Reproductive health is a public health concern

By Esther Sharon Busiku

April 7 is recognised globally as World Health Day and is celebrated annually to shine a light on specific health issues affecting populations. It’s an opportunity to promote good health and ensure well-being for people around the world.

Good health and well-being are essential for the sustainable development of any society. Any strategy(s) aimed at promoting good health, particularly women's reproductive health and reproductive health rights is integral in achieving Sustainable Development Goals (SDGs).

The World Health Organisation (WHO) defines reproductive health as the state of complete physical, mental, and social well-being in all matters relating to the reproductive system, its functions, and processes, and not just the absence of disease or ailment.

While Uganda has registered some progress in the health sector, a lot still needs to be done regarding women's reproductive health. The provisions that exist under article 33(2) of the Constitution of Uganda speak generally to the rights of women and not particularly their reproductive health.

Over time the focus has been on reproductive health issues like maternal mortality rate, adolescent pregnancies, sexual health rights, and fibroids among others. These of course have long-term effects on the health, education, and economic well-being of women and girls and should be addressed.

However, less attention is paid to reproductive conditions like endometriosis and Polycystic Ovarian Syndrome (PCOS) that equally have far-reaching impacts on the social and economic lives of women of reproductive age. They are common conditions that affect women's reproductive health globally.

Endometriosis is the presence of uterine tissue outside the uterine cavity. The misplaced tissue can grow on the ovaries, behind the uterus, fallopian tubes, on the bowels, bladder, or the shoulders causing chronic pain in the abdomen, lower back, shoulders, or pelvic areas.

PCOS on the other hand is a condition that normally affects women with polycystic ovaries. It happens when the ovaries or adrenal glands produce more male hormones than normal and as a result, enlarged ovaries with growths of fluid-filled sacs (cysts) on the ovaries. PCOS is characterized by pelvic pain, excess hair growth on the face, chin, chest, stomach, thumbs, or toes, thinning hair, and acne.

Studies have placed the prevalence of PCOS in sub-Saharan Africa at an estimated rate of about 5.6%. Similarly, the prevalence of endometriosis in Africa is not well documented, but according to a 2017 systematic review of the prevalence of endometriosis among indigenous Africans by Gichuhi J. Wanyoike et al, the estimated prevalence of endometriosis among women of reproductive age is between 2% and 10%.

In Uganda, the prevalence of the duo is not documented due to a lack of reliable data, yet they greatly affect women and girls in Uganda. PCOS and Endometriosis have no cure. The symptoms can only be managed for the duration of the sufferer’s reproductive years.

The average Uganda female experiences her first period at the age of 12 and hits menopause at 48 years. This means roughly 36 years of suffering during a time these women and girls are expected to enjoy their youthful productive years.

To spread awareness of endometriosis and its symptoms, Bump Love, a tv show on motherhood, produced an episode on endometriosis on 27th January 2023 where they hosted Ms. Sheila Nabuuma to share her journey.

“Endometriosis is a condition that is not openly talked about nowadays and yet it greatly affects the reproductive health of the sufferer,” Mrs. Mwine Rachael said on the Bumb Love episode.

According to Nabuuma, a stage 4 Endometriosis sufferer, like menstruation, the misplaced tissue sheds every month but outside the uterus (pelvic cavity) with no exit point for the blood which causes inflammation from the build-up over months hence the pain.

Sandra (not her real name) while speaking on her struggle with both PCOS and endometriosis, said she experiences excruciating pain in the shoulders every month during her menses, a different shoulder every month, and that for years doctors had failed to ascertain what the cause of the pain was.

These perplexing reproductive conditions are associated with chronic pelvic pain and infertility, with an influence on the quality of life of the sufferer as they are connected to discomfort, anxiety, depression, and social dysfunction. The sex lives of these women for example are significantly impaired as it’s been reported that there is pain during intercourse for these women.

The treatment and management costs have an economic burden that can be compared to that of managing chronic non-communicable diseases such as diabetes, and hypertension to mention but a few.

Currently, the management involves the use of birth control pills to regulate one’s periods and rest the ovaries; medication to prevent diabetes given that women with PCOS are at risk of type 2 diabetes; hormones to increase fertility and also induce periods; procedures to remove excess hair; drugs to control cholesterol as they are at risk for heart attacks and stroke. These treatments are all financially burdening for the average Ugandan woman or girl.

Sandra, whose condition is now chronic, requires Shs75m to undergo surgery in Nairobi to correct the damage to her uterus, having already spent Shs25m to do the diagnostic procedure.

It was not until Nabuuma did a laparoscopy (keyhole surgery) that her condition was diagnosed, having visited numerous doctors. The costs were prohibitive but eventually, a fundraising was held and the funds for the surgery were collected from friends and well-wishers.

The question remains; how many young women and girls across the country are lucky enough to afford such diagnostic surgeries or even pull off a fundraiser? How many know about these reproductive issues?

They suffer in silence with the help of painkillers as they question what the problem is. Some even think it's normal abdominal cramps, especially during their periods.

On the 11th of May 2022, Health Committee Chair, Dr. Charles Ayume informed Parliament that they were processing the Public Health (Amendment) Bill. The Bill seeks to address emerging public health challenges including new and emerging infectious diseases such as COVID-19 and Ebola.

This will be a good opportunity for legislation on Public Health to widen the scope to include conditions such as PCOS and Endometriosis that have become silent killers for women and girls in Uganda.

There is a need for the Government to popularize these reproductive health concerns in their healthcare policies and adequately fund research into these conditions to ease diagnosis and find possible solutions for managing them.

The proposed Public Health (Amendment) Bill should also include measures to address the stigmatization of reproductive health issues, particularly for young women and girls, who may face barriers to accessing the services.

Government must take the necessary steps to address these health challenges instead of leaving it to the doctors to prescribe painkillers and contraceptives to these young women and girls in the guise of resting their ovaries as a temporary relief. This is managing the symptoms and not addressing the actual problem. 

The writer is a policy analyst