Despite Uganda's family planning policy being so liberal that it allows all sexually-active women and men to use contraception for family planning without consent from their partners or parents, the rate of contraceptive use is still low.
At 36 per cent, Uganda's family planning unmet need is one of the highest in Africa. One of the major barriers to family planning access has been the rampant stock-outs of contraceptives in government health facilities. Addressing this problem is very crucial.
A recent rapid assessment by civil society organisations including HEPS-Uganda, DSW, and Fowode shows that some health facilities have gone for over one year without contraceptive pills, condoms and long-term methods such as implants. The sampled districts include Mbarara, Kamuli, Isingiro, Kiboga, Tororo and Mukono.
At Nankandulo health centre IV, Mbulamuti HC-III and Bugulumbya HC-III in Kamuli district, pills have been out of stock for over a year now. Biharwe HC-III, Bukiro HC-III, Kashare HC-III and Kakoba HC-III in Mbarara have all had no pills for more than ten months now.
Isingiro district, where the president presided over the World Population day celebrations recently, is even worse - over 70 per cent of the health centres there are stocked out of pills and long-term family planning methods.
Contraceptives stock-outs occur in two ways: when supplies are not available at a health facility that routinely provides them; and when a health facility, for some reason, does not provide a family planning method it is mandated to provide. The ministry of health has acknowledged that, indeed, there is a countrywide stock-out of family planning pills in government health facilities.
But they also acknowledge that family planning is a cost-effective means to lower maternal mortality rates given that it reduces the risk of exposure to pregnancy. This problem can be summed up as institutional. One of the problems is the unending ball-bouncing between National Medical Stores and the last-mile consumers, local government health centres.
Whereas the NMS always paints a picture of stacked-up boxes of reproductive health commodities in their keep, lower local government health facilities continue to suffer the blackout of supplies, even of commodities such as condoms.
There is limited choice when it comes to the number of family planning methods supplied by NMS and available at the health facilities. In most of the health facilities where our assessors reached, long-term methods are supplied by development partners such as PACE, UNFPA and Marie Stopes.
Uganda will not achieve the FP2020 commitment of providing universal access to family planning and reducing the unmet need for family planning from 40% to 10% by 2022 if this trend continues.
The problem of contraceptive stock-outs is also two-dimensional: the financing and the supply system. According to the Reproductive Health Commodity Security Strategic Plan, 2009/10-2013/14, the proportion of health facilities with no stock-outs of selected reproductive health commodities should have increased to 80% by 2015.
The government budget allocation and expenditure on reproductive health commodities, including contraceptives, should have also increased to 80 per cent by 2015. None of these have happened. Why? Lack of adequate funds.
In 2012, at the London FP2020 conference, the Uganda government pledged to increase the annual budget allocation for family planning supplies from $3.3m to $5m for the next five years and improve accountability for procurement and distribution. There is still a funding gap of $2.55m to date.
In the last financial year (2015/16), donors mobilized $11m for family planning whereas the government mobilized $2.44m as part of fulfilling the FP2020 commitments. The government still needs to allocate more funding to family planning if we are going to improve women's and children's health, reduce maternal mortality, and support women's ability to exercise their reproductive rights.
Government should support alternative distribution channels for the private sector which is currently being done by Uganda Health Marketing Group (UHMG). The National Drug Authority should not allow any unnecessary delays in the testing of products such as condoms because it always translates to stock-outs in many areas.
Community-based distribution through outreaches, youth-friendly services and social marketing has not been embraced in rural areas where it is needed most.
There is a big need for contraceptive use given Uganda's high fertility rate of 5.9 children per woman. This will help us to curb the high morbidity and mortality as well as the rapidly-growing population (3.2%).
Producing unsustainable numbers of children not only strains individuals, families, and public resources, but also impedes opportunities for economic development. Contraceptive use has the potential to lower unwanted pregnancies, decrease maternal mortality, and consequently increase welfare for our future generations.
The author is a health activist and a communications officer with HEPS-Uganda.