Executive Summary
The State of the Ugandan Child: An Analytical Overview focuses on four thematic areas, namely: health and nutrition, education, child protection and child participation; with emphasis placed on the girl child. The study relied on secondary data review and primary data collected from key informant interviews (KIIs) at national, district and community levels, as well as Focus Group Discussions (FGDs) with young people aged 14-19 and adult community members from 12 districts. The data was disaggregated to indicate trends in realization of the four categories of child rights at a national level and to depict regional, gender and age differences.
Overall, progress has been made over the last decades towards improving the well-being and realization of the rights of children in Uganda. This is especially in relation to enrollment in education, and the policy and legal frameworks in the different domains. However, progress has not been consistent over the years across the major domains of child well-being, with the situation of the girl child remaining more precarious. There is an urgent need for immediate intervention as well as long term non-conventional interventions to reverse the negative situation affecting the boy and girl child.
The health status of children in Uganda remains poor as reflected in the unmet Millennium Development Goals (MDG) and Government targets. Neonatal mortality is at 27 per 1,000 live births; infant mortality rate (IMR) at 54 per 1,000; and the under-five mortality at 90 per 1,000 live births. Malaria still dominates as the leading cause of death among children below age five, accounting for almost 28.8% of the deaths. The number of children 0-14 years living with HIV was estimated to be 147,394 in June 2015. The HIV prevalence among teenagers aged 10-14 was reported at 1.9% for males and 2.3% for females in 2013. Among young people aged 15-24 years, HIV prevalence steadily rose from 2.9% in 2004/5 to 3.7% in 2011. Malnutrition persists with one in every three children (an estimated 2 million children) stunted.
Almost half of the children in the country were not receiving full immunization as of 2011 when the Uganda Demographic Healthy Survey (UDHS) results were published. The factors underlying this situation range from poor health seeking behavior by caregivers to limited access to quality services. This calls for immediate action to address the barriers hindering timely immunization of all eligible children. Interventions in the health sector should also focus on increasing access to HIV testing for all babies born to HIV positive mothers within the set period, enrolling those who are found to be HIV positive for immediate treatment, and innovatively reaching young people with critical information and services and empowering them with life skills to negotiate safer sex and make informed decisions that keep them safe. Multi-sectoral responses are needed to address malnutrition during the early stages of childhood – the first 1,000 days – by tackling both the immediate causes such as poor infant feeding practices as well as the underlying factors such as cultural beliefs and food security.
Education indicators provide a mixed picture in relation to the Ugandan child. Early childhood Development (ECD) receives little attention and only a few formal interventions focus on the development of children under the age of three. There is little information regarding parenting practices and other informal early childhood development practices and interventions at household and community levels. Enrollment of children in pre-primary education remains very low, due to the limited availability of pre-primary schools, particularly in rural communities, and the predominance of unaffordable private sector provided pre-primary education. While there have been sustained improvements in enrollment in primary and secondary education, owing mainly to the introduction of Universal Primary Education (UPE) in 1997 and Universal Secondary Education (USE) in 2007, retention and transition of children to higher levels has remained low, and more particularly in relation to the girl child. Survival rates through primary level are very low, with data showing that in 2013, about six out of ten pupils who joined primary one made it to primary five, whereas only three in ten of them survived until primary seven. Lack of data on survival rates through secondary level presents a major data gap. According to the Uganda National Household Survey (UNHS) 2013 the two main factors accounting for high dropout and failure to transition to secondary education for girls are child marriage and pregnancy. Other factors relate to high financial costs associated with education, poor attitude towards girls’ education, hunger, lack of access to sanitary pads, poor quality of education, poor learning conditions, and teacher absenteeism among others. At primary level, literacy and numeracy remain very low with only 56.2% and 40.1% of pupils reaching a defined literacy level at primary three and six respectively.
The realization of children’s rights to protection, principally protection against violence, abuse, neglect and exploitation, continues to be a critical challenge. All forms of violence against children – physical, sexual, and emotional – have been reported to take place within family, school, and community settings, and within childcare and justice institutions. With sexual violence largely affecting the girl child and physical violence mostly affecting the boy child, gender is identified as a key risk factor alongside age, disability, poverty in the household, over crowding in schools, weak law enforcement, big family size, family separation, low level of supervision and normalization of violence practices by care givers and society in general.
Consequently, a large number of children remain vulnerable to abuse, exploitation and violence. These include: children living in extreme poverty; an estimated 2.2 million orphans; estimated 310,000 children heading households; estimated 40,000 children living in childcare institutions; children living on the streets with no adult care - estimated at 10,000; children involved in hazardous work - estimated at 507,000; children murdered through ritual practices; and children under servitude. The situation of the girl child is aggravated by early unsafe sexual debut. More than half (50.5%) of young people aged 25 years and below start sexual activity before turning 18 years old. Early pregnancy stood at 30% in 2011, within the same age group, while early marriages and teenage pregnancies are profoundly higher in the eastern and northern regions. This situation is linked to the low levels of progression to secondary education, limited access to and utilization of family planning methods, and negative cultural practices such as giving girls into marriage as early as age 12. Among young people aged 15-24 years, over 50% experience unmet need for family planning. Only 35.3% of unmarried sexually active young women are using modern methods of family planning. Female genital mutilation affects about 90% of the girls among the Pokot, Sabiny and other communities spread in six districts in north eastern Uganda, yet the prosecution of offenders remains poor owing to weak law enforcement.
Child participation in Uganda is still characterized by fragmented and short-lived initiatives. There are a few formal initiatives where children are able to have their voice heard, but these are limited in scope and their impact is equally not well documented. The issue of power-relations between adults and children in all settings remains a key barrier. While there might be varied forms and levels of child participation at the family level, these are not well documented and there is need for more research in this area. To create an enabling environment for child participation in Uganda, there is need to develop a national child participation strategy to serve as an action plan with specific interventions that are well resourced. A sector wide approach that brings on board several institutions and which specifies role and responsibilities would be critical.
The realization of children’s rights in Uganda has mixed outcomes in spite of several interventions over the last two decades. The girl child remains disfavored compared to the boy child – owing to cultural beliefs and practices and the failure to adequately address the nature of vulnerabilities and needs of the girl child throughout her life cycle. Targeted innovative interventions by multiple stakeholders are required to support the realization of children’s rights, especially that of the girl child. There are promising practices with some evidence of success that can be improved on and scaled up by both government and non-government organizations in Uganda. These would require commitment to policy, legislation, program and financing from all stakeholders.
