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Absentee fathers force women into birth controls

A woman receiving a family planning method at Kasenge Health Centre II

A woman receiving a family planning method at Kasenge Health Centre II

At just 26 years old, Hadijjah Namutaawe a resident of Kabale village, Kalungu district, already has four children.

However, when she noticed the rate at which she was producing babies, she decided to enroll for family planning by taking up a three-year implant where she is currently running a second year with it.

Namutaawe got to know about family planning during her visits to Kabale Health Centre III for immunization of her children. While here, the health workers would sensitize mothers about the benefits of family planning and so when she returned home, she had a discussion with her husband and together, they agreed to use family planning.

According to the Uganda Demographic and Health Survey Report 2022, Uganda’s fertility rate has declined from 5.4 birth per woman in 2016 to 5.2 birth per woman in 2022. One of the contributors to this decline has been the increased access to family planning services and availability of a wide range of contraceptive methods.

The RISE programme

For the last five years, Marie Stopes Uganda, with support from the UK government, has been implementing the RISE programme (Reducing high fertility rates and Improving Sexual reproductive health outcomes in Uganda). The main goal of the RISE programme was to reduce high maternal mortality rates through improving access to modern contraceptive choices to men and women in need.

The five-year programme has tackled barriers to the uptake of family planning by delivering innovative community and service-level interventions in 86 districts across seven regions of Western, West Nile, Karamoja, North Central, South Central, Eastern and East Central.

According Dr Peter Ddungu, the deputy country director, Marie Stopes Uganda and the RISE project team lead, by March 2024, the programme had served over 2.30 million clients; providing over 4.7 million contraceptives/ family planning services and generated over six million Couple Years of Protection (CYPs).

20 percent (449,320) of the clients reached with family planning services have been young people below 20 years. Additionally, 3.9 million people were reached with Social and Behaviour Change (SBC) messages.

One of the ways these services have been extended to the public has been through monthly community health outreaches to 406 public health centres across the country. During such an outreach at Kasenge Health Centre II, Wakiso district, over 50 women gathered at the health facility for family planning services.

Dr Stephen Mutegeki, head of Outreaches at Marie Stopes Uganda said they target lower-level health centre facilities because they are the ones closer to the communities and the people who access services from them are among the demographic that are multidimensionally poor so they may not have access to some of these high quality sexual reproduction services because of financial constraints.

“Over the last five years, we have seen communities transforming and changes in attitude. Initially we had resistance for uptake of family planning services especially being driven by the husbands yet they are the decision makers in the communities that we go to. However, in addition to service delivery, we execute a social and behavioral change model where we go into the communities and interact with the village health teams, political, religious and cultural leaders to try and transform their attitudes about family planning. This has been successful because the number of people who have taken up family planning services has gradually increased over time,” he said.

However, Mutegeki added that there are still isolated cases of gender-based violence because of the myths and misconceptions about family planning methods and what they can do to a woman’s body and he therefore acknowledged that there is still a lot of work to do in the community to address that.

Women during a family planning outreach at Kasenge Health Centre II
Women during a family planning outreach at Kasenge Health Centre II

Josephine Nabyonga, the nurse in charge at Kasenge Health Centre II said some of the reasons the women give for taking up family planning is that most times their men leave them to cater for the families alone and so they come for the services such that they prolong the duration they can have children again so that they plan better for their families.

“The mothers tell us that they are now the heads of families and so due to the hardships they experience while trying to look out their families, it provokes them to go and seek for these services so that they can be able to have a number of children they can ably look after with the little they can afford to get,” she said.

SUSTAINABILITY

As the RISE programme comes to an end in June this year after its five-year life span, Marie Stopes and its implementation partners are confident that the services they have providing in the communities they have reached are going to continue being extended to those who need them.

Dr Ddungu said that the sustainability aspect was top priority when the programme was being designed and that is why it was delivered through three service delivery channels; the outreach component, public health system strengthening component and the private sector component.

“Through public health system strengthening, the RISE programme has supported capacity building at over 325 facilities through on-the-job mentorship of over 750 health workers to provide quality contraceptive services. The mentorship program has skilled health workers through peer learning to build confidence and competence to deliver high-quality family planning services, particularly long-acting contraceptives which are now routinely provided at these facilities,” he said.

He, therefore, believes that even when Marie Stopes pulls out, the health workers they have trained including the Assistant District Health Officer in charge of maternal health will still be able to provide these services to the people.

Aidah Muwanguzi, the deputy district health officer, Kalungu district said that before the RISE programme came in, they had a very high number of short-term methods like injectaplans and contraception pills being given in their government health facilities, not because the women were only inclined towards short-term methods but because that was the available capacity within these facilities.

She added that some health workers stationed in different health facilities within the district were identified and trained on offering different family planning methods especially the long-term ones and these in turn also trained other fellow health workers on the same.

“The number of long-term methods being dispensed in our facilities has increased. Since these health workers are stationed at the facilities, women can now get these services anytime unlike before when they first had to wait for an outreach which would come by once a month,” she said.

Muwanguzi is, therefore, confident that even if the project is ending, there is going to be continuity of services because the health workers who have been trained are going to continue offering these services and that actually right now, there is no midwife in Bukulula sub-county that doesn’t know how to offer any family planning method.   

“And the good thing is that government facilities don’t have a high attrition rate which gives the project a leverage when it comes to sustainability because we are sure that we are not going to lose out on the skills acquired because most of these health workers are going to stay at these health facilities for a long time,” she added. 

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