Reproductive health: What every woman should know

RECENTLY, a cross-section of religious leaders convened to chart ways of addressing women reproductive health issues. The focus was on elimination of harmful practices that hinder women’s reproductive health rights. Religious beliefs, myths about family planning and limited access to reproductive health information featured prominently as a barrier to sexual and reproductive health rights. Studies have showed that the church plays a critical role in advancing reproductive health rights of women. An article titled, Faith-based organisations and HIV prevention in Africa, shows how faith-based organisations influence sexual behaviour, explaining that several factors determine the extent to which an individual’s behaviour is influenced by their religion. The article also revealed that the church has a higher level of acceptability, sometimes higher than government or foreign organisations, since they are part of the local culture. Pastor Charles Niyongere of Anglican Church Rwamagana, says the church is a critical stakeholder in advocating for sexual and reproductive rights of women. “The issue of family planning poses a very big burden for the country, it might seem light but it’s very deep if one goes into analysis. Disputes in a home arise from issues like poverty because one is not able to support their family,” he says. Niyongere says that someone’s beliefs determine the way they think and the choice of life they choose, that’s why churches should stand up, and be a guide on this matter, and, teach the benefits that come with families accessing sexual reproductive health. “Children are a blessing from God but we need to think critically to see that the children we bring into this world receive the care they need, it’s our responsibility to do that,” the pastor says. He adds that counselling services through groups like Mothers’ Union and Fathers’ Union can be a platform to discuss such matters. Why is it still difficult for women to access these services? Katie Carlson, a gender specialist and founder and CEO of Paper Crown Institute, says that women and girls face several issues when it comes to sexual and reproductive health and rights. She believes that one of the greatest barriers for girls and women in Rwanda is access to information. Adolescent girls, in particular, often have little to no understanding of how their bodies are changing during puberty, and this creates problems. “There is a lot of stigma around sexual health matters and this can mean that they come to believe in myths and misinformation passed around by their peers. For adult women as well, being able to access family planning methods is also sometimes difficult due to gender norms that give men more decision making power in relationships or in the family,” she says. Carlson explains that women who have a partner can face issues with being able to control how many children they have, which can be incredibly difficult and harmful for their health and their quality of life. She, however, believes that women and girls have a right to freely and safely access services and information around their sexual and reproductive health. These are fundamental human rights and no one can take them away, however, if these rights are not acknowledged as important in everyday life, the consequences can be dire, she warns. “There is the major issue of unwanted and unplanned pregnancies. For both girls and women, not having enough information about conception and pregnancy, as well as safe and reliable family planning methods can result in un planned pregnancies,” she says. The gender specialist also adds that because abortion is illegal in Rwanda, except in some special cases, this generally leads to a few possible outcomes which can be deeply harmful for women and girls. For instance, they keep the pregnancy, survive childbirth, and struggle to raise the child with everything that the child needs in life, particularly for young mothers who are not emotionally, financially or physically ready to handle children. Hellen Nomugisha, the president of African Youth and Adolescent Network on Population and Development (AfriYAN- Rwanda), says that women are not empowered enough to claim their rights in regard to sexual and reproductive health, hence, the hardships in accessing a safe abortion. She points out the issue of age of consent to access these rights and also the factor of gender inequality where by men think they are superior to women and this comes with different forms of violations. Nomugisha adds that women need unbiased information on sexual and reproductive health and rights plus confidentiality in places where this kind of information can be obtained from. “Women need family planning services, they need a variety of friendly and equipped centres from where they can easily visit and receive services,” she says. Women should seek professional advice on which birth control method to use. What the barricade means for women’s health A woman not having access to sexual reproductive rights would mean a limit to services like family planning, and this would mean little or no control of her fertility. Dr Rachna Pande, a specialist in internal medicine, says that a woman having many pregnancies and deliveries is exposed to risk of abnormal fetal presentation, abnormal location of placenta and bleeding. There is the risk of the uterine prolapse, where the uterus protrudes outside the birth canal and this increases with multiple child births. This leads to increased risk of cervical and pelvic infections, ulceration, urinary and fecal incontinence. As the uterus expands with each pregnancy, Dr Rachna explains, it puts pressure on the adjoining urinary bladder. “The risk of cervical cancer is also enhanced due to producing many children. Therefore it is imperative that every woman in the reproductive age group should have access to contraception, so that she can determine the number of children, she would like to have,” she adds. According to research done by Women’s Health, an online health website, a short amount of time between pregnancies is associated with more complications and may place subsequent pregnancy at risk. When pregnancies occur close together, there is an increased risk of anaemia in the second pregnancy, which could spell trouble for both mother and baby. Babies conceived less than six months after their siblings had a 40 percent increased risk of being born prematurely and a 61 percent increased risk of low birth weight, compared to women who conceived at least 18 months later. What should be done? Carlson says that the first thing that needs to be done is for communities to understand and really accept how important sexual and reproductive health is for women and girls, and to learn how to talk about it without fear or ignorance. She says, “Sex and reproduction are normal, healthy, everyday part of everyone’s life. We need to stop pretending that these things do not exist, that these real issues are not happening around us all the time and in our own families; we simply need to be brave and learn to talk about them openly if we want to change these harmful situations and ensure that everyone has the knowledge they need to be healthy and safe. “We also need to listen to the voices of women and girls to find out what they need, instead of making assumptions, and to actively respond to those voices, not ignore them or dismiss them. Girls and women need to be informed, encouraged and empowered to share their opinions, speak up about their needs, and seek out the information they want, freely and without shame or judgment.” Nomugisha is of the view that women have specific health needs related to the sexual and reproductive function and that they should be given special attention when it comes to issues to do with reproductive health. “There is need for trained and qualified nurses, counsellors and sexual reproductive health experts in all health set ups to attend to women’s needs and provide non-discriminating and stigma free services,” she says. “I also wish there was a clear law on age of consent when it comes to obtaining sexual reproductive health services without a third person being involved for the teenagers. Furthermore, we need to strengthen youth-friendly centres majorly in their mentorship programmes to reach and empower women in rural areas.” How can women’s reproductive health be improved? Mukarwego Women need to be sensitised more on the benefits of claiming their rights because some of them still have the mentality that birth control is harmful to their health. Sensitising women especially in the rural areas is also crucial. Eunice Mukarwego, farmer ************************************ Martha Nyange I thinkyoung women should be given a platform to access these services, this will in the end prevent unwanted pregnancies and even fight against sexually transmitted diseases. Martha Nyange, university student ************************************ Mukarurangwa The government should put up centres where women can access these services. With this, they will have the right people helping them with the services and information they need. Beatha Mukarurangwa, shop attendant ************************************ Mukabalisa The major issue is people in society shying away from talking about sexual matters openly, because this only makes matters worse. Parents should openly talk to their children instead of waiting for them to get false information from their peers. Jackline Mukabalisa, office administrator

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Reproductive health: What every woman should know