It takes two to plan a family

By Sarah Schewe

MANY young Ugandan men know they do not like birth control, even if they do not know much about it. “Most men think family planning is harmful,” explained Kassim Balikyweunya, 17, from his spot cheering on the sidelines of the football match. “They think those hormones destroy a woman’s uterus.”

Balikyweunya was among the 250 people at Minnesota International Health Volunteers (MIHV)’s first “Family Planning Day” in Nanseko Village. He expressed a prevalent misunderstanding about the side effects of contraceptives.

According to the 2006 Ugandan Demographic and Health Survey (UDHS), family planning awareness is high; 96.6% of women and 98.1% of men can name at least one contraceptive, but usage is low. Just 24% of women aged 15-49 report using any method of family planning.

Although this gap can be explained by multiple factors including lack of access to health services and an unsupportive partner, 26% of respondents said they do not use contraception because they fear the effects, making that by far the most common reason.

MIHV has been helping women and children with community-based healthcare programmes in Uganda for more than 20 years.

In the past, MIHV has trained traditional birth attendants to provide antenatal care, supported community immunisation campaigns, and implemented programmes for children affected by HIV/AIDS.

Currently MIHV is focusing on family planning; family planning or child spacing is one of the most powerful ways to improve life for Ugandan families. But the way is often blocked by rumours and myths.

In a 2005, the University of Alberta (Canada) study of Ugandan adolescents and family planning, researchers found that, “(Ugandan teens) hold an alarming number of misconceptions about modern contraceptives.”

In the study, one student said she did not think it was safe to use oral contraceptives, “We hear that if you start taking pills when young, you will not be able to ever have a baby or you will have crippled children and when you take the pill you start bleeding too much.”

Myths about the dangers of contraceptives have likely been perpetuated by products that have long been off the market, for 30 or even 50 years.

The benefits of modern, well-tested contraceptive methods to families are so great that overcoming old fears with current, accurate information is crucial.

“There are side effects, but they are minimal, if you see a qualified service provider,” said Ronnie Kavuma, MIHV’s community health educator. “And there are so many advantages.”

Couples who plan their families benefit from having more time to spend with children, less financial strain, and fewer health risks for both the mother and her children due to repeated and close childbirth.

Throughout September, MIHV will be hosting “Family Planning Days” on Sundays in Ssembabule and Mubende districts to promote the advantages of family planning (see sidebar) and male and youth involvement.

The events are in conjunction with district health services and the Community Development Office of the Ministry of Gender, Labour and Social Development.

The programme includes a drum performance extolling the benefits of small family size and a drama show that depicts common crises facing large families, such as inability to pay school fees.

The performances are followed by a football match. All afternoon, community health workers are available to provide family planning counselling and referrals.
The goal of the events is twofold; first, to provide accurate information and dispel misconceptions so couples can make proactive choices about family planning, and second, to encourage men to take part in making those choices.

In a June 2007 study by the United Nations Population Fund on reproductive health in Uganda, a woman from one focus group said: “I have six children and I pray that my husband will understand that I want no more.”

“Women just tell (their partners) that they go to the market (when really) they go for family planning,” explained Musoke Twaha, the social welfare officer in Ssembabule. “That’s the trend.”
According to the UDHS, 19% of married women using contraception say their husbands do not know.

Ten percent of Ugandan women use injectables, making that the most common method, followed by pills (three percent) and female sterilisation (2.4 percent).
“Many women use family planning without their partner knowing,” said Paige Anderson Bowen, MIHV’s Uganda country director.
“
Injection is the most popular method because a woman only has to go to a health facility once every three months, there are no pill packets lying around and no visible signs.”

MIHV believes that educating and involving men in family planning fosters healthy relationships and healthy families.
“If you want a woman to sustainably use family planning,” Bowen said, “her partner needs to be involved.”

Why family planning?
Family planning means giving parents the choice about when they want to start having children, how many children they want to have, how much space they want between each child, and when they want to stop having children.

Family planning also gives parents the ability to exercise more choice in taking care of their family’s health, education and economic needs.

Fewer children means less resource strain on families: parents can devote more time to their children and can still have some time for themselves; they can afford to pay school fees for all their children; they can afford medical care and are less likely to need medical care, since reducing family size also reduces many health risks for both the mother and for children.

The family planning methods currently available are pills, injectables, implants, IUDs, tubal ligation, vasectomy, condoms, Lactational Amenorrhea Method (suppressed menstruation and ovulation because of breastfeeding) and Moonbeads.