Sarah's Story

I saw a girl; she was fifteen. She came to the clinic and I examined her for some pain. I knew what had happened. So I talked to her, kindly.

Sarah Mwanje
Owner, Nyamayalwo Maternity Clinic, Kampala, Uganda

Sarah Mwanje
Sarah Mwanje, owner of Nyamayalo Maternity Clinic in Kampala, has experienced an increase in the number of young clients.  Credit: Jessica Salama

Young women are among the clients who visit the Nyamayalwo Maternity Clinic in Kampala, Uganda. Sarah Mwanje, the clinic's owner, is a midwife with more than 25 years of experience and a trusted matriarch in her community. She recently took a SHOPS Plus training module geared toward providing youth-friendly services. Referring to her the younger clientele, Sarah said, "I am an older provider; sometimes they fear talking to me more.” 

In Uganda, 70 percent of the population is under 24. One-quarter of young women give birth before the age of 19. Uptake of sexual and reproductive health services is lowest among young people. Despite an increase in the contraceptive prevalence rate for modern methods, among women 15–19 the rate is 13 percent and among women 20–24 years old it is 20 percent. The national average is 35 percent. 

Respectful, non-judgmental counseling

To address this gap, SHOPS Plus funded the development of a training module to help providers better serve youth. The module will be part of PSI’s Provider Behavior Change Toolkit. It focuses on training agents to motivate and support providers to deliver respectful, non-judgmental, quality sexual and reproductive health counseling to young people as well as counsel them on long-acting reversible contraception in the context of informed choice. The module will ultimately help youth access these services by eliminating barriers such as myths and misconceptions, lack of information, fear of judgment from providers, and negative perceptions of health providers. PSI Uganda trained 90 providers using the module.

The goal is to provide youth-friendly health services in the private sector so that women, regardless of age or marital or economic status, feel empowered to access quality sexual and reproductive health services and family planning counseling. 

Sarah Mwanje stands near a box with a sign above it that says "free condoms."

The youth module reinforces effective communication methods and underscores that empathy influences a client’s perception of quality and helps build trust.

“I saw a girl; she was fifteen. She came to the clinic and I examined her for some pain. I knew what had happened. So I talked to her, kindly. She told me about her abortion so I counseled her on contraception,” said Sarah, who took the youth training module earlier this year. “Maybe she was expecting to be scolded. You have to speak gently and nicely. Explain what is happening to her body. If you confront her, you will prevent other girls from coming.”

Attracting and training younger clients

The use of verbal and non-verbal skills when engaging youth is a key element of the training and has helped providers attract and retain more young clients. According to Sarah, “We are offering same services as before, but now have better attendance. More youth and women are choosing contraception, even the long-acting reversible methods of contraception.”