different as T?ebeletso was pregnant, and to make matters worse, she had sworn to her guardians that she would never reveal the man responsible. As if that was not enough, and in an attempt to abort the pregnancy and avoid the shame, T?ebeletso died at the hospital in Thaba Tseka last week.

The Officer Commanding Thaba-Tseka Police Station, Senior Superintendent Litsietsi Selimo confirmed the girl had died from complications related to the unsafe abortion.

“Our investigations revealed that, there was something strange about the whole pregnancy issue because she had refused to disclose the identity of the person who impregnated her and was even prepared to die rather than expose the perpetrator of the statutory rape,” Snr Supt Selimo said.

Abortion is illegal in Lesotho and can only be authorized under extenuating circumstances, which include in cases of sexual assault or health-related conditions.

Owing to these regulations, not all sexual assault survivors understand the importance of reporting assaults, particularly when the accused is a relative or has threatened to harm the survivor. This has seen a high prevalence of unsafe abortions and concealment of birth.

Sexual and Reproductive Health (SRH) experts who spoke to the Sunday Express this past week emphasised the need to make services easily accessible for girls and young women to get professional help.

They explained sexual and reproductive health as a state of complete physical, mental and social well-being in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

To maintain one’s health, they said, people need access to accurate information and the safe, effective, affordable and acceptable contraception method of their choice.

Communities should also be informed and empowered to protect themselves from sexually transmitted infections, and when they decide to have children, women must have access to services that can help them have a fit pregnancy, safe delivery and a healthy baby.

Lesotho has committed to providing quality sexual and reproductive health services to people like Tšebeletso. In 2015, the country officially commenced the implementation of activities through the Sexual and Reproductive Health Rights (SRHR), HIV and Aids Governance Project.

Through this project, the Southern African Development Community Parliamentary Forum (SADC-PF) made it increasingly clear that legislatures are important institutions whose role in any democracy has long been under-estimated.

To ensure that legislators effectively played their role of safeguarding the rights of girls like T?ebeletso from harmful practices such as unsafe abortion and prevent other sexual reproductive health inequalities, the SADC-PF held a four-day orientation workshop from 24-26 October in Mohale’s Hoek. This workshop targeted members of parliament and senators on integrating sexual and reproductive health rights and HIV and Aids governance into the business of committees.

It also aimed to open-up parliament to public participation through engagement of the civil society.

The workshop came hardly a week after the United Nations Populations’ Fund (UNFPA) launched the State of World Population 2017 report titled “Worlds Apart: Reproductive health and rights in an age of inequality.”

It stated that no country today – even those considered the wealthiest and most developed, can claim to be fully inclusive where all people enjoy equal rights and protection.

“Among the internationally agreed human rights central to human well-being is the right to sexual and reproductive health. This right was endorsed by 179 governments in the 1994 Programme of Action of the International Conference on Population and Development.”

This Programme of Action, read the report, stated that individual rights and dignity – including the equal rights of women and girls, and universal access to sexual and reproductive health and rights are necessary for the achievement of sustainable development.

The report further noted that many gaps remain in meeting these commitments, particularly among women and girls who are already marginalised by other forms of exclusion, most notably, poverty.

It further stated that many girls like T?ebeletso, from the rural areas, were far less likely to have access to contraceptives and to care during pregnancy and birth than their wealthier urban counterparts.

“Among adolescents, who are most vulnerable due to their young age, 20 percent of those from poorest households in developing countries have about three times as many births as 20 percent from richest households.”

On the other hand, the report said, those in rural areas have twice as many births as their counterparts in cities, signaling the need for urgent attention to ensure that girls like T?ebeletso have a better shot at a brighter future.

While T?ebeletso took the circumstances surrounding her pregnancy to the grave, another 15-year-old girl was saved by the courts of law a fortnight ago.

Speaking during the launch of the report on the circumstances leading to the court order, the Ministry of Health Principal Secretary, Mr Monaphathi Maraka said the teenage girl was mentally-challenged and sexually-assaulted.

A court order was issued instructing the Ministry of Health to facilitate termination of her two-month pregnancy.

“I wrote to the Medical Superintendent of T?epong Hospital asking them to provide pregnancy termination services based on that court order,” Mr Maraka said.

While the termination services have been provided, Mr Maraka noted with concern that the survivor may still be raped again and fall pregnant; adding that the family could not request for other pregnancy-preventive measures such as tubal ligation.

He said this was an indication that Lesotho needed both clinical and administrative services with the latter promoting effective legislation.

Mr Maraka highlighted a divide between rural and urban youth on their understanding of sexual and reproductive health issues.

“The urban youth have greater access to the media while word of mouth is also an important educational tool.”

The need to strengthen parenting skills also came under the spotlight, with Mr Maraka encouraging parents to openly discuss with their children sexual issues regarded as taboo in some households.

“We start seeing some gaps in our efforts if parents do not also play their role through talking to educate their children to help eliminate risky sexual behaviours that promote sexual transmitted diseases,” Mr Maraka said.

He explained that while it is important to improve access to sexual reproductive health tools, particularly in rural areas, more education was needed for sustained use of tools such as condoms.

“When you look at our landscape, you will find that accessibility of services is a challenge in the hard to reach areas in all districts. This situation does not protect girls.”

Speaking with this publication, a 13-year-old girl detailed her experience at one clinic where she had sought treatment after developing a rash around her genitals, after a netball practice.

“I was shocked by one of the nurses’ unfriendly behavior. I went there for services but ended up being harassed. She accused me of having unprotected sex with multiple partners, when it was not the case,” the teenager said.

She explained that through the Comprehensive Sexuality Education (CSE) provided at her school, she understood the risks associated with having unprotected sex. “I will not indulge in pre-marital sex. Education is very important to me because I am also an orphan who wants to have a bright future.”

However, after her ordeal at the clinic, she has lost trust in the health system.

“I think the government must make sure that sexual and reproductive health services are friendly to young people. The starting point would be to employ young and open-minded people who identify with challenges facing today’s youth,” she said.

She also explained the need to improve the coverage of private services such as those provided by the Lesotho Planned Parenthood Association (LPPA).

“Seeking medical care in my home area, Nazareth, is not easy and I think that is one of the reasons why many girls end up with unwanted pregnancies. You can imagine what would have happened had I gone there for contraceptives.”

Presenting the Equality in Relation to Sexual and Reproductive Health and Rights Report in Maseru recently, the Manager responsible for sexual and reproductive health in the Ministry of Health, Ms Motsoanku ‘Mefane said women aged 15-49 years reported to have experienced problems in accessing health care for themselves.

The report showed that a total four percent of women have reported challenges getting permission to access treatment services while nine percent said they preferred seeking services with their partners. At least 26 percent reported a problem of long distance to a health facility; 27 percent said they needed services to be free; and 42 percent reported at least one problem accessing health centres.

“A total 15 percent of young women between the ages of 15-19 were already mothers and, four percent were pregnant with their first child,” Ms ‘Mefane said.

Speaking at the same report presentation, the United Nations Populations Fund (UNFPA) Country Representative Ehsan Nuzhat hoped the report would serve as a platform and motivation to increase awareness of all stakeholders and the public at large on the need to bridge the inequality gap.

Ms Nuzhat said this would ensure that all Basotho women, notwithstanding their geographical and economic status, could have equal access to sexual and reproductive health information and services.

She said this year’s report, “Worlds Apart: Reproductive Health and Rights in an Age of Inequality,” showed how economic inequality reinforced inequalities in sexual and reproductive health.

Ms Nuzhat explained that economic inequality goes hand in hand with inequality in reproductive health, noting that when women are able to control their fertility, they can finish their education, enter the paid labour force and gain more economic power.

“We must heed the call of the SDGs to first reach those who are furthest behind to realise shared prosperity,” Ms Nuzhat said.

She further said, this could not happen without married couples or partners in the poorest segment of the country getting access to reproductive health and family planning services. Ms Nuzhat emphasized the need to prioritise services for adolescents in order to halt child marriage and prevent teenage pregnancies.

“For this to happen, there is need to tear down barriers, whether discriminatory laws, norms, or service gaps that prevent adolescent girls and young women from accessing sexual and reproductive health information and services,” Ms Nuzhat said, adding that poorest women must be reached with essential, life-saving pregnancy and maternal health care.

She said Lesotho shouldensure that it fulfilled all the unmet demand for family planning as well as prioritising women in the poorest 40 percent of households.

Explaining what UNPFA was doing with partners, including members of parliament to improve access to sexual and reproductive health services, Ms Nuzhat said her organisation was supporting the Ministry of Health in capacity building of health care professionals, development of policies, strategies and guiding tools and the procurement of reproductive health commodities.

“We are also partnering with the National Assembly on the Mohale’s Hoek workshop aiming to orient parliamentarians and senators on the importance of integrating sexual and reproductive health rights. UNFPA would like to enhance collaboration between parliamentary committees and the civil society in responding to sexual and reproductive health rights, HIV and AIDS, strengthen access to services and governance issues in Lesotho.”

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