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Melisa Chatikobo
LIMITED access to sexual and reproductive health and rights (SRHR) information is significantly affecting young people in Zimbabwe, particularly in rural areas like Mutoko.
This is due to the limited availability of SRHR education and services, which hinders informed decision-making about sexual health and well-being.
Mutoko, a fast-growing town, whose development is being driven by mining, has witnessed an influx of young girls seeking work or turning to sex work.
This has made them particularly vulnerable to teenage pregnancies and HIV/Aids.
The HIV prevalence rate in Mutoko stood at 9,90 percent last year, with females aged 15 to 29 being six times more affected than males, according to the United Nations International Children’s Emergency Fund.
Gender-based violence, rooted in patriarchal societal norms, further exacerbates women’s vulnerability, while cultural practices like polygamy and child marriages hinder women’s ability to negotiate safe sex.
Teenage pregnancies have become a major cause of school dropouts in Zimbabwe.
According to Primary and Secondary Education Minister Torerayi Moyo, 4 557 girls dropped out of school last year after falling pregnant, with 3 942 of them living in rural areas.
Ms Marvelous Chimana, a Mutoko resident, emphasised the importance of SRHR information for her and her boyfriend.
She expressed frustration with the lack of access to contraceptives and comprehensive SRHR education at the local clinic.
“When I go to the local clinic, I don’t get all the information I need on SRHR,” she said.
“The nurses at Kawere Rural Health Centre say they provide health education every Thursday before 8am, but I have never received those services.
“Most girls in my area prefer to use birth control pills, which are short-term, but when we go to the clinics, we are told they are out of stock.
“Sometimes we share pills until one of us can afford a full set.
“If someone wants a Jadelle implant, they are often referred to the district hospital because the local nurse isn’t trained to insert it.”
A Jadelle is a contraceptive implant inserted under a woman’s upper arm skin that is used to prevent pregnancy.
A baseline survey conducted by the Disaster and Environmental Management Trust (DEMT) in December 2023 corroborated Ms Chimana’s experiences, highlighting the limited availability of SRHR information and services in the area.
“Lack of trained personnel and attitudinal challenges of service providers such as rudeness, unfriendliness of nurses, ignorant health workers … nurses requesting for payment, short-tempered nurses, lack of patience and unprofessionalism. Uneducated and half-trained village health workers resulted in unprofessional delivery of SRHR services.”
A DEMT community scorecard conducted in February revealed that some participants paid as much as US$120 to obtain medicines from distant hospitals.
“Traveling long distances of approximately 10km was also cited as a challenge,” reads the report.
“Due to the scarcity of sexual reproductive health commodities and equipment, community scorecard (CSCs) participants reported paying significant sums of money … up to US$120, to acquire medicines from distant hospitals like All Souls Mission.
“These payments were often demanded upfront, hindering the full enjoyment of sexual reproductive health and rights.”
To address these gaps in access to information and contraceptives, the Zimbabwe National Family Planning Council (ZNFPC) has trained community-based distributors (CBDs) for all 29 wards in Mutoko, although not all have been deployed yet.
Mrs Joyce Kuridza, ZNFPC youth health facilitator at Chitekwe Youth Friendly Centre, said their primary responsibility was to distribute family planning products and offer sexual and reproductive health information door-to-door in their communities.
“At ZNFPC, we have CBDs available in the community,” she said.
“They are assigned to each ward, trained by ZNFPC, and can provide both short-term and long-term contraceptives.
“If girls can’t obtain what they need at the clinics, they can turn to these CBDs.”
ZNFPC communications director, Mr Donald Dube added: “CBDs are also known as ‘Mbuya Kurongamhuri’ or ‘Sekuru Kurongamhuri’.
“They are the foot soldiers, receive a salary, and obtain supplies from clinics through the Natpharm programme to distribute family planning and other SRHR products.”
However, some girls in Mutoko report that they have never seen these CBDs and are unfamiliar with the term.
Ms Chimana claimed that she has never met a CBD in Kawere and is unaware of their presence.
“I have never encountered CBDs in the community, perhaps they exist in other areas,” she said.
“I believe the Government should send health personnel to schools and public gatherings to educate people on SRHR, as there are few avenues for accessing this information in my area.”
Mrs Idah Garaipasi of 6 Girls, an organisation working to increase access to SRHR information in Mutoko said: “Access to SRHR education in Mutoko remains limited.
“People lack sufficient information because when resources are allocated, little is directed towards promoting awareness.
“Sometimes it’s overlooked, but it is crucial so people know who can assist them.
“Much more needs to be done in that area.”
ZNFPC Mashonaland East provincial manager, Mrs Sarah Dabwa, explained why some people in Mutoko have never encountered CBDs.
“In Mutoko, we only have five CBDs, limiting their coverage to a few wards,” said Mrs Dabwa.
“They are unable to reach the entire district.
“However, ZNFPC maintains a Youth Centre at Chitekwe, and the youth facilitator there engages with young people.
“Due to limited funding, there are currently no opportunities to recruit more CBDs, which explains why some areas in Mutoko may be unaware of their services.”
The DEMT survey revealed that some youths in Mutoko suggested extending service hours to enable access to sexual reproductive health services at night.
“This can be interpreted in various ways. It might be linked to their work schedules (such as night-time sex work), or it could reflect the extent of discrimination faced by those seeking sexual reproductive health services,” the report reads.
Mrs Garaipasi noted that another reason why some people prefer to access SRHR services at night was due to religious restrictions.
“Certain religious sects, like Masowe, do not believe in modern medicine, so their youths may hesitate to openly seek sexual reproductive services for fear of being ostracised by their church leaders.
“Additionally, there are cases where parents oppose their children learning about SRHR, despite the children’s interest, posing a challenge,” she added.
Culture also plays a significant role in rural areas.
Mr Mucheni Khama, a 60-year-old from Mutoko, expressed reluctance to discuss SRHR.
“Sexual and reproductive health information is a private matter. Only a married woman has the right to seek such information and ensure family planning to avoid unplanned pregnancies,” he said.
His wife, Mrs Veterai Khama, however, holds a different view.
She believes that increased community discussions about SRHR are beneficial.
“We need community health distributors to help us understand the importance of sexual and reproductive health rights, as some of our people are illiterate, and pharmacists may lack patience in explaining how to use contraceptives. I wish I had the opportunity to learn these things from a medical perspective when I was young instead of relying on aunts and traditional methods, which are now outdated,” she said.
The lack of education is evident in the DEMT survey, which showed a high availability of female condoms but low usage rates.
“While CSCs participants positively indicated total satisfaction with the availability of female condoms, they also indicated that they seldom use them and utilisation for female condoms is very low,” reads the DEMT report.
“This calls for awareness and the need for more educational campaigns to increase uptake and utilisation of this sexual reproductive health commodity.”
Another issue noted by Ms Chimana is the age of the staff at clinics, which can make young people uncomfortable discussing their concerns.
“Establishing youth-friendly corners with trained personnel can ensure confidentiality and improve the transparency of health data, such as infection rates and outcomes,” she said.
DEMT, with technical support from ActionAid Zimbabwe, is partnering with the Government to address this issue by establishing youth friendly corners across Mutoko, where adolescents can access sexual and reproductive health services.
Ms Chengeto Muzira, a DEMT representative highlighted the lack of accurate data at the community level as another problem.
Her organisation is advocating for gender-sensitive budgeting in the 2025 national budget to increase SRHR information platforms in Mutoko.
“In Mutoko, we are lobbying for approximately three percent of the district’s budget allocation from the national health budget to be directed towards family planning and youth-friendly services,” she said.
“As we prepare for the upcoming budget consultations, we are engaging with key stakeholders in relevant forums to make this possible.
“Much needs to be done regarding SRHR.
“There are instances where nurses at the ward level do not acknowledge adolescents seeking sexual reproductive services.
“Some clinics deny having cases of girls as young as 11 falling pregnant, but district-level statistics reveal such cases.
“The staff may be in denial, perhaps feeling under investigation or scrutiny.”
To improve access to SRHR information, DEMT is establishing community-based SRHR committees comprised of adolescents and key stakeholders.
Additionally, they are creating a network of community-based organisations and stakeholders working on SRHR and conducting public resource management and social accountability training.
This story is published under the Voluntary Media Council of Zimbabwe Investigative Journalism Fund with support from Action Aid Zimbabwe under the Partnership for Social Accountability Programme.
Tinaye Agere
Online Reporter