A rights-based analysis of the impact of public health emergencies on adolescent pregnancy in Busoga region, Uganda

Abstract

Public health emergencies such as COVID-19 or epidemics such as Ebola and HIV epidemics have been linked to increased vulnerability of adolescent girls to early and unintended pregnancies in the Busoga region of Eastern Uganda. This vulnerability is exacerbated by government response and containment measures that birth disruptions on adolescents’ access to essential sexual and reproductive health and rights (SRHR) services and information including on contraception hence perpetuating risks for poor outcomes and increased violations of SRHR. The Ugandan government is obliged by both domestic and international law to take precautionary measures during emergencies to ensure public safety and maintain public order. However, national governments do not waive their mandate of respecting, protecting and fulfilling SRHR of adolescents even during emergencies. The study examines government responses to public health emergencies and their compliance with Uganda’s international human rights obligations. It also explores how intersectional factors such as age, gender, socio-economic status, residence, education status compound the risks faced by adolescent girls. By providing a critical feminist perspective through the reproductive justice lens, the research underscores the need for adolescent-responsive policies to safeguard SRHR during future public health crises. During COVID-19, adolescent pregnancy rates increased significantly in the region and at the national level, with the region's rates remaining higher than the national average. It is impossible to overlook the causal and consequential link between HIV and Ebola in adolescent pregnancy, and more research is recommended. Uganda has policy gaps specifically on protecting, safeguarding and fulfilling adolescent SRHR during public health emergencies. National policy frameworks do not have specific normative provisions on ASRHR during health crises and therefore one has to use an interpretive approach to inscribe SRHR for adolescents during public health emergencies. Although the Ugandan government's restrictions on individual rights is permitted for public safety, their implementation is flawed due to being stringent, prolonged, and generally applied to all people, with limited consideration for the varying needs of intersectional groups. The state failed in the principle of proportionality between public safety and individual rights, which compromised the state obligation to safeguard ASRHR during public health emergencies. Intersectional factors, including gender, location, and socio-economic status, greatly influenced the impact on adolescent pregnancy in the Busoga region. Adolescent girls from rural and economically vulnerable communities were disproportionately affected by COVID-19 restrictions and adolescent pregnancy, as evidenced by high rates of adolescent pregnancies in rural districts compared to urban districts.