The young girl suddenly felt damp. When she stood up, there was blood from her on the chair. And she started screaming. The other girls, shocked, joined her in racing down the corridor to the staff room. When the female Physics teacher saw chattering girls before her and the bleeding, speechless, but gesturing girl in front, she wrapped her in her arms and one look around the room sent all the male teachers out.
Then the teacher began a belated health talk for the girls, as she cleaned her student up. It was menarche. That JSS 3 girl’s ignorance, and associated risk, is what some medical students from Ambrose Alli University, AAU, Ekpoma, Edo State, have dedicated their years in school to eradicating. It’s a huge vision because, “every year, an estimated 21 million girls aged 15 to 19 years in developing regions become pregnant and approximately 12 million of them give birth. At least 777,000 births occur to adolescent girls younger than 15 years in developing countries” (WHO, January 2, 2020).
On the likely causes, United Nations Population Fund, UNFPA, says: “Adolescent pregnancy is generally not the result of a deliberate choice – these girls often have little say over decisions affecting their lives. Rather, early pregnancy is a consequence of little or no access to school, information, or health care.”
Bespectacled and balanced lithely on a motorbike (Okada), Victory Agbujie’s message was simple: “There’s need to curb the wildfire called STIs. We must take responsibility for our sexual/reproductive health.” This was in August 2019 and the venue was the gate of the university and the surrounding car parks. As Agbujie preached via the public address system, over 50 fellow medical students spread out for one-on-one talks with the youths that usually populated the area.
Agbujie is National Officer on Sexual and Reproductive Health Assistant, Standing Committee on Sexual and Reproductive Health and Right Including HIV&AIDS, AAU-SCORA. It is one of the standing committees of the Nigeria Medical Students’ Association (NiMSA). Leading the team with him were Akhigbe Ehichoya, Dike Precious, Atabhotor Victory, Mogbolu Marvelous, and Onokerhoraye Gbakeji.
“At that rally, we reached over 2,500 youths and shared over 3,000 male condoms to drive home the point,” Agbujie said. “The best means is abstinence, but the use of contraceptives is a way of preventing STI and its numerous complications. However, to catch them early with sexual and reproductive health messages, we were in two secondary schools on May 21, 2019, to see the girls and teach menstrual reproductive awareness and hygiene.”
The two secondary schools were Emaudo Secondary School and Ujeolen Grammar, Ekpoma. The theme of the outreach was “Sexual and Reproductive Health: Know Right, Live Right”. But it would be difficult to appreciate the enormity of what these young men and women achieved with this outreach. They, themselves, are burning with the desire to just serve.
As Agbujie said, “the peculiarity of sexual and reproductive health is its ability to follow the classical vicious cycle’s trend. For instance, unprotected sexual intercourse leading to either STIs or pregnancy; it can still lead to both. Then STI comes with its consequences. Unwanted pregnancy can push people to procure illegal and dangerous abortive measures, which can have immediate and long term harmful effects.
“But, at the fundamental stage is awareness (or lack of it) of reproductive health. So the need to put a break to the cycle is imperative, hence the birth of the secondary school outreach program by the national SCORA team.”
However, while the SCORA team just wants to serve, data from World Health Organisation (WHO) on birth rate per 1,000 women aged between 15 and 19 years show why Agbujie’s team’s work is enormous. The data covered nine years: 2000, 2001, 2007, 2009, 2010, 2011, 2014, 2015 and 2017. Below is a table that set Nigeria’s adolescent birth rate set side by side with that of the US, UK and Ghana.
A few facts are immediately obvious from the table. First is the non-availability of data for some years and, second, the fluctuating nature of the figures for Nigeria. Both speak to the fate of the young girls in Nigeria. It means that even at the estimation level, the number of adolescent girls exposed to sexual activity without the necessary knowledge will never be known. And it never really drops.
In sharp contrast, data from the UK and the USA show a steady decline. However, in spite of the high number, there is a noticeable and relative downward trend from 2015, which coincides with the inauguration of the current administration of President Muhammadu Buhari.
Also, to properly appreciate the importance of what Agbujie and his SCORA team did, this quote from WHO on the implications of the data is important: “The adolescent birth rate, technically known as the age-specific fertility rate provides a basic measure of reproductive health focusing on a vulnerable group of adolescent women.
“There is substantial agreement in the literature that women who become pregnant and give birth very early in their reproductive lives are subject to higher risks of complications or even death during pregnancy and birth and their children are also more vulnerable. Therefore, preventing births very early in a woman’s life is an important measure to improve maternal health and reduce infant mortality.
“Furthermore, women having children at an early age experience a curtailment of their opportunities for socio-economic improvement, particularly because young mothers are unlikely to keep on studying and, if they need to work, may find it especially difficult to combine family and work responsibilities. The adolescent birth rate provides also indirect evidence on access to reproductive health since the youth, and in particular unmarried adolescent women, often experience difficulties in access to reproductive health care. (Emphasis, mine).
The above situation is what the SCORA team fought against. As Agbujie said, “we see this group of persons (adolescent girls) in hospitals and communities with complications of unprotected sexual intercourse (STIs and unwanted pregnancies). This is why we burn with the passion to enlighten young girls about their sexual rights, reproductive health, and hygiene.
“It was not easy raising the resources. But we collaborated with the associations of Law and Medical students. We also had help from the Family Planning Unit, Venerology Unit and Medical Women Association of Nigeria, all of Irrua Specialist Teaching Hospital (ISTH), and DKT International.”
He noted that to the best of their abilities, and where possible, the contact details of the students were taken and newsletters on menstrual hygiene, sexual and reproductive health are sent to them. “Although, it’s a small activity compared to the rate at which young girls are falling prey to ignorance about their body,” he said, “it’s better than nothing. In fact, online surveys have shown that the COVID-19 pandemic has worsened the situation. But nationwide, SCORA teams are doing their best via social media.”
Remember the opening story? The narrator (now a mother of two) experienced her own menarche about a week after the incident she narrated. But she was prepared, as the teacher had used the incident as an opportunity to “teach” them. However, between then (2004) and 2017, there’s been no significant change in the number of adolescent births, as covered by the WHO data.
But the Ambrose Alli University team, led by Agbujie, like others in different parts of the country, has taken it as a duty to spread the knowledge. This might save them from facing mounting cases of infections from unhygienic menstrual practices, STIs, badly procured abortions, VVF, unwanted pregnancies, and abandoned babies when they graduate and start practicing as doctors. For both the medical students and their target audience, starting early takes on profound and multilayered meanings.