United Nations Population Fund Agency, (UNFPA) has supported the Government of Uganda since 1979.
The country programme is part of the United Nations Development Assistance Framework (UNDAF), which is in line with the Government of Uganda Poverty Eradication Action Plan (PEAP) to improve the quality of life of over 33 million Ugandans.
The country programme is implemented in 13 districts; Arua, Gulu, Pader, Moroto, Masindi, Mayuge, Kotido, Kibaale, Kanungu, Kapchorwa, Katakwi, Wakiso and Yumbe.
In northern Uganda, UNFPAs’ emergency reproductive health project is implemented in Kitgum, Amuru, Amolatar, Lira, Oyam, Dokolo, Apac, Kotido, Kaboong, Nakapiripirit, Moroto, and Abim districts.
The goal of the 7th country programme (2010 - 2013) is to improve the sexual and reproductive health and rights of women, men and the youth, ensuring sustainable population growth with development and enhancing gender equity and equality of women and men.
Promoting safe motherhood
Janet Jackson, the country representative of UNFPA, Uganda, says safe motherhood ensures that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth.
However, Jackson says Uganda has not yet achieved its MDG 4 &5. “Although we see a lot being done, the figures do not indicate that the situation has gone down,” Jackson says.
According to the 2011 UDHS, maternal mortality is estimated at 438 per 100,000 live births. However, to make safe motherhood a reality in Uganda, Jackson says UNFPA is working in partnership with the Government. Below Jackson explains what UNFPA-Uganda is doing to achieve safe motherhood.
Adolescent sexual reproductive health
UNFPA believes young people should have sex education and those sexually active should access family planning services. To address the problem, UNFPA works to ensure that adolescents and young people have access to adequate and accurate information and friendly health services.
Poor roads and lack of transport is a major hindrance to safe motherhood. To address the problem UNFPA-Uganda has provided ambulances in eight districts they are operating to ease transport. “The ambulances are small enough and are able to negotiate the windy roads,” Jackson says.
The reproductive health situation has remained poor or slightly improved in certain instances. For example, Uganda’s current fertility rate is estimated at 6.2 children per woman as per (UDHS 2011).
Other reproductive indicators have also remained stagnant, poor or have slightly improved. For example, the contraceptive prevalence rate for modern methods is only 30% (UDHS 2011) and the current unmet need for family planning is 34% compared to 41% as per 2011 UDHS. Skilled attendance at birth has slightly improved from 42% to 39%.
Jackson says this an indicator that confidence is building among people and there is knowledge that birth needs to be assisted. She adds that UNFPA is providing support in reproductive healthcare, during pregnancy and childbirth.
“One of the reasons why women shun delivering at health facilities is because they lack the necessary delivery accessories. To increase the number of women delivering at health facilities, UNFA is providing maama kits to pregnant women to assist them in delivery at the health centres. They also help in treating reproductive tract infections and sexually transmitted infections, including HIV/AIDs."
The agency also supports the Government on their interventions on post-abortion care in Health Centre IIIs, IVs and referral hospitals in its focal districts in Uganda.
Jackson says over the past five years, they have equipped health center II, III and IV and the programme will be completed this year.
She explains that UNFPA has worked with the Government to introduce midwifery and this year 166 midwives have been trained in different institutions throughout the country.
“Skilled midwives are a great investment in making birth safe; both during labour, delivery and ensuring mother’s access emergency care when they need to.
Jackson says they are encouraging men to support women come to attend antenatal clinic classes. “We have got small action groups formed at sub-county level to talk about violence Against women and gender based sexual violence.
Behaviour change communication
Increased availability of culturally sensitive Behaviour Change Communication (BCC) is needed for effective positive change in peoples’ attitudes to accessing services to improve on their Reproductive health.
Through implementing partners; Population Secretariat (Ministry of Finance, Planning and Economic Development), Ministry of Gender, Labour and Social Development, working with national and community leaders such as religious authorities, medical practitioners and cultural leaders, UNFPA is promoting health practices in child spacing and
The focus of BCC interventions is to promote behaviour change of rights holders and duty bearers to ensure that appropriate services are delivered to women and their families to improve their reproductive health status.
Special emphasis has also been made to promote male involvement in reproductive health.
Policy makers still govern the framework of ensuring that reproductive health, gender, population and development issues are financially incorporated into the national budget. With limited numbers of health workers in remote areas, and disruption in reproductive health service delivery, main challenges remain.
In addition, there is still limited political support for family planning as a means of averting the high maternal mortality of 438 deaths per 100,000 live births (UDHS 2011).
UNFPA works with policymakers, stakeholders and partners such as legislators, Non- Governmental Organisations, the media, cultural and faith-based institutions.
Others include the offices of The First Lady, The Queen of Buganda and Church of Uganda - Kinkizi Diocese to advocate for policy and legislative reforms with lead to improved reproductive health status of women, men, girls and boys.
Prevention is the stronghold of UNFPA’s fight against HIV/AIDS. Emphasis on abstinence outside marriage and fidelity within marriage as promoted through “zero-grazing” in HIV/ AIDs campaigns in Uganda helps to promote safer sexual behavior among young people.
UNFPA also makes sure that condoms are readily available in health facilities and that information of their correct use is widely distributed. BCC campaigns also promote the active participation of men in the whole family network and process before and after maternal deliveries.
Pregnant women are counselled and screened during antenatal visits. They are also prepared to think about life after birth and encouraged to use family planning.
UNFPA promotes gender equality and women’s empowerment. The gender component is currently focused on five districts namely Kapchorwa, Kanungu, Masindi, Arua and Gulu.
The agency works with the Ministry of Gender, Labour and Social Development and civil society organisations such as the Reproductive Education And Community Health (REACH) project now an NGO with funding from the Netherlands Embassy to implement their program on gender mainstreaming and interventions on SGBV.
The country programme aims to increase access by stakeholders to information, counseling, social support and treatment of and protection against sexual and gender based violence.
Objectives of the programme
*Help ensure universal access to reproductive health, including family planning and Sexual health, to all couples and individuals on or before the year 2015.
*Support population and development strategies that enable capacitybuilding in population programming.
*Promote awareness of population and development issues and to advocate for the mobilisation of the resources and political commitment from stakeholders and Government of Uganda.