Family Planning- Uganda runs out of contraceptives
Mar 22, 2010
SHE was 16 years when she had her first baby. In six years, she was a mother of four. Tired, she sought the help of a herbalist in vain. She was pregnant again before her little one was barely three months.<br>
By Chris Kiwawulo and Irene Nabusoba
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SHE was 16 years when she had her first baby. In six years, she was a mother of four. Tired, she sought the help of a herbalist in vain. She was pregnant again before her little one was barely three months.
Desperate, she went to Mityana Health Centre III, but they had only pills. She could not take them because her husband did not approve of contraceptives. She was advised to use depo-povera — a type of contraceptive and was injected.
However, she discontinued the contraceptive after three months because of prolonged bleeding and frequent headahces. Now a mother of seven and probably still counting, her only hope lies in a permanent method, tubaligation, which her local facility cannot provide.
This is the story of Eseza Nabbanja, 37, wife to Dan Kaweesa of Myanzi subcounty in Mityana district. “I have been struggling to get a family planning method since 1997, long before anyone in this village new about modern contraceptives.
My husband was against it because he wanted to have more children,†Nabbanja says. She thinks the situation has improved because NGOs are educating locals about the benefits of family planning.
But the long-term contraceptives are rarely available at Mityana health centre. “You have to trek to Mityana Hospital which is about 25km away,†she says.
Many women in rural areas want to space or stop their births but have no access to family planning services, especially long-term methods that are favoured by many because they are ‘discreet’.
A survey by Reproductive Health Uganda (RHU) to assess reproductive health supplies — particularly contraceptives availability in rural facilities — confirmed that many women are at a crossroads.
The Resource Mobilisation Awareness Project (funded by the Bill and Melinda Gates Foundation) also recently organised a media survey to increase access to family planning supplies in upcountry health facilities in Mityana, Kampala, Jinja, Lira and Apac districts.
Mityana
Marjorie Namagembe, an enrolled nurse at Nama Health Centre in Mityana, says they only have short term contraceptives like pills and condoms plus few rounds of injectaplan.
“Since there is a perennial drug shortage, women come for other treatment and only consider family planning on the side. It is worse when they travel long distances and don’t find a method of their choice,†Namagembe says. Women resort to drug shops and private clinics.
Unfortunately, Namagembe says some of them administer the expired injections are while others do not bother to ascertain whether the women are pregnant when they seek the method.
“Many women miscalculate the return date, some returning pregnant and receiving the contraceptives, only to allege that the method failed them,†she observes. The nurses are trained to insert implants and intrauterine devices (IUDs) but they do not have the apparatus. “We used to conduct community outreaches to
No supplies in Apac
Mary Ruth Akullu, an enrolled midwife at Ayer Health Centre III, says they give oral contraceptives and Injectaplan.
“We can also offer other methods, save for the permanent ones but we do not get these supplies. We always demand but we are never given,†she says.
However, NGOs like MarieStopes, PACE and RHU conduct outreaches at Aboke Health Centre IV, which is about 10km away, where many of Akullu’s clients are booked and referred. Since their schedules are not defined, many women still miss out.
“People do not want pills, yet we have them in plenty. Some expire in the stores. They want long-term methods.
The health ministry should come to lower units to see how we are missing out on opportunities.
I often talk to district officials when they come for support supervision but they say they can’t do much,†she says.
Alex Eyul, a clinical officer with Aboke Health Centre, says they have long-term methods like implants and coils but lack gloves and syringes.
“We give them to people who are willing to buy them. Since Injectaplan is out of stock, we have to wait for outreaches. Sometimes, tubal ligation is available but the doctor could be away,†Eyul says.
Aboke subcounty, the most densely populated in the district, serves 20,2562 people and has one medical officer.
“We refer most of our clients to Aber Hospital, about 40km away, or to Lira Hospital, 25km away.
Otherwise we offer all services including tubal ligation. The demand is high when we conduct community outreaches or get NGOs camping here,†he says.
Western region suffers
A medical superintendent of a non-profit-making hospital with a family planning programme that serves more than 700 couples each month wrote to The New Vision about the plight.
He said for the last one year, the National Medical Stores (NMS) supplied the hospital with injections, oral contraceptive pills and implants. They also invested in staff who deliver family planning free of charge in hard-to-reach parts of the country.
Suddenly, NMS stopped supplying drugs to non-government health units.
The hospital was referred to the Joint Medical Stores (JMS), who said they do not stock contraceptives for religious reasons, thus the shortage.
“We purchased emergency supplies from PACE, but will have to pass their cost onto our patients,†the source said.
Poor women with the highest need for family planning, cannot afford it.Â
A source from NMS who preferred anonymity says the drug body has run out of contraceptives.
Hamis Kaheru, the spokesperson, was reluctant to comment. Dr. Jennifer Wanyana, the commissioner of reproductive health in the Ministry of Health, says: “We are aware of the problem. It is countrywide and affects all the contraceptive methods.
“We are trying to put contraceptives in basic drug orders to be supplied monthly.â€
Barriers
Besides supplies shortages, there are other barriers to accessing contraceptives
Poor access to family planning services and information for young people
Conservative cultural and religious beliefs about young people and sex
The communication gap between service providers and would-be clients that hinders counselling and decision-making on choice of contraceptive method
The existence of myths and misconceptions about contraceptives, fear of using contraceptives because of the side effects and myths like causing infertility
Women do not control their sexual and reproductive health choices. Male partners determine contraceptive use and decide which method their partners should use.
The real picture
The government allocates funds for contraceptives but only a small percentage (10%) of the allocation is actually disbursed
Over the next 15 years, the largest generation of young people will enter their reproductive stage, increasing the demand for contraceptives
Without a balanced population growth, Uganda’s economy and many of the goals outlined in the Millennium Development Goals could go backwards
    Â
SHE was 16 years when she had her first baby. In six years, she was a mother of four. Tired, she sought the help of a herbalist in vain. She was pregnant again before her little one was barely three months.
Desperate, she went to Mityana Health Centre III, but they had only pills. She could not take them because her husband did not approve of contraceptives. She was advised to use depo-povera — a type of contraceptive and was injected.
However, she discontinued the contraceptive after three months because of prolonged bleeding and frequent headahces. Now a mother of seven and probably still counting, her only hope lies in a permanent method, tubaligation, which her local facility cannot provide.
This is the story of Eseza Nabbanja, 37, wife to Dan Kaweesa of Myanzi subcounty in Mityana district. “I have been struggling to get a family planning method since 1997, long before anyone in this village new about modern contraceptives.
My husband was against it because he wanted to have more children,†Nabbanja says. She thinks the situation has improved because NGOs are educating locals about the benefits of family planning.
But the long-term contraceptives are rarely available at Mityana health centre. “You have to trek to Mityana Hospital which is about 25km away,†she says.
Many women in rural areas want to space or stop their births but have no access to family planning services, especially long-term methods that are favoured by many because they are ‘discreet’.
A survey by Reproductive Health Uganda (RHU) to assess reproductive health supplies — particularly contraceptives availability in rural facilities — confirmed that many women are at a crossroads.
The Resource Mobilisation Awareness Project (funded by the Bill and Melinda Gates Foundation) also recently organised a media survey to increase access to family planning supplies in upcountry health facilities in Mityana, Kampala, Jinja, Lira and Apac districts.
Mityana
Marjorie Namagembe, an enrolled nurse at Nama Health Centre in Mityana, says they only have short term contraceptives like pills and condoms plus few rounds of injectaplan.
“Since there is a perennial drug shortage, women come for other treatment and only consider family planning on the side. It is worse when they travel long distances and don’t find a method of their choice,†Namagembe says. Women resort to drug shops and private clinics.
Unfortunately, Namagembe says some of them administer the expired injections are while others do not bother to ascertain whether the women are pregnant when they seek the method.
“Many women miscalculate the return date, some returning pregnant and receiving the contraceptives, only to allege that the method failed them,†she observes. The nurses are trained to insert implants and intrauterine devices (IUDs) but they do not have the apparatus. “We used to conduct community outreaches to
No supplies in Apac
Mary Ruth Akullu, an enrolled midwife at Ayer Health Centre III, says they give oral contraceptives and Injectaplan.
“We can also offer other methods, save for the permanent ones but we do not get these supplies. We always demand but we are never given,†she says.
However, NGOs like MarieStopes, PACE and RHU conduct outreaches at Aboke Health Centre IV, which is about 10km away, where many of Akullu’s clients are booked and referred. Since their schedules are not defined, many women still miss out.
“People do not want pills, yet we have them in plenty. Some expire in the stores. They want long-term methods.
The health ministry should come to lower units to see how we are missing out on opportunities.
I often talk to district officials when they come for support supervision but they say they can’t do much,†she says.
Alex Eyul, a clinical officer with Aboke Health Centre, says they have long-term methods like implants and coils but lack gloves and syringes.
“We give them to people who are willing to buy them. Since Injectaplan is out of stock, we have to wait for outreaches. Sometimes, tubal ligation is available but the doctor could be away,†Eyul says.
Aboke subcounty, the most densely populated in the district, serves 20,2562 people and has one medical officer.
“We refer most of our clients to Aber Hospital, about 40km away, or to Lira Hospital, 25km away.
Otherwise we offer all services including tubal ligation. The demand is high when we conduct community outreaches or get NGOs camping here,†he says.
Western region suffers
A medical superintendent of a non-profit-making hospital with a family planning programme that serves more than 700 couples each month wrote to The New Vision about the plight.
He said for the last one year, the National Medical Stores (NMS) supplied the hospital with injections, oral contraceptive pills and implants. They also invested in staff who deliver family planning free of charge in hard-to-reach parts of the country.
Suddenly, NMS stopped supplying drugs to non-government health units.
The hospital was referred to the Joint Medical Stores (JMS), who said they do not stock contraceptives for religious reasons, thus the shortage.
“We purchased emergency supplies from PACE, but will have to pass their cost onto our patients,†the source said.
Poor women with the highest need for family planning, cannot afford it.Â
A source from NMS who preferred anonymity says the drug body has run out of contraceptives.
Hamis Kaheru, the spokesperson, was reluctant to comment. Dr. Jennifer Wanyana, the commissioner of reproductive health in the Ministry of Health, says: “We are aware of the problem. It is countrywide and affects all the contraceptive methods.
“We are trying to put contraceptives in basic drug orders to be supplied monthly.â€
Barriers
Besides supplies shortages, there are other barriers to accessing contraceptives
Poor access to family planning services and information for young people
Conservative cultural and religious beliefs about young people and sex
The communication gap between service providers and would-be clients that hinders counselling and decision-making on choice of contraceptive method
The existence of myths and misconceptions about contraceptives, fear of using contraceptives because of the side effects and myths like causing infertility
Women do not control their sexual and reproductive health choices. Male partners determine contraceptive use and decide which method their partners should use.
The real picture
The government allocates funds for contraceptives but only a small percentage (10%) of the allocation is actually disbursed
Over the next 15 years, the largest generation of young people will enter their reproductive stage, increasing the demand for contraceptives
Without a balanced population growth, Uganda’s economy and many of the goals outlined in the Millennium Development Goals could go backwards