Picking her contraception pills should have been easy.  Jacinta Kemigisha had done it countless times before. But when she got to a health facility in her village in Kibirizi, Kasese district, early this year, the nurse shook her head. 

We do not have your pills today, she said. 

Kemigisha, a 35-year-old mother of five, desperately needed the pills to stop her from conceiving. She had already given birth to more children than she could ably take care of and didn’t want any more kids. So she determinedly walked to the nearest village with a health centre, some seven kilometres away. 

There, nurses told her she had to pay for the pills. “I didn’t have any money on me. So I walked back home,” she recalled. 

Kemigisha isn’t the only one. A report (https://www.heps.or.ug/publications/report-family-planning-commodity-financing-supply-chain-uganda) by the Coalition for Health Promotion and Social Development or HEPS-Uganda shows three out of every 10 women in the reproductive age group in Uganda cannot access modern contraception. 

“Many women cannot access family planning services because they are asked to pay for the commodities,” said Denis Kibira, executive director for HEPS-Uganda. “We have also had reports of stock outs (of these family planning commodities) especially during this coronavirus pandemic.”  

But other women cannot access modern contraception because of myths and other perceptions surrounding family planning in the country. 

“In some societies, people think women will not be able to conceive and give birth when they start family planning at a young age,” said Andrew Kyamagero, journalist and family planning advocate. “Some think they will give birth to children with defects.” 

However, poor access to modern contraception has consequences — and Uganda can already testify. 

The country has one of the highest fertility rates (estimated at 5.4 children per woman) globally. It also posts one of the highest teenage pregnancy rates at 25%. 

This high fertility rates have resulted in one of the youngest and dependent populations in the world, with more than half Uganda’s 43 million people below 15 years and more than three quarters under the age of 30.  

But re-prioritising family planning — which allows women to choose when and how many children to have — can reverse this and greatly improve individual households’ quality of life that eventually translates to the rest of the population. 

“Family planning does not only protect women from pregnancy-related risks,” said Kibira. “It also improves maternal and child survival and reduces cases of unsafe abortions.” 

He said family planning could also improve women’s empowerment and promote social economic development. It can enable Uganda reduce its fertility rate and dependency ratio for accelerated economic growth. 

Dr. Jotham Musinguzi, director general for the National Population Council, said family planning could reduce Uganda’s young dependent population vis-à-vis its working group, allowing the country to harness a demographic dividend. 

“It is a no brainer that families become more stable and can contribute to social economic development when they give birth to children they can ably take care of,” said Musinguzi.  

But Joan Kilande, programme officer at HEPS-Uganda, said the country needed to increase its domestic investment for family planning to reap rewards. 

“We are asking government to create a dedicated budget for family planning commodities from its domestic resources,” said Kilande. “This can sustain availability of contraceptive commodities in the country.” 

“The Ministry of Finance, Planning, and Economic Development should also fulfill its commitment to allocate $5 million (or UGX17.7b) to family planning every year, from domestic resources,” she said. 

“Government needs to start funding its very important programmes for sustainability,” said Kilande. “We cannot continue to rely on donors to fund our family planning. We saw what happened when the coronavirus hit these two years and a number of donors withdrew their support towards funding FP commodities. We had stock outs.”

As well as calling government to ring fence monies for family planning, Kilande wants the country to increase its funding for the commodities. 

“One of the biggest gaps in financing family planning supplies is that government budget allocations have consistently remained below its $5 million annual spending commitments,” she said. 

For instance, government allocated UGX14.72 billion (about USD 3,966,928) to NMS under budget-line for family planning commodities this financial year, which represents just about 80% of the commitment of $5M, she said.

The experts also called government to expedite process for implementation of the National Health Insurance Scheme.  

Parliament passed (https://www.parliament.go.ug/news/5054/affordable-medical-care-offing-health-insurance-bill-passes) the long awaited national health insurance bill that outlines the overall structure for the health scheme early this year.  
 
Parliament passed the bill with a pre-set benefits package that includes a range of essential health services such as family planning, counseling, and other services.  

“The national health insurance scheme would strengthen our health system and enable every Ugandan to access quality health care whenever they need it,” said Kilande. 

But President Yoweri Museveni is yet to assent to it. 

Dr. Jane Ruth Aceng, minister for health, however, said government was committed to improving family planning services in the country.  

She said government has committed to annually ring fence 50% of the domestic resources allocated for procurement, warehousing and distribution of family planning commodities from the reproductive health commodities budget by 2025. 

During the launch of the FP2030 commitments (last week) government also committed to increase modern contraceptive prevalence rate for all women in Uganda from 30.4% in 2020 to 39.6% by 2025 and to reduce unmet need from 17% in 2020 to 15% by 2025. 

Government also committed to improve quality of family planning counseling (related to available family planning options, possible side effects, their management and switching) among community health workers.

“We have to reduce cases of teenage pregnancies in the country,” said Aceng. “What has happened during this coronavirus pandemic (when cases of teenage pregnancies soared in most of the country) is unacceptable. “We cannot continue to see our girls get pregnant when we have information. It should never happen again.”