“I was afraid for my life”

BUJUMBURA, Burundi—"During my youth, I had to abort four times. I was afraid for my life when [on one occasion] it was dark and the doctor had only two candles to light [the room]," says Cecile Nshimirimana*, 28, a student in Bujumbura.

When a young person falls pregnant, in many cases it means the end of her schooling and an early start to married life, often a forced ‘solution’ as a means to avoid shaming the couple’s respective families.

For a girl who becomes pregnant and has ambitions to study and move forward in life, the only option left is an illegal abortion, with all the risks that entails.

The fear of being judged by society, and the shame heaped on their families when they become pregnant while unmarried, weighs heavily on girls and leads to many opting to have an unsafe abortion.

"For a girl who becomes pregnant and has ambitions to study and move forward in life, the only option left is an illegal abortion, with all the risks that entails," Ms. Nshimirimana says.

Induced abortion is illegal in Burundi, except when the woman's life is in danger due to pregnancy. As a result, unsafe abortions are a common reality, and these expose young women to an increased risk of complications.

Young people have the right to information and services

But the means to avoid pregnancy is not always readily available to young people.

At some point in their lives, they will need to start making decisions about their sexual and reproductive health, which will affect their future.

However, the majority of adolescents do not have sufficient knowledge to take full responsibility for these decisions, which leaves them vulnerable to forced sex, sexually transmitted infections including HIV, and unwanted pregnancies. This is according to the follow-up report of the Addis Ababa Declaration on Population and Development (AADPD).

Discussions of sex considered taboo

As an adolescent, Ms. Nshimirimana faced this challenge.

"I saw embarrassment on my mother’s face when I asked her questions regarding sexuality and relationships with boys," she says.

Adequate information on sexuality enables young people to make informed decisions about their own sexuality and health, helps them develop practical knowledge and adopt more responsible behaviour.

Like many adults, it was difficult for Edouard Hatungimana, 56, a father of six children, from Gisoro Hill, to understand why adolescents and young people need to be fully informed of their sexual and reproductive health and rights (SRHR).

"We did not understand the importance of discussing sexual and reproductive health, especially why our children should learn [about this] because we assumed it would drive them to perdition," he says.

My own parents were disappointed in me when I wanted to know more about my sexuality.

But empowering adolescents on SRHR is key to helping them avoid potentially irresponsible behaviour, Ms. Nshimirimana believes.

"How can we adopt responsible behaviour regarding sexuality if no one, not even our parents, can discuss it openly with us? My own parents were disappointed in me when I wanted to know more about my sexuality," she says.

Challenges facing Burundi’s youth

Burundi has more than eight million inhabitants, more than 50 per cent of whom are women and 56 per cent are under the age of 20 years. This means that most of the Burundian population consists of young people, and they face several challenges in terms of their SRHR.

The main barriers are limited access to information and services on SRH, as well as lack of support from parents, the community, and service providers.

Another challenge young people face relates to myths and misconceptions about the potential side effects of modern contraceptive methods. For instance, many people believe that contraceptive use could lead to infertility and cancer.

It's challenging for a [young woman] to go to the clinic and get her contraceptive pills, but normal for a young man to get condoms.

And failure to respect gender equality in society increases the vulnerability of girls and boys.

"It's still challenging today for a girl to go to the clinic and get her contraceptive pills, but normal for a young man to get condoms," says Ms. Nshimirimana.

Young women are more comfortable discussing contraception at youth-friendly health centres, where they are able to open up and get accurate information in an environment that assures confidentiality, she believes.

But at present, there are very few health centres offering SRH services for adolescents.

With a reproductive health service coverage of 90 per cent – meaning at least one health centre per 5 kilometre radius – and a demand for family planning by more than 5 per cent of young women aged 15-19 years, greater effort is needed to integrate SRH services, and involve communities and girls’ male counterparts.

High fertility and teen pregnancy rates

According to Burundi's 2016-2017 Demographic and Health Survey, the fertility rate remains high, with an estimated average of 6.4 children born per woman during her fertile life.

When it comes to access to SRH services, adolescent girls are clearly being left behind.

Almost 47 per cent of family planning needs are being met by modern methods, the 2016-2017 DHS showed. However, the percentage of teenage mothers who had not planned their recent pregnancy was 8 per cent.

Promoting young people’s sexual and reproductive health

However, some progress is being made.

The National Programme for Reproductive Health (PNSR) has developed an integrated social networking approach to promote the reproductive health of young people.

Attractive spaces are being set up in youth-friendly health centres and in schools to provide teenagers and young people with venues to share their SRH concerns.

The network, which was formed to encourage adolescents and young people to access information and services, is managed by school representatives, community and youth associations, and solidarity groups formed mainly by religious leaders and parents.

Several organizations, including UNFPA, work with the Government of Burundi to develop comprehensive sexuality education programmes, both in schools and through community-based training and awareness campaigns.

UNFPA has developed a capacity-building and communication for behavioural change strategy that is related to SRH and targets teachers and peer educators in schools, as well as actors of 26 community-based social networks.

“Finally, we are supporting communication activities that aim for free dialogue between religious leaders and adolescents and youth, about life skills and SRH.”

“Finally, we are supporting communication activities that aim for free dialogue between religious leaders and adolescents and youth, about life skills and SRH,” says father-of-six, Mr. Hatungimana.

Towards "zero pregnancies" in schools

UNFPA also advocates for adolescent and youth SRH topics and family planning to be integrated into the students’ and teachers’ curricula.  

This is one of the strategies being adopted to achieve the goal of "zero pregnancies" in schools, to help increase school completion rates, especially for adolescent girls and boys.

In regard to unwanted pregnancies and the risk of complications due to illegal abortions, which our children are facing, it is clear that we have to change our behaviour.

“In regard to unwanted pregnancies and the risk of complications due to illegal abortions, which our children are facing, it is clear that we have to change our behaviour," says Mr. Hatungimana.

It is initiatives like these that stand to make a significant difference in the lives of girls and young women, in particular – young women like Ms. Nshimirimana.

"Some days, I think of how I could have avoided getting pregnant again and again, if only I had the information and the means necessary to protect myself," she reflects.

By Aimee Manimani Nsimire

* Name changed to protect her privacy.