Empowering young people in their sexual health choices in Tanzania

One of the facilities that Y4H supports is the Kivukoni health centre in Ulanga, situated in Tanzania's south-east Morogoro region. Here, Zawada Kassimu Zangamela, aged 19, was able to access contraception and learn about family planning. Read her story:

"I had to drop out of school after getting pregnant while in form two. Even though I had no complications, it was a difficult period for me. When I started going for my antenatal visits at the Kivukoni health centre, I was scared of what the service providers there would say and feared a backlash, given my young age. Surprisingly, they were very welcoming, kind and helpful. Throughout my pregnancy, the staff there would often educate me about family planning, the different methods available, its benefits and why I should consider it after delivery."

"After giving birth to my son, the service provider advised me to use family planning and I decided to use an implant method. My son is now three months old; I want a better future for him. I believe using family planning will help me with the spacing of my children. I am not ready to have another child as I am not financially stable. Also, being a young mother is not easy. I have many responsibilities, which I already find hard to juggle. Based on my circumstances, I decided I did not want to return to secondary school to continue my education. Instead, I have joined a course in sewing, and I am almost graduating. This is the only way I can work and provide for my son."

"Back then, the only information I knew about family planning was what I learned from friends and peers at school. I didn't know much about the methods or what family planning entailed. But now, I am well equipped with the necessary knowledge and can easily access services at the health centre. Looking back, if I had access to the right information, I could have made a different choice. In hindsight, if I knew what I know now, I would strive to finish my education and get a job before considering becoming a mother."

Emmanuely Yusuph Mphalimbega, 19, is a student who also lives in Ulanga. He lives with his adoptive grandmother in Lupiro village. A typical day for him starts with him completing his household chores and going to the farm. Emmanuely is a client at the Lupiro health centre, a Y4H-supported facility. Read his story:

"Before, I knew little about condoms or how to protect myself against sexually-transmitted infections (STIs) and other infections. I became friends with one of the health service providers at Lupiro health centre, who introduced me to the Y4H project. After taking an interest in what he said, he started counselling me on preventing STIs and why I should avoid peer pressure and other vices like drug abuse. After a while, he encouraged me to visit the health centre for further information. I slowly warmed up to the idea and decided to come to the facility. I was very scared the first time I came here, but he was very welcoming when I arrived. He took his time to educate me on the importance of sexual and reproductive health (SRH) services and the various methods of contraception and showed me how to use a condom correctly."

"Since then, I always use condoms when I have sex. If I didn't get this information, I probably would have become a father by now, which would have presented many challenges, as I wouldn't be able to provide for the child. As a student, I am not ready to start a family. So, by using protection, I am assured that my partner and I are well protected against unintended pregnancies and diseases. Whenever I run out of condoms, I go to the health centre for more. I believe it's very important for us young people to get an SRH education as it's the surest way of preventing teenage pregnancies and abortions, which lead to many losing their lives. To achieve this, it's paramount for adolescents and youths to take an active role and become agents of change by informing, educating and raising awareness of these services to their friends and peers. So far, I have influenced six of my friends to come to Lupiro health centre to access SRH information and services."

In 2022, the Y4H project conducted a one-week training for health workers on sexual and reproductive health, including family planning and the provision of youth-friendly services. Sophia Emmanuel Magombana, 38, a service provider at the Kivukoni Health Centre, was among the health workers selected to undergo the training. Read her story:

"Whenever I received a young person at the health centre seeking family planning and other SRH services, I would immediately associate them with promiscuity. But since I underwent the training, I completely changed my outlook on offering SRH services to young people and I have come to understand why it is crucial for them to have access to these services."

"Before the training, I would offer SRH services to young people, but with a lot of judgement. I was also unfriendly to them as I felt family planning was meant for adults. But everything changed for me when I was selected to attend a one-week SRH training, which included family planning and the provision of youth-friendly services. During the training, I started putting myself into their shoes by relating to their daily experiences and trying to understand their challenges. Armed with this new knowledge, I decided to change my negative attitude and resolved to accommodate them. As a result, adolescents and youth have come to trust me enough to open up about their sexual life without fear or judgement."

"Apart from offering them SRH services, we also introduced weekend clinics designed to increase access to SRH information and services for adolescents. So, my colleague and I oversee the clinics with support from the community health workers. During these clinics, we usually integrate 'edutainment' activities such as games, sports, health education on relevant topics and integrated services provision, especially family planning. So far, attendance has been very encouraging. Often, we see new faces as they introduce and recommend their friends to come to join us and they get concerned if we miss holding a session. I would say the weekend clinics appeal to most adolescents because they expose them to much knowledge on sex. As a topic, sex is almost a taboo in most homes, but in reality, young people know these things and so it's my responsibility to share information about how to practice safe sex."

"What keeps me motivated is seeing the impact that access to adolescent SRH services can have at the community level. Looking back, most adolescents would drop out of school due to unintended pregnancies, leading to high numbers of unsafe abortions and other negative health outcomes. Other adolescents and youth were against SRH services – citing the different myths and misconceptions, some believing contraceptives can cause barrenness. Back then, I had no experience on how to handle such cases. Although we rarely get such cases, I am now more accommodating and understanding. I am able to meet adolescents at their level and communicate with them by providing the correct information and services."

The Youth for Health project also trains youth champions to advocate for their sexual and reproductive health and rights, and hold governments and decision-makers accountable. Mbuya Abass Ngwega, aged 19, is a youth champion who lives in Mwaya village, Ulanga.  Read her story:

"I had a difficult upbringing. I lost my father while I was in primary school and my mother had to take up the responsibility of raising and providing for me and my three brothers. Life wasn't easy. I was constantly sent home due to a lack of school fees, as my mother works as a small-scale farmer. Unfortunately, I was forced to drop out of school while in secondary. It was a tough period for me as this meant I could no longer achieve my dreams. In the meantime, I couldn't stay idle, so I looked for work and got a job as a shop attendant. Despite these challenges, my dreams of becoming a leader were still alive, so I constantly looked for ways and opportunities to fulfil my aspirations. I knew becoming a youth champion was the best way to achieve that."

"When I heard that the Y4H project was looking to appoint youth champions in my area, I immediately applied. The selection process was not easy as it was based on defined criteria, which included age, basic formal education, and demonstrated knowledge and interest in adolescent sexual reproductive health and rights/family planning (SRHR/FP), among others. Fortunately, I was selected as one of the youth champions representing the village of Mwaya."

"As a youth champion, it is my duty to meet with my peers and discuss various health issues every Wednesday and Thursday of the week. As part of my role, I also participate in the weekend clinics at the Mwaya health centre, where we play games and hold ASRH counselling and education sessions. I sometimes support the service providers by facilitating a session on various topics, such as STIs and HIV/AIDs. I also refer my friends and peers to health centres for access to SRH services – especially contraception."

"Among the topics I am passionate about is unintended pregnancies, as this hits closer to home. I had two friends in my class back in school, and both became pregnant. As a result, they had to drop out of school. One tried to procure an abortion, but unfortunately, she lost her life. It was difficult for me as she was my dear friend."

"Becoming a youth champion has changed my life. Firstly, my self-confidence has improved. Secondly, I have also had the opportunity to meet and interact with influential people/leaders. I also had the chance to go to the national parliament, where we presented some of our issues for decision-making, which was a big deal for me."

"I am thankful to the EU co-funded Y4H project as it has empowered young people like me by giving us a platform to discuss and share some of our challenges openly and, in turn, we have seen progress in solving these issues. I can say that, to some extent, some of the challenges we present during our hearing sessions with local leaders have been resolved. For instance, we presented an issue on a health centre at Mwenge village lacking youth-friendly rooms, and soon enough, a youth-friendly room was assigned at the facility, where adolescents and youth can go and get services confidentially and without judgement."