Figure 46: Overall coping strategies adopted by households

After relatives and government, the next sources of support to households in the two subcounties during the lockdown were neighbours and town or community leaders. The presence of neighbours and relatives as common sources of support for needy households is evidence of the old age spirit of solidarity/oneness that is still very much prevailing in most communities despite the strong push of modernity and its individualistic tendencies. This is often reflected in slogans such as “muno mukabi” and similar connotations found in other languages.

Overall, diversifying sources of income (78.4%), curtailing household expenditure (51.6%) and working longer hours (41.8%) were the main coping mechanisms that were employed by households to minimize the effects of Covid-19 and associated prevention measures as indicated in figure 46 below.

Figure 46: Overall coping strategies adopted by households.

90

80

70

60

50

40

30

20

10

0 78.39

Diversified income sources 51.65

Curtailing HH expenditure 41.76

15.02

8.42

Working for longer hours Increased borrowing Other

As indicated above, other coping mechanisms included working longer hours and increased borrowing. It is worth noting however that some coping mechanisms such as increased borrowing could have long-term devastating on the socioeconomic status of livelihoods such as an untenable level of debt, that could make it difficult for households to provide for the basic needs of members as priority is expenditure is channelled to debt repayment. In some instances, loans have also been known to lead to the loss of household assets such as land and other productive assets.

4.0 Conclusions and Recommendations

4.1 Conclusions

Impact of COVID-19 on young people’s access to and utilization of SRHR services

In most of the facilities assesses, the provision of most SRH services went on uninterrupted during the lockdown. This was attributed to routine supply by the district, with support from NGOs, especially regarding mobilization and sensitization. Only three services namely: testing for RTI/STIs, sex and sexuality counselling and IUDs were not available at some facilities during the lockdown, while female condoms were available but at a cost.

Contraceptive methods (18.35%), HIV screening and testing (17.9%), SRH counselling and information (10.86%) as well as pregnancy testing (10.11%) were the most needed SRH services by young people during the lockdown. The least needed services were treatment for abortion (1.5%), SGBV counselling and support (1.9%) and postnatal care (3.75%). The need for these services was generally higher among the 15-19 age category. However, the need for maternity and child delivery services as well as postnatal care was highest among young people aged 20-24. On the other hand, young people between 10-14 years were more in in need of SRH counselling and information than any other service. Overall, there is a strong relationship between young people’s age and the need for SRH services, but the difference in the need for the services by sub-county was not striking.

The most sought services by young people were antenatal care (93.33%), pregnancy testing (93%), and maternal and child delivery (92.31%), while the least sought were SGBV counselling, SRH counselling and information and testing for other STIs. Overall, a majority (93.6%) of young people who sought services obtained them. The ability to seek for and utilize SRH services was higher among young people in the intervention sub-county (Mpungwe) than the Control (Baitambogwe). However, the Pearson Chi-Square value of 0.044 points to a weak relationship between seeking for and utilizing services on the one hand, and the sub-county on the other. This was further confirmed by the odds ratio of 1.0 which suggests a weak association between the predictor and outcome variables.

The predominant source of SRH services for young people was the public health facility, owing to the proximity of the facility and affordability. Failure to seek for and obtain the needed SRH services was attributed to a mix of supply and demand factors including provider characteristics. Specifically, limited awareness on where to seek the service was the overriding inhibitor for the young people to seek the needed SRH services. Other reasons included; transport challenges and stigma associated with some SRH services. On the other hand, unavailability of health workers, inability to afford the cost of the service and unavailability of the services were the major inhibitors to obtaining the needed services.

Although the proportion of the young people who had any form of disability was much lower (3.4%), qualitative data indicated that this category experienced disproportional challenges

in accessing SRH services during the lockdown. This was mainly due to limitations on transport because of the lockdown and associated ban on public transport as well as long distances to health facilities. Owing to these same challenges, young people in hard-to-reach areas such as islands were even more disadvantaged given that supply of SRH products was limited. Nevertheless, the study did not observe any systemic factors that constrained the provision of SRH services to vulnerable groups of young people at large.

Sexual behaviour, access, and utilization of contraceptives

Whereas the majority (83%) of the young people reported having engaged in sexual intercourse during the lockdown period, contraceptive use was reported by only 60.8%. The use of contraceptives during the lockdown was however higher (53.9%) in the intervention sub-county than in the control. Despite the slight variations in the observed results, the use of contraceptives cannot be attributed to the peculiar factors in the intervention and control sub-counties as evidenced by the P-value of 0.384.

Male condoms and injectables accounting for 55.4% and 26.2% were the most common forms of contraceptives methods used by young people during the lockdown, while the least used were female condoms (1.54%), lactational amenorrhea (1.54%) and implants (3.1%). The predominant use of male condoms may be explained by the extensive availability at most health facilities and in the community at no cost. Indeed, public health facilities were the dominant source of contraceptive for young people during the lockdown. The most dominant reasons for not using contraceptives among young people were partner objection, need for children and fear of side effects. Prevalence of pregnancy among young people during the lockdown was 21%, with the Pearson Chi-Square result of 0.000 suggesting a strong relationship between contraceptive use and pregnancy/conception.

Role District and community leaders in the access of SRHR services

The majority (72.2%) of the caregivers interviewed did not know any role or assistance rendered by the district and other community leaders in facilitating young people’s access to sexual and reproductive health services during the lockdown. On the other hand, 10.3% and 2.2% respectively reported that local leaders were instrumental in raising awareness about SRH services and issuing movement permits. Only 7.6% of young people interviewed were reported to have obtained SRH information from local leaders/politicians, 5.63% from VHTs and 2.11 from religious leaders. In addition, the district and community leaders were instrumental in eliminating various supply and demand-related factors that affect the provision of SRH services including the supply of the needed SRH products to health facilities in the district. However, local leaders are reported to have experienced challenges in supplying SRH products to facilities in hard-to-reach areas such as islands.

Impact of the pandemic on the households of young people 10-24.

Homegrown food was the main source of food for a majority (85.7%) of the households during the lockdown. The majority of the households could afford two or more meals per day for adults (96.6%) and children (79.1%) at the time of the study, and there were no significant variations between the intervention and control sub-counties as evidenced as a Chi-Square value of 0.88. However, 20.3% and 28.3% of the households in Baitambogwe and Mpungwe sub-counties respectively could not afford a minimum of three (3) meals a day during COVID19 lockdown between March and April 2020. On the other hand, the majority of the households in both sub-counties could afford at least three meals a day. Although weak, there was a relationship between the main source of food and food security during the lockdown, as evidenced by a Pearson Chi-Square result of 0.030. There was no relationship between food security during the lockdown and the sub-county as evidenced by the Chi-square result of 0.127.

The results show that COVID-19 and the associated containment measures such as the lockdown had an adverse impact on employment. In 23% of the surveyed households, it was reported that a member lost a job, while a majority (70%) of the caregivers were reported to have experienced a decrease in working hours during the lockdown, the majority of whom were engaged in casual labour (16.7%) and business/trading (13.3%). On the other hand, the largest increases in working hours were reported among caregivers engaged in casual labour (66.6%), farming (65.7%), salaried employment (60%) and business/trading (60%). Households which experienced a decrease in income and an increase in expenditure were 89.4% and 80.22% respectively.

Among all the surveyed households, 39.6% had a member who experienced emotional violence during the lockdown, while 18.3% and 5.9% had members who experienced at least one form of physical and sexual violence, respectively. On the other hand, 47.9%, 39.3% and 10.5% of young people reportedly experienced some emotional, physical, and sexual violence respectively during the lockdown. Furthermore, 61.9%, 42.5% and 58.2% of caregivers interviewed were of the view that cases of emotional violence, sexual violence and physical violence respectively had increased in the community during the lockdown. These results were corroborated by data from the police that indicated that in total 300 cases of domestic violence were reported in Mayuge between January 2020 to March 2021, with many other cases thought to not have been reported.

The most dominant strategies adopted by families to deal with the challenges posed by COVID-19 and the associated lockdown were depletion of savings (75.1%), sale of livestock/poultry (48.72%) and borrowing money (41.4%). More than a quarter of households (34.43) skipped making payments on their loans. The majority (85.1%) of the surveyed households did not receive any form of aid during the lockdown. Among those that received aid/assistance, food (35%) and cash/money (23%) were the most dominant forms of support to make ends meet. Relatives and government accounting for 45.83% and 35.42% respectively were the most dominant sources of aid for families in need during the lockdown.

Overall, a majority (78.4%) of the surveyed households reported having had to diversify their income sources to cope with the challenges of the lockdown, while 51.7% reduced household expenditure and 41.8% increased working hours.

An overwhelming (93.59%) number of young people who sought SRH services during the lockdown ultimately accessed them. Of these, slightly more than a quarter (27.1%) paid, while the majority (72.74%) did not incur any cost to access services. Among those who paid, a majority (52.2%) were in Baitambogwe, while the rest were in Mpungwe sub-county. Among those who paid, 68% regarded the cost as high, while 28% found the cost of SRH services to be affordable. A majority (62%) of the young people who accessed and utilized services paid for themselves, while 13% were paid for by their caregivers/parents. More than half (55.7%) of the young people interviewed reported that SRH expenditure had increased since the imposition of the lockdown, while 22.2% did not observe a decrease.

4.2 Recommendations

• Strengthen the capacity of parents to effectively engage in sex and sexuality talks with their young people. A lot more needs to be done to change the demystify parents’ attitudes towards SRH. Information, Education and Communication about SRH for young people should emphasize the notion of age-appropriate interventions. • In the same spirit, there is a need to continue sensitization aimed at progressively changing the societal wide negative attitudes, beliefs and perceptions regarding SRH in general and family planning in particular. Religious, cultural, and other opinion leaders need to be targeted and involved. • Reach A Hand through their community structures such as the peer educators and in partnership with other players the SRH sector need to accelerate the SRH campaign beyond schools and other formal settings to informal community spaces where young people routinely meet and interact. • Continue to lobby the government to provide adequate funding for youth-friendly corners and ensure that staff there are trained in the provision of youth-friendly SRH services. • Improve the coordination between the providers of SRH services, especially information. Formation/strengthening the capacity of working groups that bring together all key stakeholders in the space of SRH promotion and service delivery. • The design and implementation of COVID-19 resilience interventions response to vulnerabilities created by the pandemic would be vital in restoring and/or improving the livelihoods of the population in Mayuge district.