World Contraception Day 2016: A step toward universal access to reproductive health services in Uganda

By Dr. Gideon Kikampikah

Today, almost one in three women age 15 to 49 in Uganda are using contraception to help plan their families, protect their health, and pursue their dreams. Fifty years ago, when I was a young medical student, this would have been unimaginable.

At the time, women who wanted to prevent or delay pregnancy had few options available to them. Even at the largest hospital in Uganda, Mulago Hospital, contraceptive options were limited and government policies restricted what family planning services we were able to provide. Until the early 1990s, only five percent of women were using any method of contraception and women gave birth to an average of more than seven children.

In recent years though, Uganda has taken important steps to prioritize women's health and ensure that couples have access to quality family planning services. As we celebrate World Contraception Day today, and recognize the progress made toward improving access to contraceptives, we must also acknowledge the work that still needs to be done. We must continue to advocate for increased allocation of resources for family planning, build strong networks of local family planning champions, and address the multitude of cultural and socioeconomic factors that still prevent women from using family planning services.

Family planning is one of the most cost effective interventions to improve the health of women and children. If we expanded access to family planning to the more than 220 million women around the world with unmet need, we could likely reduce maternal mortality by up to one-third. In Uganda alone, contraceptive use in 2015 may have averted more than 547,000 unintended pregnancies and saved 2,000 maternal deaths.

Increased use of family planning also has ripple effects on a country's overall development. Countries that prioritize the economic, education and health needs of their citizens, set themselves up for rapid economic growth. Uganda has recognized the importance of universal access to reproductive health services in helping the country achieve middle-income status by 2040 and the government is committed to reducing women's unmet need for family planning to 10 percent by 2020.

This commitment has been critical in making family planning more available in health facilities and acceptable in communities, but there is still room for improvement. Almost a quarter of women age 15 to 49 in Uganda do not wish to become pregnant but are not using any method contraception, and in poorer, hard-to-reach communities, unmet need can be as high as 40%. The country still has one of the highest fertility rates in East Africa as well as the highest proportion of women giving birth before age 20.

To improve the wellbeing of Ugandans and support economic growth, we must all be family planning champions and take an integrated approach to reproductive health. Often family planning programs have been left only to the Ministry of Health and civil society partners. However, if we are to realize the demographic benefits that we aim to achieve, it is important that all leaders - religious, cultural and governmental - speak out about the benefits of spacing births. Additionally, we must continue to prioritize universal education, as we know that educated girls are likely to marry later and have fewer children, who in turn will be more likely to survive and be better nourished. Lastly, we must seek to leverage the strengths of the private sector to reach all segments of the population and maximize available resources.

Across much of Uganda, the use of contraceptives is not openly discussed among young unmarried women due to strong cultural and religious beliefs. In some instances, opposition to family planning is so strong that women using contraceptives may experience gender-based violence. Cultural and religious leaders have an enormous amount of influence and educating them on the benefits of family planning as well as building them up as champions would positively impact their communities.

Additionally, to increase awareness and use of contraceptives, an integrated approach to healthcare delivery is critical. If every doctor, nurse or midwife discussed family planning options and addressed common myths and misconceptions about contraceptives with patients and relatives at every visit, many more men and women would have information on the services they need to better plan for their families and future.

As a private sector practitioner, I see many women and children seeking healthcare and I cannot over emphasize how their health needs are inextricably linked. Not only can mothers receive information about family planning when they come for antenatal care visits or their child's immunizations, but addressing mother's and children's needs together can save lives and has economic and social benefits. More physicians, from across the public and private sector, must be trained on the importance of addressing women's health needs across the continuum of care and on the various contraceptive options available. Organizations like Jhpiego, a non-profit affiliated with Johns Hopkins University, which I had the privilege to train with, are educating providers in Uganda to on the latest in reproductive health service delivery, like postpartum family planning.

There is no "one size fits all approach" to reach universal access to reproductive health services. Increasing contraceptive use will require investments across differing sectors and a network of diverse supporters. Now, more than ever, the private and public sectors must work together to ensure all women in Uganda have full access to a range of contraceptives options and can make informed choices to use them.

Dr. Gideon Kikampikaho is a Senior Consultant Gynecologist/Obstetrician at Kololo Polyclinic. He served as the Deputy Director of Mulago Hospital for 16 years and as an OBGYN for more than 30 years. He retired from government service in 2010. Dr. Kikampikaho is also an Alumni of Jhpiego - an international, non-profit health organization affiliated with Johns Hopkins University.