Halima Shaban
16 December 2007
Kampala — TOPISTA Imayitum, a 30-year-old mother of eight and resident of Achanga IDP Camp in Katakwi district, was one of the mothers from the IDP camps who attended a mobile reproductive health clinic, recently.
The area has been ravaged with war, where the only recreation for men and women was unprotected sex.
"I want to stop giving birth because when I had my eighth born, my uterus ruptured and the doctor advised me to stop giving birth.
The children are also many yet my husband does not work. Looking after them is a problem, but whenever I bring up the issue of family planning, my husband abuses me and sometimes beats me," says Imayitum.
Early this month, the Family Planning Association of Uganda celebrated 50 years of operation in Uganda at a ceremony held at Hotel Africana. Despite half a century of availability of the services, more women who want to space births or stop, cannot easily access contraceptives.
There is an increase in the number of people who would like to use family planning, but are unable to access the services. This unmet need was 52% in 1989. It reduced to 29% in 1995, but increased again to 35% in 2001 and has shot up to 41% according to the 2006 Uganda Health Demographic Survey (UDHS).
Unmet need refers to the number of women who want to limit having children and those wishing to wait for two or more years for another child, but are not using contraceptives.
Prof Florence Mirembe, a lecturer at the School of Medicine, Makerere University, says two in five married women in Uganda have unmet needs for family planning and about 25% of these need family planning to space their births. She says 16% require family planning services, but are not accessing them.
The survey indicates that the average fertility rate is 6.7 (4.4 children per woman in urban areas and 7.1 children per woman in rural areas).
It further reveals that 41% of the married women in Uganda do not want to have more children or prefer sterilisation, while 35% want to wait for two or more years before the next birth and 16% want to have a child in two years.
"Although the number of those using any method of family planning has increased, from 23% in 1995 to 24% in 2006, this number is still low. This is a result of factors, including rapid population growth, that have led to the unprecedented increase in the number of young people who need sexual and reproductive health services," says Mirembe.
Dr Anthony Mbonye, the assistant commissioner for Reproductive Health in the Ministry of Health, says the increase has brought more people into the brackets of family planning users, putting pressure on provision of services, yet this has not attracted more funding for sexual reproductive health programmes.
Elly Mugumya, the director of Reproductive Health Uganda (RHU), formerly Family planning Association of Uganda, says the association will focus and give prominence to long term methods such as Depo provera (a contraceptive injection), implants, intra-uterine contraceptive devices like the coil and tubal ligation, where the fallopian tube tubes are tied.
They will target, especially, the rural women who may find such methods convenient.
"From vertical family planning, we have transformed ourselves and are now providing comprehensive integrated sexual reproductive health services. With the transformation, the number of clients has increased," says Mugumya.
"Reproductive health is a basic human right. When parents choose the timing of pregnancies and the size of their families, lives are improved and children grow up healthier.
"By delaying marriage, limiting the number of children, timing and spacing her births; a woman will have greater opportunities for education, employment and involvement in her community and will be able to play an active role in ensuring her family's welfare," Mirembe says.
She adds that about 300,000 unsafe abortions occur every year with government hospitals spending millions to treat infections and complications of over 80,000 women every year.
Joyce Mpanga, a member of the RHU executive committee, says unlike in the past when family planning was perceived as a means of preventing people from giving birth, such attitudes have changed. Many people now consider it a strategy to pursuing quality lives.
Mbonye praised RHU for its outreach programmes and encouraged its members to establish centres in rural areas that provide family planning services and other sexual reproductive needs on a routine basis.
He said due to lack of family planning, some women had contended with poor sexual reproductive health indicators such as unwanted pregnancies, or ailments like cervical cancer that would have been prevented if the services were offered daily.
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