COVID-19: Make family planning an essential service

Apr 27, 2020

The government should provide assistance, including providing alternative transportation for public health workers who assist in family planning.

By Deborah Nakatudde 
Not that long ago in Kampala, a mother of seven children talked with her health provider about family planning. She had tried different methods but they had left her with side effects. So, her doctor recommended an injected hormonal birth control. She agreed with her doctor and she was successfully provided with a shot that would prevent unwanted pregnancies for the next three months. 
Soon, she will have to go back to get another shot, but there is a problem. Going and returning will not be easy because public and private transport in Uganda was suspended last week with the confirmation of 33 COVID-19 cases in the country.  
This mother is one of the tens of thousands of women who will not be able to access their birth control services in the coming weeks and possibly months due to a lack of mobility and a health system focused on screening and managing COVID-19 cases with less attention on other essential health needs. 
Hormonal injections are the most popular family planning method used by women in Uganda but without intervention, up to three million women will not be able to access modern methods of contraception from public health facilities due to the government's efforts to stop the spread of the coronavirus. Most public health care workers live far away from the facilities and—like many working Ugandans— have no other option for affordable transportation when restrictions are put on public transport. 
The government should provide assistance, including providing alternative transportation for public health workers who assist in family planning to ensure that women who need a supply of modern family planning contraceptives will be able to get them. Additionally, we should also ensure that all health care service providers have Personal Preventive Equipment (PPE) so that they can work safely. This will help keep the facilities open so that women, who can walk to their local clinic, receive their birth control for as long as the country is fighting the Coronavirus.
Though these are unusual times, with whole communities under lockdown, the need for family planning has not gone away. If anything, it is even more in demand as people are spending more time with their families and loved ones, and seeking comfort to manage this difficult time. It is a matter of fact that people will continue having sexual intercourse.
Uganda has 8 million women of reproductive age and the high levels of unintended pregnancies can be attributed primarily to nonuse of contraceptives. In 2008, an estimated 1.2 million unintended pregnancies occurred in Uganda representing more than half of the country's 2.2 million pregnancies. Such unintended pregnancies result in either abortion or unplanned births. Without birth control, we will see a surge of unintended pregnancies and its outcomes.  
According to the 2011 Uganda Demographic and Health Survey (DHS), more than four in 10 births are unplanned, ranking Uganda's pregnancy rate among the highest globally. This is attributed to the fact that the majority of the women who would want to prevent pregnancy cannot afford the cost at a private facility and so seek services from the government-aided facilities or wait for free medical camps organized at their respective communities. The survey also showed that of contraceptive users in Uganda, 54.4% prefer injectable contraceptives to other birth control methods. 
According to the African Population studies, the pill was the most modern method of contraception in most sub-Saharan countries but in recent years, the use of injectable contraceptive has quickly increased in popularity. 
To be sure, there are alternatives to family planning including condoms, which can also prevent sexually transmitted infections. However, married partners do not consistently use condoms. There are also other forms of birth control such as pills, implants and IUDs. However, birth control pills require the user to remember to take them at the same time every day which could be a bit stressing to the users whereas implants contribute to a weight gain in one of ten women. IUDs require minor surgery which, along with some myths and misconceptions around them, instils fear among some women who are then reluctant to use them.
Let's ensure that our public health workers can get to and from work, are well-protected at work, and that women can access contraception. 
At a moment when people are concerned about staying safe from the Coronavirus, an unwanted pregnancy shouldn't be an additional concern.  
Deborah Nakatudde is a grassroots organizer and advocate in Kampala, Uganda and an Aspen Institute New Voices Fellow. Follow her on Twitter at @Nakatudde_Debby. 

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