14 May 2008
Kampala — Modern family planning methods can save Ugandan mothers from the excesses of motherhood, if only their husbands could cooperate, writes Bamuturaki Musinguzi
"We as a couple would go in for family planning because the nature of life and cost of living today requires that you count the costs that you go into," Sam Opolot cautions.
Seated by his wife, Alice who keeps nodding as a sign of agreement - at the Outpatient's Clinic at Kibuli Muslim Hospital in Kampala, where his she had come for her routine antenatal check-up, Opolot says: "If you are going to have children you have to think of how you will look after them."
He further adds: "Think of how having many children affects the health of your wife because giving birth alone takes its toll on her body. So you wouldn't want to expose her to so much risk."
The Opolots knowledge of family planning is an indication that this health system is becoming popular as evidenced by the 2006 Uganda Demographic and Health Survey (UDHS), which reveals that family planning in Uganda is highly influenced by education, wealth and introduction of modern methods like injectables as well as the urban - rural divide.
Ninety-seven percent of married women and 99 percent of married men know at least one method of family planning. Over 90 percent of both women and men know about pills, injectables, and condoms. "Fewer than one in five women, however, understand that a woman is most likely to conceive halfway between her two menstrual periods," the survey observes.
In the survey conducted by the Uganda Bureau of Statistics (Ubos), twenty-four percent of married women are using any method of contraception, and 18 percent are using a modern method. The most popular modern methods are injectables, used by 10 percent of married women and the pill, used by three percent of married women.
Use of modern family planning is more than twice as high in urban areas as rural areas (37 percent versus 15 percent). There is also substantial variation in modern contraceptive use by region, ranging from 8 percent in the north to 40 percent in Kampala. Contraceptive use differs significantly across educational categories.
Use of any contraceptive ranges from 13 percent among users with no education to 46 percent among those with secondary or higher levels of education. Use of modern methods among these groups increases substantially from 9 percent to 35 percent respectively. "Nevertheless, contraceptive use remains low, at only a quarter of married women."
The survey shows that use of contraceptives methods among currently married women in Uganda has increased notably from 15 percent in 1995 to 24 percent in 2006.
The increase is especially marked for modern methods which more than doubled in the 11 years between 1995 and 2006, from 8 percent to 19 percent when districts not surveyed in the 2000/01 UDHS are excluded from 1995 and 2006 data. This increase, the report says is mostly due to the rapid rise in the use of injectables from 3 percent in 1995 to 11 percent in 2006.
Over half of the women (52 percent) obtain their products from the private medical sector, while over one-third obtain them from the public sector, and 13 percent from other private sources. More than six in ten (65 percent) married women not using any contraception at the time of the survey say that they intend to use family planning in the future. Half of these prospective users (51 percent) favour injectables, and 14 percent cite the pill as their preferred method.
Men have been accused of being the biggest stumbling block in the access of family planning services as the senior nursing officer, Kibuli Muslim Hospital, Elizabeth Musoke says: "Men stop their wives from employing family planning out of ignorance because they have not been sensitised thinking that their women will fall sick or get hurt." Musoke adds that: "While others may agree with the wives as to the number of children they will have, some men have gone ahead to marry more women - upsetting the wives who in turn say: 'Why shouldn't I have more children because my husband is going to have children as well with the other wives?'"
Polygamy, the practice of having more than one wife, is relatively common in Uganda. Just over one-fourth of married women (28 percent) and 17 percent of married men are in polygamous unions.
The report notes that older women are more likely to be in a polygamous union than younger women. Polygamy is also slightly more common among rural women (29 percent) than urban women (23 percent).
The prevalence of polygamy is highest in West Nile (38 percent) and lowest in the southern area and Kampala (17 percent each). "Uneducated women and those in the poorest wealth quintile are slightly more likely to be in polygamous unions than other women."
"Other men impose conditions on their wives to have, let's say, two children and yet the wives want more children - and will force them to abort if they get pregnant," Musoke observes.
"This cuts across all religious - cultural divide and academic levels. In some cases the women are pressurised and influenced by relatives and friends to have more children arguing that men are not reliable because they will get co-wives."
Musoke's advice to married couples is that if they have agreed to any form of family planning, the men should help their wives and escort them to health units for counselling among others. "Women have more knowledge on health issues because they always go to health units than their husbands," Alice Opolot chips in.
"If the wife has accepted to go for tubal ligation, why doesn't the man also go for vasectomy? So in the end you have women producing children for consolation, security and protection against the husband and father," Musoke said.
Ugandan women report an ideal family size of five children, while men report 5.7 children as the ideal number. Ideal family size is higher among women in rural areas than urban areas (5.2 versus 4.0).
At the regional level, the ideal number of children for women ranges from 3.7 children in Kampala to 5.3 children in the north and western regions. Women on average have 1.6 children more (actual fertility) than their ideal number (wanted fertility).
The proportion of women who cited a desire for more children soon has decreased from 23 percent in 1995 to 17 percent in 2006 when the numbers are adjusted to account for the different geographic regions covered in the surveys. "This suggests that women are realising the disadvantages of large family sizes," the report observers.
Unmet need for family planning services is defined as the percentage of currently married women who either want to space their next birth or stop childbearing entirely, but are not using contraception.
Two in five currently married women (41 percent) in Uganda have an unmet need for family planning. The unmet need differs by region, from 23 percent in Kampala to 47 percent in West Nile. The need for spacing (25 percent) is higher than the need for limiting (16 percent). Currently only 37 percent of the demand for family planning is being met, and 46 percent of last births were either unwanted or wanted later.
The report further shows that overall, over half (58 percent) of contraceptive users discontinue use within 12 months of adopting a method. The discontinuation rate is highest among users of male condoms (71 percent) and lowest among injectable users (47 percent). The 2006 UDHS shows that fertility continues to be high in Uganda with little national change in the last ten years. At current fertility levels, Ugandan woman will have an average of 6.7 children in her lifetime.
"Only women age 15-19 show a decline in fertility, indicating that they are marrying, having first sex, and having their first child at later ages," says the report. The report indicates that unplanned pregnancies are common in Uganda. Overall, 13 percent of births in the five years preceding the survey were not wanted, and one-third of births were wanted later.
The 2006 UDHS follows the 1988-1989, 1995, and 2000/01 UDHS surveys, which were also implemented by Ubos. It is the first UDHS to cover the entire nation because insecurity restricted data collection in each of the previous three surveys.
It was designed to provide information on demographic, health, and family planning status and trends in the country.
A nationally representative sample of 8,531 women age 15-49 (95 percent of those eligible) and 2,503 men age 15-54 (91 percent of those eligible) were interviewed. This sample provides representative estimates of health and demographic indicators at the national and regional levels, and for rural and urban areas.
Use of antenatal care from a skilled provider is high in Uganda, at 94 percent. Very few mothers, 17 percent, seek care early in their pregnancies. Furthermore, less than half of the births are assisted by a skilled provider, and only 23 percent of mothers received postpartum care within the critical first two days following delivery.
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