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Family Planning- Uganda walks a wobbly path

By Vision Reporter

Added 15th November 2009 03:00 AM

THAT Uganda loses 16 mothers to pregnancy and childbirth everyday is as strange as it is true. To put facts into perspective, this is an equivalent of losing a commuter taxi full of expectant mothers everyday.

THAT Uganda loses 16 mothers to pregnancy and childbirth everyday is as strange as it is true. To put facts into perspective, this is an equivalent of losing a commuter taxi full of expectant mothers everyday.

By Joel Ogwang

THAT Uganda loses 16 mothers to pregnancy and childbirth everyday is as strange as it is true. To put facts into perspective, this is an equivalent of losing a commuter taxi full of expectant mothers everyday.

“People will make ‘noise’ when a taxi kills the (expectant) women than when they die while delivering,” says Charles Zirarema, the acting Population Secretariat director.

The daily loss translates to 6,000 women dying during or after delivery in Uganda annually. This is a maternal mortality ratio of 435 deaths per 100,000 live births.

According to Hassan Mohtashami, the United Nations Population Fund (UNFPA) deputy country representative, pregnancy is the most joyful time for a mother, the family and the community.

“But it is also very painful when the mother dies during delivery,” he says.
Most of the heroines lose the ‘battle’ and succumb to death in ways that could be avoided if sexual and reproductive health information and services were universally available.

Sylvia Ssinabulya, the Woman MP for Mityana district, says it is the poorest couples that have least access to these amenities. Hence, about 41% of married women who want to postpone or delay child bearing cannot do so.

“This is because they have no access to Family Planning services.”
This results from lack of sensitisation and inadequate supply of reproductive health commodities like contraceptives and condoms.

Ssinabulya says promotion of family planning would avert the 35% of all maternal deaths and 10% of childhood deaths in Uganda.

Formation of FPAU
To address the need of the time, the Family Planning Association of Uganda (FPAU) was born 51 years ago.
“But we needed to look at a human being in totality,” says Elly Mugumya, the executive director of Reproductive Health Uganda (RHU).

However, with the rising cases of HIV/AIDS, gender, post and ante-natal issues, that were also related to reproductive health, FPAU was re-branded. This gave rise to the formation of RHU.

While family planning was misinterpreted as a ‘woman- only’ business, limited to child spacing, reproductive health cuts across all ages and sex.

The common global family planning methods include female sterilisation, contraceptive pills, injectable contraceptives, barrier methods like condoms and cervical caps, vasectomy, implants, intrauterine devices and contraceptive jells.

In Uganda, injectables, pills and condoms are widely used because they are relatively cheap, accessible and easy to use.

Reproductive health has increased access to reproductive services and safe sex practices as young people access condoms and other birth control services.

As a result, teenage pregnancy has dropped from 43% in 1995 to 25% in 2005. Voluntary HIV/AIDS counselling and testing has also increased.

Challenge of reducing maternal mortality
During the UN Millennium Summit in September 2000, 147 heads of state and governments met and drew Millennium Development Goals (MDGs) actions and targets contained in the Millennium Declaration adopted by 189 nations.

The MDGs are eight goals to be achieved by 2015, responding to the world’s main development challenges.

These include:
Goal 1: Eradicate extreme poverty and hunger

Goal 2: Achieve universal primary education

Goal 3: Promote gender equality and empower women

Goal 4: Reduce child mortality
Goal 5: Improve maternal health

Goal 6: Combat HIV/AIDS, malaria and other diseases
Goal 7: Ensure environmental sustainability

Goal 8: Develop a global partnership for development.

In line with reducing Goals 4 and 5 of reducing by two thirds the mortality rate among children under five and reduce by three quarters the maternal mortality ratio, Uganda still faces hurdles that threaten to cripple its ambition by 2015.

According to Rukia Chekamondo, the finance state minister in charge of privatisation, the country is still below the targets and may not achieve the MDGs.

This is in spite of the tremendous efforts made on achieving Goal 2.
Chekamondo notes that results showed increase in new HIV infections with the burden of treatment and care in most developing countries, including Uganda.

“Young people remain vulnerable to sexual and reproductive health conditions, including teenage pregnancy,” she says.

UNFPA’s Mohtashami called for the prevention of pregnancy before 18 years and after 35 years as this increases incidences of maternal mortality.

“There should be a minimum of three years between two pregnancies,” he says.
“The less the number of pregnancies a woman has, the less the risk of dying in childbirth.”

Dr. Jotham Musinguzi, the former Pop-sec director, says Uganda and indeed other African states’ failure to achieve Goals 4 and 5 stem from underfunding of reproductive health.

For example, under the Abuja Declaration, 2001, African states set a target of allocating at least 15% of the total national annual budgets to the health sector to achieve universal coverage of reproductive health services by 2015.

Musinguzi, now the regional director of Partners in Population and Development Africa regional office, says this largely remains a paper work.

“African governments need to follow up their pledges with financial commitments,” he says.

Currently, Tanzania has the highest budgetary funding (11%) towards the health sector in East Africa, followed by Uganda (10.8%) and Kenya (9%). The other challenge to Uganda in achieving the MDGs is the high population growth rate.

Demographic figures
At a 3.2% growth rate and a fertility rate of seven children per woman, Uganda has one of the world’s fastest population growth rates. The population has increased from 23.5m in 2000 to 27.6m in 2005 and is expected to reach 32.9m in 2010. It is estimated that the population increases by 1.2m annually.

By 2020, Uganda’s population is projected to rise to 46.6m and to hit 54.8m come 2025. Currently, the population is estimated at about 31 million people.

It is also estimated that a quarter of Uganda’s female teenagers have already had children, leading to early marriage, school drop-out and high maternal mortality.

Experts have expressed concern over Uganda’s increasing population, warning that this will stunt gains of economic growth and development.
“We have to ensure that the population grows at a rate equal to the available resources,” says Zirarema.

Unmet family planning need
A woman has unmet need for family planning if she says she prefers to avoid a pregnancy, wanting to either wait for at least two years before having another child, or stop child bearing altogether, but is not using any contraceptive method.

Unmet need for family planning in Uganda accounts for 41%, costing the country a whooping $101m annually, according to the UNFPA.

This is a drop from 52% in 1989. While the figure reduced to 29% in 1995; it rose to 35% in 2001 and 41% in 2006.
The percentage of women using family planning rose from 23% in 1995 to 24% 2006.

While 41% of married women don’t want to have more children, 35% want to wait for two or more years before the next birth and about 16% want to have children in two years.

Janet Jackson, the country representative of UNFPA, says investing in reproductive health commodities not only promotes the health of mothers and babies, but also saves money and ensures healthy men, she says.

This would benefit the poorest women and regions in shrinking the health gap between the rich and poor, while fast-tracking the MDG targets.

“For every dollar spent on a family planning commodity, it saves nearly about $3 on maternal and newborn care,” she says.

Therefore, while thinking about the future, Jackson says, there is an urgent need that must be catered for to curtail maternal mortality and meet the MDGs.

It is worth noting that Goals 4 and 5 are key to achieving all the MDGs since a health birth reduces and eliminates unnecessary expenses on medication and ensures continuity of education which is a key component in fighting poverty.

Family Planning- Uganda walks a wobbly path

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