Solutions in search of problems, Uganda edition

By Rebecca Oas, Ph.D. | September 13, 2018

Yesterday, the Guttmacher Institute Tweeted this:

To begin at the end, it should surprise nobody that the Guttmacher Institute, which exists to promote sexual and reproductive health and rights (SRHR) programs and policies, thinks that anything they might report highlights the need for the one thing they do.  When all you have is an IUD, everything looks like a uterus.

But it’s a bit unclear exactly what Guttmacher sees as the problem here, or exactly what their solution will be.  If half of adolescent pregnancies in Uganda are unintended, are they concerned that the figure is too high…or too low?

In an earlier post, I pointed out how the United Nations Population Fund (UNFPA) made a big deal of how 43% of all pregnancies in the developing world are unintended (a Guttmacher figure, for the record), while neglecting to mention that in developed regions, the number is 46%.  Context is important, after all.  If what’s needed in the developing world is more SRHR programs and policies, maybe we should start by looking at those countries so keen to export them and see how it’s working out there.

Looking at the United States, The Guttmacher Institute reports: “Nationally, seventy-five percent of pregnancies among 15–19-year-olds were unintended […] in 2008–2011.”

In the Uganda data, only the outcomes of unintended pregnancies are broken out by birth, miscarriage, and abortion, with abortion accounting for 15%.  The Guttmacher Institute published data on the outcomes of pregnancies aged 15-19 in the United States for 2013, but did not separate it out by pregnancy intentions.  They reported that 29% of adolescent pregnancies ended in abortion.  Presumably, this percentage as a subset of unintended pregnancies would be higher.  So, unintended adolescent pregnancies are presumably over twice as likely to be aborted in the United States compared with Uganda.

Obviously, marriage is a key driver of adolescent pregnancy in Uganda, as opposed to the United States.  According to UNICEF data, by way of Girls Not Brides, 10% of girls are married by age 15 in Uganda, and 40% are married by 18.  Teen marriage is much less common in the United States: data from the Pew Research Center indicate that 5 of every 1,000 adolescents (without disaggregating by sex) aged 15-17 in the United States are married, and 18 of every 1,000 aged 18-19.

So, what does all this actually mean?  Adolescent pregnancies in Uganda are far more likely to occur within marriage, be intended, and not end in abortion, than in the United States.   Child marriage is obviously a problem in many countries, and women and girls benefit from being able to grow, mature, and complete their education before forming families.  But the Guttmacher infographic on Uganda was not about ending adolescent marriage; it linked to a fact sheet about induced abortion and the particular risks to unmarried adolescent girls with insufficient access to “safe” abortion and contraceptives.  Given that, it seems strange that Guttmacher would want to lead with the fact that (only) half of adolescent pregnancies in Uganda are unintended, given that the figure is so much higher in the United States.  (For what it’s worth, data on intendedness of pregnancies to adolescents in developed countries other than the United States do not appear to be routinely collected.)

So, if the fact that about half of pregnancies to adolescents in Uganda are unintended suggests the need for more SRHR policies and programs, as Guttmacher claims, what would be the intended outcome?  That fewer pregnancies in that age range would be intended?  That more would be ended by abortion?  No matter what the facts being reported, Guttmacher’s policy prescriptions are the same boilerplate stuff they’ve always been saying: more abortion, more contraception, more SRHR, no matter the country or context.