A Holistic Approach to Family Planning
By Senfuka Samuel
Uganda’s population growth rate is one of the highest in the world at 3.2% and the biggest percentage of is the population is young people. In addition, Uganda’s women are very fertile with each producing an average of 6.2 children. According to the Uganda Demographic Health Survey (UDHS) 2011 preliminary findings, the maternal mortality rate is still unacceptably high at 354 from 435 per 100,000 live births.
The World Health Organization estimates that about 300,000 abortions are carried out every year in Uganda and abortion related complications are one of the leading causes of admissions to gynaecological wards in hospitals across the country. There is no doubt that most of unsafe abortions are because of unintended pregnancies and the failure to prevent those pregnancies through access to timely family planning services and information.
To reverse this trend, we must ensure universal access to family planning services and commodities to Ugandans, who have demanded for it. Uganda’s unmet need for family planning currently stands at 41% and the contraceptive prevalence rate (CPR) is below average at 30%. The CPR varies by residence, region and methods used. It stands at 46% and 27% in urban and rural areas respectively whereas 26% use modern methods and 4% still use traditional ones.
It is known that Family Planning is one of the key proven strategies to reduce maternal mortality and an opportunity to reduce unintended pregnancies, this is especially important in Uganda where abortion is illegal under the Constitution if not recommended by a medical officer for saving the life of a mother. During my independent visits and interactions with key players in family planning and maternal health in general including NGOs, Donor agencies and development partners, private healthcare providers, health professionals, media representatives, politicians and maternal health champions, I found out the following key issues which limit uptake of the services. Addressing these barriers need a holistic approach.
- More information -It was evident that the biggest barrier to family planning use rotates around accessibility to information and services. The approach of stocking and storing contraceptives at health facilities is not very attractive to would be users. Family planning is not a disease that will force people to seek medical attention hence an urgent need to rethink about the approach and adopt some innovative ways such as social marketing, use of pharmacies, clinics, integrating it to the antenatal care among others. There growing views of adopting a community based approach for administering some methods which do not require high skills training. It was also noted that some rural based health facilities close early without being insensitive to women’s time poverty due to their gender roles. It should also be noted that nearly 95% of contraceptives are procured by donors and the little that government allocates it is not released at times making the supplies inadequate.
- Tackle myths -Myths and perceptions about family planning impact negatively on the uptake of the services. There so many negative views held by different people including some health workers on family planning methods. For instance there myths and perceptions that it causes infertility, abnormal fattening, weakening women’s sexual libido and energy to work on their farms among others. There is need to package appropriate and harmonized messages and information at all levels before it is disseminated to the target audience. It is also widely perceived that family planning is for only women-few people are aware about methods for males. There should be deliberate efforts to mobilize and work with community structures to raise awareness and ensure confidence among the targeted community members.
A Service Provider shows a man how vasectomy is done as a male family planning method at Marie Stopes Centre, Mbale district
- Increase choice - Method mix. In some instances there is limited choice available to the clients. It is important to ensure that all methods are available at access points because some are preferred against the others. It has been reported that contraceptive pills get expired at health centre IIs and IIIs where the procurement and supply of drugs and supplies is based on a push approach (supply driven).
- More health workers - Skills gap to deliver various methods and management of side effects is also a critical obstacle to family planning. Some methods like implants, intrauterine devices (IUDs)/coils and vasectomy require a well trained provider to give adequate information about the methods, likely side effects and carrying out the procedures and managing the side effects. Such skilled health workers are inadequate or lacking in some communities or health facilities.
- Empower women - Gender and cultural biases have also proved to limit utilization of family planning services even where they are accessible. Still being a patriarchal society, women have to get consent of their spouses before making a decision to use family planning. Most of the times they face stiff resistance from their spouses and the consequences are always regrettable including a lot of pressure from the man’s family members. It’s strategically important to target and increase the male involvement in provision of family planning services and information.
- Work with faith based groups - There strong faith based views which do not recommend or accept some family planning methods. It will be important to use some biblical views and approaches to engage faith based leaders for their buy in. For instance in the book of Genesis 1:28 it says that: God blessed them and said to them “Be fruitful and increase in number; fill the earth and SUBDUE it. Rule over the fish of the sea and the birds of the air and over every living creature that moves on the ground.”
- Include young people - Youth friendly environment for family planning services lacks in most access points. This prevents the young adolescents who are most vulnerable to access information and family planning services.
Linking the above, it was a very important political statement from the Uganda head of state to attend the London Summit on Family Planning on 11th July 2012 which coincided with the World Population Day. From an advocate point of view there were some wins and opportunity for continuous engagement.
- The President made a commitment to increase the family planning budget to US $ 25 million for over the next five years translating into US $ 5m each financial year from the current US $ 3.3m. This will be a good tool for holding him and the government accountable but also to ensure that the funds are allocated in priority areas. Increasing domestic budget allocation for family planning supplies and commodities is a good pointer to sustainability.
- The President has always been perceived to have negative attitude towards family planning by asserting that Uganda and Africa need a big population to propel economic growth through provision of market for goods and services. There is need to use this opportunity to nurture his interest and views on family planning and enlist him as strategic ally for family planning.
Simultaneously, the Prime Minister Hon. John Patrick Mbabazi as a Chief Guest at the official marking of World Population Day pledged to follow on an earlier government decision to waive taxes on the contraceptives. This is an opportunity for CSOs and other players to advocate for immediate issuance of an instrument by Government of Uganda stopping Uganda Revenue Authority from collecting the tax.
For efficient and effective delivery on the commitments there is a need to strengthen the technical and institutional functionality of the key players involved in the supplies distribution chain. This calls for strong Public Private Partnerships to close the gap where government does not have existence (public health facilities).