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Chapter 5. Findings

5.3 Interventions targeted at reducing adolescent pregnancy

5.3.3 Implementation challenges

Others may say due to sanitary conditions they do not have money to buy pad… so there was a time we even had pad in the school, when we identify such issues we give them pads. Some of these pads are donated from the health directorate. (School teacher 2)

5.3.3 Implementation challenges

A number of challenges have hindered the implementation of the intervention programmes aimed at reducing teenage pregnancy. As narrated by the key informants, some of the interventions are helping to reduce the rate of pregnancy among adolescent school girls. The health professionals however complain of the negative societal perception of medical contraceptive that discourage some adolescent girls from using them. At the school level, teachers complain of the lack of support and motivation to assist them implement the programmes in a more effective and efficient manner.

Societal perception of medical contraceptives

Health workers have to deal with the societal perception of the side effects of medical contraceptives. There is a wide spread view of the negative side effects of medical contraceptives. People who have negative experiences with these contraceptives create the impression that anyone who uses it will experience similar outcome. There is a general believe that these contraceptives can cause infertility or sickness. The health workers therefore have an extra duty to educate the general public about the side effects of these contraceptives and the fact that each individual reacts differently to them. Some of the adolescent mothers explained why they did not use any form of birth control;

Ok, when I was in school I was told that you can protect yourself through using condom or injection but for me I am afraid of using those things, those medicine, they say you will become fat, I do not want it. (Emefa)

when I was in JHS a nurse came and talk to us about family planning but me at that time I did not know anything and also people used to say if you do that thing you will get sick, you will get fibroid, plenty sickness, so me too that time I was not feeling to do it. So I had information about family planning but I did not understand it. (Akos) One of the midwives also confirmed such perceptions about birth controls;

…because the grown-ups even say they do not like it or they will become sick… they say if you use family planning you will get fibroid, so they are afraid of getting fibroid, they do not know the mechanism about family planning. (Midwife 2)

54 Lack of teacher motivation

The teachers also complained of limited funding to support or motivate them for the extra work they do in organizing reproductive health education. The teachers narrated how they pay for their own transport and feeding whenever they have to attend a workshop to receive training and guidelines on reproductive health education. This limited funding also affected the frequency with which training programmes were organised for teachers. Some of the schoolteachers expressed their frustration over the lack of funding and support for the programme;

…Motivation? Even our normal work there is nothing like motivation, even when the teachers go for the workshop, apart from water, they give them water to drink that is all, no transportation, nothing. They come and complain but then what else do we do, we take them as our children. But I think it is not the best. (Head teacher 1)

Other teachers also mentioned how the lack of funding affects the organization of regular workshops to update them of current trends and what they need to do differently;

there used to be frequent workshops for us but they will tell you for lack of money they are not able to organize any workshop, so some of us are dwelling on past experiences and because we have taken it upon ourselves to help, we look out for means to help, but I know most of my colleagues in other schools are not interested in this whole thing because there is no motivation so everybody seems to be going about his or her own business. There is nothing. (School teacher 1)

The lack of interest of some teachers to participate in reproductive health education owing to the lack of motivation as expressed by one of the key informants (school teacher 1), seems to reflect in how some schoolteachers are reluctant in mobilizing their students for the school health talk. This was expressed by a midwife who is in charge of organizing health talks in schools in her community;

The problem we have with the school health is the teachers, sometimes when we send the letter, instead of them to organise, we will go and they will say oooo we have forgotten. Right now we are doing some school screening, we sent the letter to them they fixed the time, when we went there they said the pupils came and they are only 6, like we need their parents to be present, but they were only 6 so we should go and they will reschedule, so it is very difficult for use to do these things and the community as a whole, so that is why the club is not that effective as at now. (Midwife 3)

55 Congested school curricula

With the recent introduction of a new teaching curricula, the schoolteachers complained of not having extra time to organise reproductive health education on a regular basis. One teacher explained how they have to schedule extra time after morning worship to talk about reproductive health;

Sometimes we do not have time, lack of time, we are using a new curriculum so we do not close early and it is fully packed, so when we see that we are not able to meet when we are supposed to meet then after our short worship on Wednesday then we bring the topic and everybody enjoys. (Head teacher 1)

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