Socio-Cultural, Religious and Sexual & Reproductive Health Education in Ghana

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The Author, Francis Npong works  with Savana Signatures as a communications Officer

She bends, eyes peeking in pain and drops the kitchen knife with which she has been peeling cassava since morning. “I feel like something is coming out of me,” Fatimatu Yakubu aka Lamisi says hurriedly. She sighed aloud hmmm in response to a sharp back pain as she tries to stand up straight.

She drops the knife to support her waist. She clenches her fist and holds her belly tightly with the other hand, Lamisi disappears behind the barn. She resurfaced few minutes later to resume peeling and slicing cassava.

Lamisi had come to farm early in the morning to gather and peel cassava her husband has been busily harvesting. Lamisi’ responsibilities include helping in the farm as a house-wife.

Though her condition had been there after her sixth child, she refused to disclose it to her husband for fears that she might be denied sex, abandoned and probably chased out of her marital home.

In her village-Nanton, a woman is often being accused of witchcraft, humiliated and banished into makeshift homes called “Witches Camps”. “I just also want to avoid this embarrassment of having to be blamed for my circumstance and be called a “witch”, she says.

“This usually pushed out of me, it slips out into my women-hood (vagina) when I stressed myself or squat too hard”. Sometimes with abdominal pains, Lamisi is stricken psychologically but only turned to God in prayers hoping that one day; heavens will take care of her condition.

Lamisi is experiencing what we called uterine prolapse. Uterine Prolapse is a sexual health condition that occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

Uterine prolapse can happen to women of any age however women who have had one or more vaginal deliveries within a shorter period can have their pelvic muscles weakening resulting in uterine prolapse.

According to Mayo Clinic that specializes in women’s health, uterine prolapse occurs when there is damage to supportive tissues during pregnancy and childbirth, effects of gravity, loss of estrogen and repeated straining over the years.

Lamisi was married out at the age of 15 and had had two miscarriages and six births by the age of 30. “She had almost one year child bearing intervals. This affected her pelvic floor”, a medical officer says. To Lamisi, her condition is a spiritual attack that sought to destroy her marriage. She had no knowledge about her sexual and reproductive condition.

Her refusal to disclose her sexual and reproductive health also stemmed from the fact that it is forbidden for people in Nanton village to openly discuss this important matter. In Nanton, sexual education is non-existence. It is completely repugnance to educate children about sex and sexuality in this village and many other Ghanaian societies. Early marriages and unprotected sexual intercourse are naturally acceptable when a young person reaches puberty.

According to a gynecologist, Mohammed Sadiq, her tendons and muscles in her pelvic floor are too weak to keep the uterus tight which slips into her vagina frequently. Uterus prolapse is often caused by overwork, not enough recovery time between pregnancies or pregnancy at a young age, he said. “But uterine prolapsed is treatable in many ways; surgery, exercise and use of pessary ring to hold the uterus tight”, he says.

By sunset, Lamisi is already exhausted as a result of carrying heavy loads such as firewood, water, and gathering cassava tubers while carrying her one year old baby at her back. She rushes back home when the sun is giving out light to prepare evening meals for the entire household after which she takes her break.

She takes a deep breath sprinkles dawadawa (home-made spice) and salt over her soup, gulps few spoonful of the soup (dry okra mixed with ground paste) to determine the taste of it. She knew the her family taste and always fix a meal according to that taste. “I first experienced uterine prolapse few days I had my sixth child. I went to toilet and my uterus slipped”, she said.

Lamisi’ condition has gone beyond mild uterine prolapse. In spite of the excruciating pain she experiences, she prefers to live with the condition to keep her marriage then disclosing it and losing her husband. She bears all the pains including sexual pain as a result of her condition.

She looks much older than her 30 years, her face lined with wrinkles from age, hard work and social pressures. But torn between shame and fears of broken home and being accused, Lamisi kept her condition as a top secret.

Lamisi is among millions of women the over world who are suffering from various debilitating and excruciating sexual and reproductive health related conditions. Like, Lamisi many women do not have a convenient and private platform to access their sexual and reproductive health information.

Uterine prolapse is among many sexual and reproductive health conditions many young women are suffering from in silence.

According to a study by the UNFPA, one third of 600,000 women with uterine prolapse require surgery to strengthen the pelvic floor and tighten the walls of the vagina, or a hysterectomy. In less severe cases, exercise can strengthen the muscles of the pelvic floor. A ring called pessary can be inserted in the vagina to hold the uterus in place to prevent the uterus from slipping. This information, Lamisi could not seek medical redress to her problem because she lacks information and education about SRHR and its services.

Though there is no data in Ghana for example about the prevalence of sexual and reproductive health conditions such as uterine prolapsed, the number of such cases could be overwhelming. The reasons are that culture, social and religious norms bar Ghanaian society from discussing sexual and reproductive health issues.  Like Lamisi, many Ghanaian women are barred by socio-cultural and religious norms to openly discuss their sexual and reproductive health issues.

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Puberty Rights ritual (Dipo) in Ghana, picture Buta photogrqaphy

Even Ghana Education Service law forbids in-depth lessons on sexual and reproductive health issues at the basic schools where children were supposed to learn and know more about themselves. This makes it difficult for the young people to realize and access SRHR information and services. Coupled with this is the non-existence of youth friendly centers to cater for young people SRHR issues.

This is why an initiative of an ICT for development organization called Savana Signatures’ sexual and reproductive health and rights platform is laudable.

The platform known as Sexual Health Education Plus (SHE +) provides access to free, private and convenience SRHR information to young people. The platform is aimed at reducing the way young people infect themselves with sexual transmitted infections (STIs) or conduct unsafe abortions, while providing them education on their sexuality among other things.

Like Lamisi who never had access to a platform to access information about her sexual and reproductive health, young people in Northern, Upper West and Volta Regions are exploring the SHE+ platform to improve on their sexual and reproductive health conditions.