By Arthur Baguma
WITH a hoe on her shoulder and a baby on her back, she walks with a stoop. Three bare-foot children dressed in tatters closely follow her. At the age of 25, Kobusingye is a mother of four children, all less than seven years old. Kobusingye, who hails from Kanungu district, in western Uganda is carrying her fifth pregnancy.
Despite over 50 years of family planning in Africa, Kobusingyeâ€™s plight and that of many other African women justifies the need for more family planning awareness campaigns.
Population analysts say poor family planning cripples the health, economic growth and social development of African countries.
Peter Ibembe, the national programme manager of Reproductive Health Uganda, says family planning in most African countries has had setbacks due to deeply rooted cultural beliefs such as the considering children as an asset.
In addition, most communities in Africa treasure children as a bridge between generations, which is vital in ensuring the continuity of clans and cultures.
â€œResources are limited yet those available are getting depleted due to surging population levels,â€ Ibembe observes.
According to the Uganda Demographic and Health Survey of 2006, Uganda's maternal mortality ratio stands at 435 deaths per every 100,000 live births, most of which emanate from unintended pregnancies.
Low contraceptive use has been highlighted as one of the factors leading to frequent births, which leads to high maternal mortality rates.
Prof. Augustus Nuwagaba, a researcher on poverty and an economist, says family planning is vital for safe motherhood yet the unmet need for contraceptives has risen to 41% from 35% in 2001.
He says unsafe abortions, arising from unintended pregnancies highly contribute to maternal deaths. Explosive population growth is a result of frequent child bearing, high fertility and lack of family planning.
Statistics indicate that only 24% of women in the reproductive age use contraceptives.
At 6.7 children per woman, Uganda has one of the highest mortality rates in the world.
This puts it in the third position after Niger and Yemen.
Hannington Burunde, head of communications at the Population Secretariat, says lack of access to modern contraceptives and information are some of the reasons for poor family planning.
He adds that misconceptions such as infertility and producing deformed children when a woman uses contraceptives, are some of the obstacles to family planning use.
While the relationship between fertility and economic development is complex and often reciprocal, research in developing countries has shown that reducing fertility rates can yield economic benefits at household and national levels.
Reproductive health experts believe political support is crucial in addressing the challenges of family planning.
Ugandan politicians have often contradicted the national policies on population and family planning by calling upon people to produce many children.
This flouts the policy which requires one to have a manageable family.
â€œGovernments should put in place affirmative programmes, focusing on family planning to enable women regulate birth, space children and produce when they want,â€ says Ibembe.
High fertility in poor families affects children and leads to high rates of household poverty, illness, and maternal and child deaths.
It also adversely affects national social services since most families are too poor to afford securing services such as education and medication, leading to an increase in dependency.
On the other hand, having a manageable number of children ensures the familyâ€™s economic stability, where each childâ€™s needs will be commendably met.
Determining the number and spacing of one's children is a basic human right.
Couples are entitled to accessible and affordable family planning services and information to help them exercise this right to save the lives of mothers and children.
The Geneva Foundation for Medical Education and Research says, family planning aims at assisting families in achieving the desired number of children, with appropriate spacing to ensure optimal growth and development of each family member.
Poor child spacing risks the life of the children and the mother if she produces every year. This means she never gets time to recover before the next pregnancy.
In addition, the children do not get enough care from the mother.
CONSTRAINTS TO BIRTH SPACING
Constraints to family planning in Africa
Socio-cultural norms that govern family formation and reproductive behaviour.
Difficulties in communicating sexual and family life to outsiders.
Cultural resistance to modern contraception.
Lack of awareness and education especially in rural areas where 60 - 70% of the population still lives.
Service delivery constraints (resources, sustainability, cost, setting, etc.).
What should be done?
Information, education and communication in family planning.
Training of personnel for service delivery.
Prevention and treatment of infertility.
Prevention and treatment of sexually transmitted diseases and HIV/AIDS.
Supervision and evaluation.
Operational research in family planning.