[00:00:01] Madeline: Hello and welcome to SHE SOARS. Her Voice. Her Rights.

[00:00:05] Amal: We are CARE Canada’s Youth Champions, a group of young people across Canada who are passionate advocates for Sexual and Reproductive Health and Rights (SRHR).

[00:00:13] Lauren: We’re excited to discuss and raise awareness about young women’s rights and choices in Kenya, Uganda and Zambia.

[00:00:20] Amal: Together, we will explore how these global issues connect to our lives as Canadian youth and discover ways in which we can all take action.

[00:00:27] Lauren: We will also talk about the SHE SOARS* project, which improves access to health and education, which are areas we want to see change in.

[00:00:34] Everyone: Join us!

[00:00:35] Lauren: Hello, and welcome back to another episode of the SHE SOARS podcast. You’re joining us for part two of the “She speaks out: SRHR Stories around the world” series. We’ve been collecting stories from youth in regards to their Sexual and Reproductive Health and Rights, also known as SRHR, and we’re really excited to continue sharing them with you today.

[00:00:55] We’ve received stories from North America to East Africa. The majority of people we heard from were between 18 and 40 years old and all identified as female. So in the first part, we talked about period stories and the stigma, and what it might mean to alleviate some of that stigma. We’re excited to move forward today and I’ll pass it over to Amal to introduce the themes we’re going to be covering.

[00:01:16] Amal: Thanks Lauren. Many of us will have experiences that can be scary, confusing or embarrassing, which is why we came up with this idea. It helps us to realize that we are not alone going through things like having bodily concerns or questions about your health and rights. I also want to let listeners know that we’re joined with Amanda again, who is from the Youth Advisory Board. Thanks for joining us, Amanda.

[00:01:40] Amanda: Thank you for having me, Amal and Lauren. My name is Amanda Banura, as mentioned, from the Youth Advisory Board in Uganda. It’s always exciting to be here.

[00:01:50] Amal: Awesome. Great to have you. So in this second part of the episode, we’re going to be focusing on two remaining themes that we identified through reviewing the stories. So the theme that we’re going to be talking about today is related to Sexual and Reproductive Health knowledge, attitudes and behaviors, and taking a look at self-advocacy in the medical system.

[00:02:09] And then the last theme that we’re going to be discussing today is stigma regarding sex before marriage and learning about Sexual and Reproductive Health in adolescence. I’m looking forward to this discussion and I’ll pass it over to Amanda, who will share the first story that we have today.

[00:02:27] Amanda: Awesome. Thank you Amal. I am so excited to share with you the first story from Canada. And this is the story: “When I was 21 years old, I was working as a camp counsellor. One day, we took the kids on a field trip and the moment I stepped off the school bus, I felt something inside of me flip.

[00:02:49] I wasn’t familiar with this feeling so I assumed it was a cramp or a stomach bug. As we trekked down the beach, the painful feeling in my abdomen got worse. I could hardly keep up with the kids so I took a break. The lifeguards came over to assess whether I could have appendicitis. But I downplayed how bad I felt.

[00:03:11] At one point, they offered to call an ambulance as I was hunched over in more pain, at which point I volunteered to have my mom pick me up instead. I didn’t want to risk looking stupid and dramatic if it turned out nothing was wrong. While waiting for my mom, I threw up and regretted not taking it more seriously.

[00:03:31] Once I reached the nearby hospital, the doctor asked me to rate my pain, to which I replied a seven, thinking that getting in a car accident would hurt more than this. I distinctly remember my mom being upset that I didn’t rate it higher. She had never seen me in so much pain before. I also remember feeling worried and suggesting to the doctor, could it be something with my reproductive organs?

[00:03:59] But he didn’t seem too concerned and sent me home with some over-the-counter painkillers. That night I woke up in so much pain that my mom rushed me to another hospital where they did some tests, including an ultrasound. They quickly discovered I had a twisted fallopian tube that was blocking my blood flow and required immediate surgery.

[00:04:20] Sometimes they can fix it or remove part, but in my case, they had to remove the whole fallopian tube and ovary because it was so damaged. This may not have been the case if only the problem had been recognized and addressed sooner. The doctors told me that my reproductive health would be okay in the long-term.

[00:04:41] But I definitely felt how a girl like me could be dismissed in the healthcare system as the first doctor I had didn’t seem to think my pain was real. He also didn’t do further tests, refer me or give follow up. Through this experience, I learned the importance of advocating for yourself.

[00:04:59] From the moment I stepped off the bus to the hospital, I needed to be my biggest advocate because if I didn’t take it seriously, no one else would. It also speaks to the need for healthcare providers to take young people seriously when they report pain and ask pointed questions, not just assume they don’t know about their bodies or are being dramatic.

[00:05:24] If I would have spoken up for myself and taken action sooner, and had doctors who took me seriously, I would have had a better experience and results. Well, there we have a long and intense story. Over to you, Lauren. 

[00:05:39] Lauren: Yeah, thanks for sharing that, Amanda. When I read that story yesterday it really stuck with me. I have some friends that have gone through similar experiences with getting diagnoses for endometriosis or things like that, where they’ve just been dismissed. They say it’s just normal period pain and are dismissed.

[00:05:56] So it’s important to be your own advocate in the healthcare system, but it is also a shame that it has to be that way right now. I’m looking forward to diving into a discussion about that. I will share the next story, which is also from Canada: “When I went in for my first Pap test at 21 years old, I was surprised to get a call from my doctor telling me that my results were abnormal and that I needed to come back in to see her again. Knowing that Pap tests were screening tests for cervical cancer, I felt panicked. Did this mean I had cancer? When I returned to see my doctor, she informed me that the results might mean I had an a Human papillomavirus (HPV) infection.

[00:06:31] Having always practiced safe sex, I was shocked and confused. How did this happen and did I now need to worry about passing it on to others? My doctor explained that HPV infections are very common, it is often symptomless in men, and only the vaccine can protect you from getting infected, so I didn’t do anything wrong.

[00:06:51] There are many strains of HPV and the vaccine I got when I was young didn’t protect me against as many strains as the newest one, which she recommended I get as a booster. Well, I did have to get a biopsy done, which is a tissue sample, to make sure I didn’t show any signs of cancer progression.

[00:07:08] My care providers explained that cervical cancer develops slowly. The abnormal test results I got really just meant that I would need to have more frequent testing to make sure it didn’t go any further. Four years later, and my last few Pap test results have been totally normal. Nothing to worry about.

[00:07:24] I wish I had had a better understanding of Pap tests, Sexually Transmitted Infections (STIs) and cervical cancer risks so I didn’t have to feel that sense of panic when I first heard that result.” Thank you for sharing that story. I’ll pass it on to Amal.

[00:07:38] Amal: Thanks Lauren. That’s a great story. I remember reading it and thinking it’s very common for girls to go through that. Even myself when going to the doctor and hearing something new, it’s like, why have I not learned this previously? So I resonated with that story. I’ll pass it over to Amanda, who will start us off with a set of discussion questions that we were thinking about.

[00:07:59] Amanda: Thank you so much, Amal and Lauren. I love the theme of advocacy and standing up for each other. And that leads us to my first question: Why is it that women and girls are often dismissed in the medical system? And what are some strategies to address this? 

[00:08:15] Lauren: The first thing that comes to my mind is women were kept out of the medical field for so long. It is only really in recent decades that women have been able to become respected doctors in the medical field. So I think those hundreds of years of historical research and testing and everything completely excluded a lot of women’s issues.

[00:08:34] And I think while a lot of progress is being made, there is definitely a lot of work to be done playing catch up and reprioritizing potentially a lot of the research projects and focusing more on women’s issues and taking them seriously.

[00:08:48] Amal: Yeah, thanks Lauren. I think that definitely plays a huge role in the experiences that women and girls go through in the medical system. And it brings me back to the thinking of having treatment and care that is patient-centered. So not only the questions that doctors will ask you once you are in the patient room but building that relationship with patients to include questions about their overall wellbeing to make people more comfortable and feel heard once they’re engaging with family doctors or in hospitals. That’s the thing I think about when I think of some strategies to address this as well.

[00:09:24] Amanda: I agree with you, Amal and Lauren. To add on to that, I have a feeling that the general assumption of people when it comes to women in the medical system and dismissing us is because they believe we have so many problems – we’re the ones who get taken easily by pain, we have menstrual cramps, headaches, mood swings, hormonal imbalance, etc. But I feel like that is not a reason we should be dismissed. Because we are the best teachers of our own realities.

[00:09:52] We can explain or understand what we go through. So I think we need to be in the medical system. If there is a woman with fibroids in the hospital and there is a nurse who has lived through that experience, I think they are the best teachers to know and understand how to treat them or manage such situations. Over to you, Lauren. 

[00:10:11] Lauren: I’m going to take it to a more personal level. If anyone has experiences that they want to share about their own experience advocating for themselves or being dismissed in the healthcare system, or anything related to your SRHR journey in the healthcare system that you feel like sharing, feel free.

[00:10:27] Amanda: Yeah, I would like to go first on this one. I have loads of experiences to share in the medical system. One time I was taking my young sister to the heart institute and they looked at both of us like tiny dolls. They said, “Why are you here? You should be with an adult.” And I was the older sister trying to be an adult in this situation. They kept on saying, “No, you can’t be here. Go back and bring an adult.” I felt so offended by that.

[00:10:54] And then there is another incident that happened to me recently. I had a teenage mother who was due to give birth and she was in so much pain. And I kept on calling this midwife, “Madam, hey, nurse, can you come help this girl?” Because the contractions were getting intense. Every contraction she was pushing.

[00:11:09] And I think that was becoming dangerous. And the nurse kept on telling me, “Just tell her to keep walking. The baby should go down.” So I told this girl, “You know what, lie on the bed and do what you feel you should do.” And before we knew it, the head was popping out.

[00:11:23] So the nurse came running and things happened so fast. And I was thinking: So why didn’t you really pay attention when I was telling you this? Anyway, those are a few experiences I can share.

[00:11:34] Amal: Thank you Amanda for sharing your experiences. It is always great to hear personal experiences when we are talking amongst each other to get a better understanding of how we experience these themes that we are discussing.

[00:11:46] I think on my side, I have experienced more so dismissal going to healthcare facilities and clinics. For example, I remember one time when I had missed three months of my period, which makes you kind of worried, right? So you want to go to the doctor and get an understanding of what they think might be going on. When I went and I explained the situation that it wasn’t pregnancy, it was just gone for three months, they said, “Just wait it out. It will just come back soon.” So there was never any follow up, advice or referrals or anything like that. So I think I can definitely resonate with the first story that Amanda shared where the respondent experienced the same kind of dismissals within the healthcare system. 

[00:12:30] Lauren: Thanks for sharing your stories. I definitely can resonate with that feeling of ‘maybe they didn’t hear me just because I’m a young girl’ but it is frustrating to feel like you’re going to the authority on the matter and then they basically don’t give you the time of day. I’ll pass it over to Amal for our last discussion question. 

[00:12:48] Amal: Thanks Lauren. So one of the things that I was thinking about when the second story was shared inspired this question: Do you have experience learning knowledge about STIs and cervical cancer testing in school, and if you remember, was this included in the curriculum?

[00:13:05] Lauren: For me, I would say most of my Sexual and Reproductive Health education actually was quite a fearmongering like, ‘You will get an STI and this is what it is going to look like and it can lead to cervical cancer.’ So that was a lot of what the education was.

[00:13:20] However, it wasn’t very proactive and de-stigmatizing. It wasn’t saying things like getting an STI can sometimes be normal, this is what testing looks like and these are your steps if you think you have one. It wasn’t really like that. It was more like you shouldn’t do X, Y or Z, or it will result in something abnormal and shameful.

[00:13:38] So I think it is potentially important for SRHR curriculum to include information about STIs, cervical cancer testing, etc. but doing it in a much more empowering and informative way instead of intentionally to scare youth, honestly.

[00:13:54] Amanda: I agree with you Lauren. In my experience, learning about SRHR knowledge goes back to primary school. There was this organization that came to train peer educators and they took us out for a camp. We thought it was all about having fun but later in the morning they brought this video and said they had a movie to show us. 

[00:14:13] It was connected to how HIV spreads and Acquired Immune Deficiency Syndrome (AIDS) and all of that. And then later they showed us hardcore pictures of STDs and it was just like you said, Lauren, to scare us off. But to me, it was a mind-opener because I realized this is when my real advocacy life and journey started.

[00:14:34] Young people can’t go through herpes and all of that. It gave me the courage to really speak about it. I think all that needs to be included in the curriculum. It’s not in the curriculum because take, for example, where I come from, that curriculum is separated by age. By the age I got to know something, it is not the same things they are going to learn at that age today. 

[00:14:57] Amal: Thank you both for talking about your experiences navigating curriculum. I know for me, I feel like I didn’t learn about any of this stuff until I took classes like biology in high school where they talked about it in the biological sense of STIs, cervical cancer, etc.

[00:15:13] But I don’t really remember it being in specific SRHR curriculum. Thank you both for engaging in the discussion. We are going to move on to theme three about stigma regarding sex before marriage and learning about reproductive health. So we have Amanda who will introduce the first story.

[00:15:30] Amanda: Thank you, Amal. Well, our story is from Kenya. Here it is: “When I was in my lower classes in school, I was told that sex before marriage was bad and the conversation would end there because talking about sex was a taboo.

[00:15:47] I wish that I went through sexual education because I would have used the knowledge I know now to prevent myself from having the sexual experiences and activities I encountered back then.” That’s our respondent from Kenya. Over to you, Lauren. 

[00:16:02] Lauren: Thank you very much. I will also be sharing a story from Kenya. So her story was that she got pregnant when she was in her second year of college. She says, “It was a very traumatizing experience being pregnant in school as you will be stigmatized.

[00:16:16] This led me to be suspended from school. At home, my relatives refused to continue paying my school fees and chased me away, which led me to stay with my grandparents until my due date. Currently, my child is 10 months old, and it is a really hard job raising her. This has led me to do different part-time jobs in order to provide for my daughter and grandparents for their daily needs, and at least to save some money so that I can go back to school to finish my education and be a doctor.”

[00:16:42] For the second question, “Can you remember a time when you felt embarrassed, misunderstood or doubted yourself in relation to SRHR?” The respondent says, “After delivering my baby, I wanted to go back to school, but I was rejected. They said I can’t study at the same time as I can take care of my child. They doubted my capabilities to study and denied me the chance to prove that I can do it.” Wow.

[00:17:04] And then the respondent says, “When I wanted to do family planning, my family didn’t approve of it, but I was already sensitized about my sexual and reproductive rights and its advantages. I had experienced the consequences of unplanned pregnancy so I got a contraceptive implant and I know I’m safe now.” Thanks so much for sharing your story all the way from Kenya. I’ll pass it over to Amal.

[00:17:25] Amal: Thanks Lauren, so this next story is from Uganda, where they spoke about their experience of sex before marriage as a taboo topic, especially within family dynamics. So this respondent asks what to do with these feelings she has for a boy. She talks about how it’s embarrassing how she is supposed to behave. Her mother tells her that even looking at boys, she will fall pregnant.

[00:17:48] Her mother threatens to send her away from home if she ever did. She says that she is not supposed to like boys. She is 16 years old. She is always afraid of her mother’s eye. She feels that she knows what is in her heart, so she keeps her feelings away. So that is our story from Uganda. 

[00:18:06] Amanda: Wow, I’ll make a brief comment on the stories that you and Lauren just gave. First of all, yeah, that was a serious taboo, and we still have these taboos going on in the context of where we come from. I can feel for her. But at 16, you make your own choices.

[00:18:23] But I have this burning question, Amal and Lauren: How can we take some steps to de stigmatize family planning, especially among youth? And how can we support our fellow youth? 

[00:18:35] Lauren: Yeah, that’s a great question. I think it all really starts with education. This is what I have been saying, but I will say it again because I think it’s important. I think including this in the SRHR curriculum in schools is really important. And maybe even getting a couple speakers in who have had the lived experience of having an unplanned pregnancy and can talk through how having contraceptives have changed their life, or what they wish they knew. Different interactive components like that can make family planning a bit more accessible and less stigmatized by actually talking to people that have benefited from it.

[00:19:11] Amal: Yeah, thank you Lauren for sharing that. I think that is a really important part and it makes me think to add on to that one of the key things, especially among youth, when you’re talking about family planning is including families and communities as well because they always play a big role in how youth engage with health services.

[00:19:31] So having that education, not only for the youth. And hearing from peers as you said, who have gone through this experience and benefited from family planning, but also having family members and communities having those sessions as well. That can change the thinking and the norm that is within the community. So I think that is a key thing to consider as well.

[00:19:53] Amanda: Yeah, I agree with both of you. The more you know about something, the better you can make the right choice and the right decision. I flashed back to a symposium we had recently on ending teenage pregnancies and child marriages in Uganda.

[00:20:09] One of the colleagues gave as her last remark, “Prevent.” But as she said that, a colleague said, “We don’t want to talk about contraceptives for our young people.”

[00:20:20] And I’m thinking, how are you going to prevent teenage pregnancies if you’re not talking about contraceptives? We are shooting ourselves in the foot. In the same way, how are we taking steps to destigmatize family planning if we’re not talking about it? And how can we support youth wanting to explore?

[00:20:33] Because the more we tell them no, the more they come closer. It is like you are pushing them to explore and be excited about this. Just openly bring the family planning methods, give them options, give the side effects and how to manage them and let life move on. Because either way, if you refuse to give them the education, they will get it from the internet. It is a global village. Anyway, thank you so much, Lauren and Amal.

[00:20:57] Lauren: Thank you both. So that brings us to the end of our episode. Thanks everyone for listening. If you haven’t listened to part one yet, I definitely recommend that you go back and do that because we also shared a lot of really empowering stories from that episode. And I wanted to give a big thank you to Amanda for joining us and sharing on this podcast. You are a really great guest to have on and we hope to have you back in the future.

[00:21:18] Amanda: I look forward to that.

[00:21:20] Lauren: Yeah, absolutely. And then a quick shout out to our next episode. The Youth Champions will be discussing common myths and misconceptions in the SRHR space. So we look forward to having you join us!

[00:21:31] Thanks everyone. 

[00:21:32] Amal: Thank you Amanda again for joining us. It’s always great to have you. 

[00:21:36] Amanda: Thank you, Amal and Lauren. It’s always a pleasure to join you.

[00:21:39] Amal: Thanks for listening to SHE SOARS. If you liked this episode, please share it on social media, connect with us in the comments or give us a like.

[00:21:48] Lauren: Make sure to catch our next episode by subscribing to our channel and following us wherever you get your podcasts.

[00:21:54] Madeline: Follow @carecanada on Instagram for updates on our show and the project.

[00:21:59] Lauren: SHE SOARS stands for Sexual and reproductive Health and Economic empowerment supporting Out-of-school Adolescent girls’ Rights and Skills in Kenya, Uganda and Zambia.

[00:22:10] Madeline: The project is funded by Global Affairs Canada. Check out our global partner organizations:

[00:22:15] Amal: Youth Coalition for Sexual and Reproductive Rights, the Center for Reproductive Rights and Restless Development for even more project updates.

[00:22:24] Lauren: Thanks again for listening. Until next time!