Sexual Reproductive Health and Rights for Karamojong Youth

The right to family and marriage is provided for in the Uganda 1995 Constitution with the age of consent set at 18 years old (Republic of Uganda, 1995). Despite this legal provision, the traditional practice of child marriage persists in many ethnic groups in Uganda.  Arranged marriages (by parents without the consent of the girl) and courtship rape  (where a girl is abducted and forced to have sex by her potential husband) are still common practices in regions like Karamoja. 
Child marriage is closely linked to teenage pregnancies since the young brides are expected to get pregnant soon after getting married. As of 2015, teenage pregnancy rate in Karamoja was 30%. The negative consequences of teenage motherhood are well documented. Evidence shows that adolescent mothers are twice as likely to die from pregnancy and delivery complications compared to those who are older, have high fertility rates and their babies have higher chances of dying. In addition, teenage motherhood has negative effects on the socioeconomic status of the mother, and hence the child, because it inhibits girls participation in education limiting her economic opportunities (FIDH and FHRI 2012). In addition, teenage pregnancy is an indicator of unprotected sex and hence exposure to HIV infection. 
Improved infrastructure, economic activity in trade and mining alongside relative peace have also been accompanied with an escalation of the HIV incidence in Karamoja. The prevalence rate has increased from 3.5% in 2006 to 5.3% in 2016. An evening walk around the KamSwahili slum of Moroto town will bring you face to face with teenage girls transacting with mining truck drivers and business people. These are scenes that were considered taboo in the Karamoja culture and unseen decades ago. 
Sexual Reproductive Health and Rights for Karamojong Youth
Building on the successful Youth Empowerment Programme (2010-2013), Restless Development in partnership with Reproductive Health Uganda have been working towards increasing the demand and supply of SRH information and services in Karamoja under the “Sexual Reproductive Health and Rights Programme for Karimojong Youth” from 2014 to date.
How it works
The Sexual Reproductive Health and Rights program builds the capacity of young Karimojong to lead community initiatives in promoting safe sex and health service uptake. Over this period of time, Karimojong volunteer peer educators have been empowering their peers in-school and out of school to make informed SRH choices, and further supporting them in their livelihoods development, recognizing food insecurity as a key driver of transactional sex and the spread of HIV.
The project, which has focused on youth ranging within the ages of 15-30 years in the two districts of Napak and Moroto, is in its third and final year of implementation. So far, it has directly reached 6,990 community youths, 5,166 out of school and 1,824 in school youth, who have being engaged in a variety of activities such as peer educational sessions, health centre talks and school awareness campaigns among others. And it has been implemented in the eight sub counties of Nadunget, North Division, and Rupa in Moroto District and in the Sub counties of Lotome, Ngoleriet, Matany, Lokopo and Lorengecora in Napak District.
Caption: Youth engaged in a school awareness campaign run by health workers
The Sexual Reproductive Health and Right programme has contributed not only to our Sexual Rights goal area, but also to the Living and Voice goal areas. 
Sexual Health: Young people are making informed decisions about their SRH, contributing to improved SRH, including reduced incidence of HIV, chanding perceptions and attitudes as well as breaking down widely accepted negative practices.
In order to help empower young people to make informed decisions about their sexual health the program conducts peer to peer educational sessions, school outreaches, community awareness events like health days and community dramas (plays).
The project has equipped young people with the right information on approaches and techniques to better protect their health and avoid STIs. 90% of the targeted youth reported using the ABC (Abstinence, Be faithful and use a Condom) method to prevent HIV and STDs which represents a 22% increase in young people adopting safe sexual practices.
Furthermore, 80% of the youth have demonstrated possession of core life skills to engage in safe sex, up from 56% at baseline. This has checked their ability to say no to early sex, to request for protection measures from their sexual partners, and being in a position to say no to negative peer influence.
Also the percentage of young people accessing SRHR services (HIV testing & counselling, accessing and using condoms and other modern contraceptives) has increased from 45% to 70.3% at the end of the project. 
Caption: Reproductive Health Uganda during one of the community outreaches providing free HIV testing and counselling
Our implementing partner, Reproductive Health Uganda, has engaged with health providers to address young people’s SRHR needs, contribute to improved services and increase service uptake by youth. They have achieved this by building the capacity of health workers and village health teams (VHTs), establishing and equipping youth resource corners, and conducting health centre talks. All the above has contributed to the creation of a conducive environment within which youth can seek and access SRH services. Some of the achievements can be summarised as:
A 20% increase in the capacity of health workers to deliver youth friendly services to community youth from 67% at baseline to 87% by the end of year 2. These service providers have been equipped with basic knowledge and understanding of the provision of youth friendly services (YFS) which include: affordability, accessibility, privacy and availability.
74% of the youths interacting with the trained health workers reported to have received a YFS from the health service point they’ve visited, up from 45% at baseline. This shows how the health workers have strived to ensure services are appealing to the youth.
Additionally, health workers have been conducting community outreaches where young people were able to access STI screening and treatment services. The community outreaches were used as a platform to encourage the youth to visit their respective health centres to seek exhaustive SRH services.
Youth resource corners (YRC) have been set up in 10 health centres existing in the area. These YRC were equipped with television sets, benches and mats, health educational materials and games to create an attracting environment for the youth to interactively be engaged while waiting at the health centre.
 Livelihoods: Young people have been able to generate independent livelihoods by setting up and maintaining group agri-businesses. 
Restless Development trained and empowered 64 community youth groups in managing their own businesses,, such as cereal banking and animal rearing. We build the technical capacity of these groups to ensure they  are in a position to manage their enterprises with minimal support, after programme closure.

Caption: Two members from one of the youth groups which engaged in cereal banking as an alternative livelihood as a result of this programme

As a way of fostering cohesion and promoting sustainability of the groups, a village savings and loans association (VSLA) component was introduced to each of the groups. This has played a big part in improving the saving culture of the youth. Now more than 40% of the youth groups are actively engaged in weekly savings. 
Caption: one of the youth groups checking the individual contributions by group members
Voice: Through our advocacy efforts we aim to create an enabling environment for young people to access youth friendly sexual and reproductive health services. Young people present issues identified through our work and shared their own experiences with different youth stakeholders through a number of dialogue meetings held both at sub-county and district level. These dialogues created a platform to establish links with policy makers and helped the youth to identify whom to engage with to lobby for SRHR issues affecting young people. A total of 502 young people participated in local decision making processes related to SRHR and HIV in the different sub-counties where the programme was implemented.

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