23 Aug 2011

Reducing the unmet need for Family Planning in Uganda

The following thought provoking article appeared on the Uganda newspaper, The new vision. It provides very useful suggestions that I feel Reproductive Health practitioners in Uganda can translate to pratice. Please, read on:

"We didn’t know that there is Family Planning until we produced seven children in nine years. Our usual thinking was that this is God's plan. We are now regretting because we are unable to look after our children and we are a laughing stock in the village". Such is a tale of a young couple of less than 40 years of age, about the problems it is facing because of lack of Family Planning.

But if we all became true to ourselves and planned for our families, we would get part solutions to most of the challenges affecting our planet today.

This is because Family Planning is almost the driver for every global problem.

Currently, around 200 million women say they want to delay or prevent pregnancy but are not using effective contraception. Either they have no access to it or they think they will not get pregnant.

This has resulted into millions of unintended pregnancies, ill health and maternal deaths.

Dr. Godfrey Mugyenyi an obstetrician at Mbarara Diagnostic Centre and Mbarara University Teaching Hospital says that access to contraceptives empowers women and can save their lives. Family planning gives good maternal health, in the same way immunization gives good child health.

Contraception can prevent 2.7 million infant deaths a year worldwide, it can reduce poverty, slow population growth, ease the pressure on the environment and make for a more stable world. He adds.

Being able to plan how many children to have and when to have them is a recognized human right. But this right is not yet realized, especially among the poor, says Dr. Emmanuel Byaruhanga, a consultant obstetrician/gynaecologist at Mbarara and Ibanda Hospitals.

Current global situation
In 56 developing countries, the poorest women average six births, compared to 3.2 for the wealthiest.

Fewer than 20% of sexually active young people in Africa use contraception. Apart from lack of money, barriers include insufficient knowledge, fear of social disapproval, side effects, myths and misperceptions about the partner's opposition.

Every year, 190 million women become pregnant and nearly 50 million resort to abortion.

An estimated 68,999 women die every year from unsafe abortions. Millions more suffer long term disability.

The Ugandan situation
According to the 2006 Uganda Health demographic Survey, over 1.4 million women would like to delay a pregnancy in order to space their children or stop child bearing but have no access to contraception. Only 24% of married women in Uganda aged 15 - 49 use family planning.

This survey identified lack of accurate information about the benefits of family planning, poverty, cultural/religious and also lack of women empowerment as the major obstacles to contraception in Uganda.

Therefore as the world population rises it is imperative to focus on meeting the unmet need for family planning and in the process, help solve many problems and contribute to the Millennium Development Goals (MGDs). More than 190 nations have committed to achieve the MDGs, eight International Development targets, which range from reducing poverty by half to improving maternal health, by 2015.

Reducing the unmet need
How then can we solve the unmet need for family planning in Uganda and the developing world? Dr. Mugyenyi says that there are many ways to reduce the unmet need and may include the following:

Health education campaigns
The ministry of health should revitalize massive health education campaigns. There is need to realize that the current population growth trends are unacceptable and something needs to be done urgently. Everybody should be brought on board including political leaders. Most of us remember how it was done in the 80s and 90s against the scourge of HIV/AIDS, that drum that sounded before and after every news and headlines on radio Uganda and Television. If we managed to bring down the prevalence of HIV from as high as 30% in 1992 to 5% in 2002, why not improve contraceptive prevalence from 23% to at least 60% in 5 years?.

The menstruation cycle and natural contraception methods
Many women will tell you that they are avoiding pregnancy using natural methods including safe days and breastfeeding. When you ask them which days are safe, the answers are dangerously variable. The need to give the right information to our women cannot be over emphasized.

Mobile and wireless technologies:
In Uganda today the emergency of mobile and wireless technologies is widespread, because today the mobile phone subscriber base in Uganda is about 12.5m. The old woman even in the most remote areas of Uganda has a radio and a mobile phone. Partnership with the rich and successful telecom companies, the numerous radio stations in the country would enhance transfer of health related information from the textbook/health worker to the population who are in dire need.

Even the obvious is great news to the very learned population in Uganda. In Cuba, health education talks on radio stations and television is synchronized in a way that all stations are talking about the same thing at a particular time. When mobile phone companies are introducing new products see how they advertise, how they paint buildings and road carnivals and so forth, we need to partner with them to help increase the contraceptive awareness in our population.

Social gatherings
Social gatherings such as churches/mosques, market places, funerals etc. proved to be important in curbing the HIV epidemic in Uganda in the 90s. The role of dance and drama in social mobilization is clear. We need to develop programs to mobilize and utilize these available talents and opportunities in reproductive health education.

Political will:
We hear that members of parliament and all other politicians move 'door to door' during times of campaigns, convincing the electorate. While they can do that to get votes, they should also do that to sensitize their communities about the need for family planning. I have never read any ones campaign program that stipulates health education and mobilizing the masses for good health.

Let us not promise bridges where there are no rivers. Many times we tell them that we are going to build hospitals and health centers… when we know the resources are limited and we can't achieve this in the short political term of office. Education is the only long term investment that we can impart to the masses.

Local council meetings:
How often are health matters an agenda at the LC meetings? When did you last invite the health worker at your health unit to talk to the committee members about maternal mortality, family planning or a reproductive health issue? How will we mobilize the masses when we don't have the facts? What are the roles of the secretaries for health? And the secretaries for women affairs? Time has come to make women's health a priority from the grass root because they are the mothers of our nation.

The condom
The condom is an integral means of controlling unintended births and Sexually Transmitted Infections. The stigma that has been attached to its use by especially religious sects must be broken. Why would we listen and take as gospel truth the facts about the condom from a religious leader whose basic science knowledge is very limited. Even I believe the word condom is not reflected in the book of God, the Bible.

An undesired child is your household burden, you will bear it alone God being your guide.
Long term contraception

Vasectomy, bilateral tubal ligation and the intra-uterine device must be promoted because of their high effectiveness and reduced undesired effects. Counseling the couples together for family planning should be emphasized. Distigmatizing these effective methods is critical to the success of the programs targeting increasing the contraceptive prevalence and reducing the unmet need in Uganda.

Family planning and people with disabilities
People living with disabilities have been left out on Family Planning programs as in many issues of our social life.

While contributing to Kampala Conversations an online discussion about Family Planning by participants of the International Conference on Family Planning that was held in Uganda in November last year, James Aniyamuzaala, the President of Uganda Federation of Hard Hearing, says that there is a need to have inclusive family planning programs that target persons with disabilities such as the visually impaired, hearing impaired, physically impaired and mentally impaired women.

The Thai experience
I recently attended an International Conference on Women's Health and Unsafe Abortion in Bangkok, Thailand and I was amazed at how one man has mobilized Thai people to embrace family planning with tremendous success.

Senator Mechai Viravaidya who is also known as Mr. Condom has added flavour to family planning campaigns with a very high degree of success.

He has introduced condom blowing contests in schools between school children and teachers and at tertiary institutions, organized miss condom beauty pageants, introduced ideas of Santa condom and condom Christmas trees to help make the condom friendly.

He has also organized vasectomy festivals where men are given prizes and sensitized about the benefits of vasectomy, like vasectomy means better life and bigger inheritance; non pregnancy gifts where a woman who has not had a pregnancy for three years is given let’s say a prize of a heifer, etc.

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