Bonny and withered, with a baby strapped on the back, Irene Akello is six months pregnant and struggles to balance a pot of water on her head.
Though Akello says she is 26 years old, she can easily be mistaken for a woman in her late thirties. Akello a resident from Lagoro sub-county in Kitgum district says she has had four children in fi ve years. Akello's woes lie in her semi-illiterate husband.
Over the past fi ve years Akello has expressed desire to use contraceptives to space and limit her births but has been stopped by her husband.
"My husband is against the use of contraceptives. Whenever I mention going to a health center to pick some for myself, he reminds me how he married me to give birth to children," Akello narrates her ordeal.
This has resulted in Akello having unwanted pregnancies despite her desire to control her births. Immaculate Aribu from Amuria district is a mother of two: One-year-old Okurut and two-year-old Apolot district.
She says she has by God's grace managed to delay conception because she resorted to using safe days as a birth control method.
"My husband does not want to hear anything to do with use of contraceptives. He always threatens to send me packing the day he will discover that I am using contraceptives," Aribu laments.
Akello and Aribu are cases of thousands of women who want to use family planning services to space and control a number of children they would wish to have but their hands are tied.
According to Dr. Betty Kyadondo the head family health department at Population Secretariat says that because of such instances Uganda's unmet need of family planning now stands at 34% as per the Uganda Demographic Health Survey 2011.
"Though there is a reduction of 7% from 41% as per in 2006, we cannot say Uganda is doing well. There is need to ensure family planning services are available and qualifi ed personnel are in place to address family planning needs of women," she said.
She noted that the majority of women especially in rural areas would like to delay pregnancy, space their children or stop child bearing altogether but do not have access to any contraceptive method.
She adds that high total fertility rate of 6.2 children per woman (UDHS 2011) is one of the causes of Uganda's high population growth. She attributes the high fertility rate to early initiation of sex with the average age being 17 years.
"Girls start to have children as early as 15 years, without using any contraceptives and continue to have children until menopause sets in," Dr. Kyadondo notes.
Other factors include: short birth intervals with babies less than 24 months apart, pregnancies beyond 35 years, cultural practices that lead to early, close and late pregnancies and sex preferences where male children are preferred.
With the contraceptive prevalence rate at 30% (UDHS 2011) Dr. Kyadondo says the idea of family planning has not been well embraced especially in the rural areas.
She notes though National Medical Stores has procured plenty of short term contraceptives like pills, injectables and condoms but women in rural areas seem to prefer long term contraceptives like implants because they are convenient and give them longer protection.
Dr. Kyadondo says there is need to empower women to be in charge of their own reproductive health if Uganda is to achieve the expected fertility rate of about 5 children per woman. "
Aside, there is need to address the issue of early pregnancies by keeping the girls in school. Women holistic empowerment for example equipping them with life skill to enable them earn a living in addition to the availing them with family planning services