Hope Springs Health Foundation: Protecting girls’ rights

Problem

Uganda’s rate of teenage pregnancies stands at 25%, which is amongst the highest rates in East Africa. During Uganda’s first COVID lockdown in 2020, pregnancies among girls between 15 and 19 increased by 28%. 34% of girls are married before the age of 18. This not only violates basic human rights, it also hinders educational opportunities.

In Mayuge District, the teenage pregnancy rate stands and 67% and the HIV prevalence stands at 7% beyond the national prevalence of 6.2%. One underlying cause are cross-generational relationships. Teenage girls are commonly preyed upon by older men known as “sugar daddies,” who give money and gifts in exchange for sex. Older men have been sexually active longer and have had more sexual partners, and thus are a high-risk group to transmit HIV. Especially in rural areas, in addition to little basic knowledge regarding sexual and reproductive health, girls often lack relevant life and social skills, including making positive decisions, self-esteem, patience, assertiveness, and bargaining power.

Girls who marry before they turn 18, have lower school completion rates, higher rates of unpaid labour and poorer health outcomes. Evidence shows that it leads to a greater risk of STIs, such as HIV, and higher rates of domestic violence. Teenage pregnancies are one of the top causes of death among girls in Uganda.

Solution

One effective intervention is the 'Sugar Daddy Awareness Classes,' a brief school-based training program that aims to raise awareness among adolescent girls about the risks associated with engaging in relationships with older men. These one-hour trainings are conducted in grade 8 (ages 12-14) by qualified female facilitators and focus on changing the risk-reward assessments of participating girls. One year post intervention, a large RCT in Botswana showed that girls who received the “sugar daddy” messaging were 28% less likely to be pregnant one year later than girls who were simply told to abstain from sex. Similar results were observed in a study conducted in Kenya.

Azurit Foundation teamed up with D-Prize to support locally-led, high-impact organizations at a very early stage (pre-seed) that are underfunded but positioned to serve people who otherwise would not be reached. One of the organizations that received funding through D-Prize and the Azurit Foundation is Hope Springs Health Foundation Uganda (HSH), established in 2023. Many existing approaches do not adequately acknowledge the necessity for local institutions to play a role in eradicating teenage pregancies. There has been a considerable lack of engagement of community-based systems like cultural and religious institutions, self-help groups, and schools in efforts to curtail the problem. Locally-led organizations such as Hope Springs Health Foundation Uganda are well positioned to understand local contexts and involve relevant stakeholders. For its pilot, the partner started by systematically mapping schools in Mayuge district and selecting the three most suitable for the Sugar Daddy Awareness Classes.

HSH has designed a data-driven set up from day one. They are interested in knowledge and mindset shifts but the ultimate target is a reduction in pregnancy rates and HIV transmission. This information will be collected one year post intervention and compared to their baseline data. In addition, qualitative data are collected through interviews and focus groups with students, teachers and facilitators.