Six children to her name already, Sarah Nalubega, a resident of Bulera Sub county in Mityana district has always desired to use contraceptives. But the rather negative stories that continue to be told about contraceptives have made her leave child birth to fate.
“Let me just produce my children until God decides that I should stop. I don’t want to get tumors or have an endless menstruation,” she asserts.
Nalubega is one of the hundreds of the residents that flocked Bulera playground for the launch of the district costed family planning implementation plan for the next five years.
From conversations with her peers, she has been told that contraceptives not only make a woman have an endless menstruation but also causes general body weakness and constant headaches.
An interaction with a number of other women shows a similar trend. Four of the mothers I spoke to at the event have at least six children with no plans of stopping.
With an estimated population of 331,266, the district has a relatively high fertility rate of 7.5 as compared to the national rate of 5.9 children. Every year, a total of 16,563 pregnancies are registered in the district.
The district has an unmet need for family planning at 46%. This is much higher than the national rate at 34%. Child bearing as revealed by the District Health Officer, Fred Lwassampijja starts quite early around here.
The men on the other hand hold their own misgivings about contraceptives. Ronald Kalule, another resident who has just become a father doesn’t seem as keen to family planning. Asked if he would opt for the male condom just so their child can get to the recommended two years, he answers in the negative.
“Using condoms in a marriage is not easy. Your partner is going to suspect you for having extra-marital affairs. It becomes quite challenging if you are introducing the idea later on, yet even when you were just dating you never used them,” he argues.
Much as a number of interventions especially by civil society organisations are going on in the district, not much has changed. Misinformation and social restrictions as explained by Janepher Katumba, a family planning champion under the Women Reproductive Rights Advocacy Programme, is still strong in the district.
“Decisions are still largely made by men in our community. So, until the men are engaged, family planning will continue to be an act women do in hiding hence making it less effective,” she explains.
But also the civil society organizations only run programmes in just a limited space. The programme Katumba works with for instance runs in just two parishes from two sub counties. Most people she says get information from their peers but these are people using their own biases to make conclusions on a given contraceptive.
The inadequate staff at health facilities according to Katumba also limits access to information on family planning. Sometimes, a health centre has only one midwife who is supposed to carry out immunization and handle other maternal related cases. Most times, these are overwhelmed and only focus on immunization.
Staffing level at the district is currently at 66% with 431 out of the required 700 health workers.
A 2014 DSW survey in the district also highlighted the different fears people in this community have especially on the side effects mixed with misconceptions about family planning services.
“Some local people harbour feelings that contraceptives promote promiscuity, immorality and prostitution,” read the report.
For the first time however, as explained by Lwassampijja, the district with the help of partners such as Deutshe Stiftung Weltbevolkerung(DSW) Uganda, Reproductive Health Uganda, PACE among has come up with a Family Planning Costed Implementation Plan for the next five years.
Highlighted in the Family Planning Implementation plan, local people do not have a clear source of information about family planning services and related issues.
“For the few local people who turn to health workers for technical advice and guidance, the health workers are themselves constrained with heavy work load, coupled by the fact that sometimes one may lack capacity to fully explain the facts associated with contraceptives. Additionally, there is no age specific sensitive information that targets groups of persons for example youths, adolescents, elderly.” reads the plan.
The goal of the sh3b plan is to improve awareness of family planning services, service delivery and access, contraceptive security, financing, policy and an enabling environment and stewardship, management and accountability.
Previous according to Lwassampijja, the district was allocating about sh10m for the whole financial year towards awareness campaigns on family planning. This he argues could only afford as much.
Though the government provides contraceptives, the DHO says they have been having shortages especially for the long term contraceptives. Women are therefore left with not much choices to pick from.
The Chief Administrative Officer as represented by the deputy, Moses Kisembo referred to the plan as not only a landmark but a blue print in efforts to improve access o accurate information and family planning services.
“The implementation of the plan will help families to plan and have children by choice and not by chance and determine the number of children they can manage and look after properly,” he said.
The district intends to bring the unmet need for contraceptives down to 10% and teenage pregnancies to 15% at the end of the five years.
Mityana draws its plan is drawn from the sh622b national family planning costed implementation plan (2015-2020). This is meant to increase the number of women in Uganda currently using modern contraception from approximately 1.7 million users in 2014 to 3.7 million in 2020.
Contraceptive use in Uganda
Considering the different economic backgrounds, the Uganda Demographic Health Survey 2016 puts injectables as the most used method of modern contraceptives at 18.5%. This is followed by implants (6.3%), female sterilization (2.7%), male condoms (2.4) and pills (1.9%) in that order.
The number of women currently not using any contraceptive method is at 61% with majority in the lower income category.
Family planning refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods. Contraceptive methods are classified as modern or traditional methods. Modern methods include female sterilisation, male sterilisation, the pill, the intrauterine contraceptive device (IUD), implants, injectables, male condoms, female condoms, emergency contraception, standard days method (SDM), and lactational amhenorrea method (LAM). The other methods such as rhythm, withdrawal, and folk methods are grouped under traditional.