Addressing access to sexual reproductive services holistically

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Alvine Kapitako

Windhoek – It is often said that older nurses are the reason young people shy away from approaching clinics for contraceptives, and to get sexual education and associated counselling. These services, called sexual reproductive services, are offered free of charge at the state health facilities, but very few young people use them. 
New Era gauged the views of those at the forefront of sexual reproductive health on the trends in accessing these services at health facilities.

“It is a little bit difficult for young people to access sexual reproductive services because the nurses are not friendly and they do not provide sufficient information on contraceptives,” youth activist, Makena Henguva of the African Youth Adolescence Network said in a recent interview with New Era.
The organisation provides sexual reproductive services to young people who fear possible tongue or eye-lashing at state health facilities.

“The reality is young people are having sex and we cannot shy away from that,” said Henguva.
Young people should know where to access sexual reproductive services and empower themselves with information on preventing pregnancies and contracting sexually transmitted illnesses, including HIV.

“The moment that you tell a young person that they are too young to be having sex they will not come back to that clinic because they feel that you are judging them,” said Henguva, who noted that this tends to be the attitude of some nurses at state health facilities.

Generally, elderly nurses tend to judge young people who ask for condoms or other contraception services, Henguva explained. “But it’s not all of them and we don’t blame them because sometimes the workload is too much,” added Henguva.

She also demystified perceptions that a young person who goes to a health facility for contraception is promiscuous.

“That is not always the case. Sometimes these young people just want to protect themselves,” Henguva added.
In most cases, young women and girls are the ones who are misjudged for seeking sexual reproductive services.
“In most cases, it is the ladies who access contraceptives. The partners only come when they want to help girlfriends to get the morning after pill (emergency contraceptive). It is really okay to access contraceptives because whether you do or not people are still going to judge you,” said Henguva.

Meanwhile, a registered nurse at the Namibia Planned Parenthood Association (NAPPA), Fungai Bhera said young people, regardless of their age, should be allowed access to contraceptives.
“If you see a young person coming to the health facility for contraceptives that means that sex is involved. Sex brings about pregnancy if it’s not with contraception,” said Bhera.

NAPPA Clinic is youth-friendly. The legal age for accessing contraceptives at the clinic is 14 years, Bhera explained.

However, children as young as 10 years are not refused this service if they seek for it. “If a minor is involved in big people’s things they are a mature minor,” said Bhera, explaining why even children as young as 10 should not be excluded from sexual reproductive services.

At NAPPA, young people are more comfortable to seek sexual reproductive services, added Bhera. “Most of them are free to come to us because they know that they can be helped. But you still find those who are shy but as they come for their follow-ups they become free,” said Bhera.

Bhera said the youth believe that older nurses are not hearing them.
“It is only that there hasn’t been much sensitisation (on the part of older nurses on how to handle young people accessing sexual reproductive services). There is training going on and with time it will be a thing of the past,” said Bhera.

Young people accessing sexual reproductive services at NAPPA Clinic are taught about family planning and how to prevent sexually transmitted illnesses.

“We also tell them that if they are not yet sexually involved they should consider waiting because there are many things involved, especially in love relations,” said Bhera.
On a busy day, Bhera and her colleagues attend to 40 to 50 young people between 14 and 24. “Some days are busier than others,” Bhera added.

Dr Shonag Mackenzie, a senior lecturer at the University of Namibia’s Health Sciences campus, expressed sentiments similar to Bhera, saying that a person as young as 13 years old should be using contraceptives if they are sexually active.

“We recommend that anybody who doesn’t want to get pregnant and that is mostly young women should be using contraceptives. So even if you’re very young person and you’ve had your periods you can get pregnant. You’d obviously prefer them not to be sexually active at 13 but if they’re sexually active and they’ve had their periods then they should be using contraception,” said Mackenzie referring to the high teenage pregnancy in the country.
The national teenage pregnancy rate is 19 percent. The highest teenage pregnancy rates are observed in Kunene, Omaheke, Kavango East and West as well as Zambezi regions at 38.9 percent, 36.3 percent, 34 percent and 28.1 percent, respectively.

The high teenage pregnancy in Namibia is multifactorial, Mackenzie added. Further, she stated that there are many misconceptions among adults and children that contraception is bad for women. “Culturally, contraception is still not accepted in a lot of places. So, we have to have that general understanding that contraception is not good,” said Mackenzie.

As a result, there is need to change education on contraception, she stated. “We have to start seeing contraception as not just about preventing pregnancy but about the health benefits it’s got for women,” she said. Women on contraception are at lower risk uterine fibroids, among others, Mackenzie pointed out.
“We need to have contraceptives at all clinics locally and countrywide. There is still a problem with access because we haven’t had enough contraceptives,” added Mackenzie.

Nurses are being trained on respecting confidentiality, said Mackenzie. This means that even if it is a family member that they are serving with family planning, they may not disclose to other family members, Mackenzie explained.

“What we’re doing is part of our training is on respecting confidentiality because they nurses might not think that it applies to their nieces or family.  They just sometimes think that if it’s family it’s different,” said Mackenzie. She also stressed that if the nurse does not agree with a child or the daughter of someone they know they cannot go and tell their parents.

“And the law is very strict. It allows you to give contraception to a child without the knowledge of their parent or guardian’s consent. The reason the law was written like that was to decrease unwanted pregnancies,” added Mackenzie.

The philosophy of the Ministry of Health and Social Services and its donor agencies is “confidentiality is key but nurses have to take a holistic approach”, explained Mackenzie.

This means talking to the young girl about the risks involving sexual activity at an early age while also providing the sexual reproductive services.

“You have to make sure because we do have sexual abuse. We do have power relationships and some young women are having sex because they’re being forced into sex. I might end up giving her the contraception but referring her to social worker doing other child protection things at the same time because I still don’t want her to get pregnant but I will be trying to protect her as a child,” said Mackenzie.

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