“Go alone, I am not pregnant to go to the hospital with you,” is the response Caroline Nabuzale, an expectant mother got from her husband, Lazarus Mazune, when she asked him to accompany her to the health centre III for Family planning sessions during her antenatal visit.
Nabuzale went to antenatal clinic alone and was advised by medical workers to start using family planning contraceptives to avoid conceiving again because she already had eight children in 10 years. When she shared her new knowledge with her husband that evening, he stopped her midway with a slap, and warned her never to bring up the topic again; “I’m the only child my parents had so, it’s my duty to reproduce for the clan.”
Ten babies in eight years
“I have had eight children in a space of just 10 years, we are living in poverty, all my dreams have been shattered. I have been ostracised by my family. They say I’m producing like an illiterate, and I am a disgrace. I don’t understand why my husband does not think about family palnning,” she says.
Nabuzale is not alone. There are many women who are victims of domestic violence in the remote areas due to FP and therefore fear discussing the issues surrounding FP with their husbands.
According to a study by Reproductive Health Uganda (RHU), more than 50 per cent of women are scared of discussing family planning issues with their husbands.
RHU’s Project Officer, Nathan Tumuhamye, says they found that most of the men do not want their women to use family planning methods because of fears such as over bleeding. Consequently, many men are more comfortable discussing FP issues with their male peers.
Joseph Waninda, a Behavioural Change Communication specialist says in Uganda, contraceptive use is still low at only 24 per cent.
There is a high unmet need of 41 per cent, meaning one in four women don’t want to get pregnant but lack access to family planning services and information. Also, nearly half of the poorest women say their most recent pregnancy was unplanned.
The state of World population report 2013 reveals that only 26 per cent of Ugandan women have access to a modern method of contraception.
Dr Charles Kiggundu, a consultant Gynecologist/Obstetrician at Makerere University Medical School, says a large section of the men don’t want their women to get involved in family planning for fear of side effects. “There is no magic to contraception.
Each method works differently for different women but sometimes, it comes from inappropriate use. For example, skipping the brown pill in the pill plan method will result in severe side effects,” Dr Kiggundu explains.
The gynaecologist nonetheless emphasises that to fight maternal health problems in Uganda, it is important to observe, clearly identify and give importance to the two roles of fatherhood and motherhood. He calls upon men to be supportive of their wives, get involved in child spacing plans, help in providing pre-natal, obstetric and post-natal care, and above all, engage in family planning and not to leave it to women alone.
The UNFPA Executive Director Dr Babatunde Osotimehin consented women face many challenges, including lack of accurate information on sexual and reproductive health, as well as cultural and religious limitations, and the fear of domestic violence from their spouses. She says FP is increasingly being recognised as critical not only for individuals’ reproductive health and rights, but also for economic growth.
“When couples are able to plan the size, and spacing timing of their families, mothers and children are healthier. Access to sexual and reproductive health information and services also improves girls’ school attendance, which leads to greater opportunities and yields benefits for the community,” says Dr Osotimehin.
Dr Tom Otim, a senior gynecologist at Mbale Regional Referral Hospital says births resulting from unintended pregnancies also have a higher chance of having birth defects and low birth weight. “Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood, and more behavioural issues in their teen years.
Without sufficient reproductive health information and services, there are likely to be high rates of adolescent pregnancy, obstetric fistula, unsafe abortions and HIV infection,” explains Dr Otim.
While addressing a conference on how voluntary family planning services can help accelerate development co-hosted by Uganda’s Ministry of Health and UNFPA, President Museveni emphasized the need for men to join the women in FP.
“Family planning is good for the health of the mother, children, and for the welfare of the family,” said the President.
State Minister for Primary Health Care Ms Sarah Opendi, urged government to do more to ensure that youth-friendly reproductive health services are scaled up and made available to more young people. “Family planning is no longer an issue of only women. It is an issue of everyone.”
The executive director of Center for Human Rights and Development (CEHURD) Mr Moses Mulumba said influencing men’s attitudes towards FP is therefore critical to increasing contraceptive prevalence in a society.
“Family planning is essential to achieving all of the Millennium Development Goals and among the core issues discussed that deserve greatest attention are policies that address unmet contraceptive need; consistent and correct contraceptive use; contraceptive technology that makes adherence easy and cost-effective; and increased service delivery, so that all who wish to receive FP have access to it.
“Decision-making on contraceptive use should be a shared responsibility of men and women,” added Mr Mulumba, a lawyer and an advocate of reproductive health.