Time for Uganda to prioritise family planning investments

Friday July 1 2011

By Jotham Musinguzi

Facing severe budget shortfalls at home, many donor countries are considering—or already implementing—cutbacks in their foreign aid programmes. This includes support for crucial international family planning programmes. For example, the United States, the global leader in supporting contraceptive services in the world’s poorest countries, reduced its 2011 international family planning and reproductive health assistance by $33 million.

In the face of this new reality, Uganda must step up its own funding for family planning—not just because the donor community is stepping back, but because it is in Uganda’s own self-interest to do so. The time to act is now.

As Uganda looks for ways to sustain the strong economic growth it has experienced in recent years, it’s important to remember that social and economic progress is linked to improved access to quality family planning services. Such services save women’s lives, save the country money, and create a healthier, more productive society. Failure to support these services now will only end up costing more down the line.

In Uganda, low levels of contraceptive use are already taking a toll. Seven in 10 women who want to avoid pregnancy are not using an effective contraceptive method. As a result, more than half of all pregnancies are unintended.

In rural areas, where 85 per cent of the population lives and where family planning services are scarce, the poorest women now have an average of two more children than they want. These additional births increase economic hardship among the most vulnerable families, leaving them with fewer resources to invest in education, healthcare and other basic needs. Unplanned births also limit women’s ability to work, making the cycle of poverty even harder to break.

Unintended pregnancy is also a serious threat to the health and survival of women and newborns. It often results in a high-risk birth, for instance, one that occurs too soon after a previous delivery or when a woman is too young. This reality is starkly reflected in Uganda’s high rates of maternal and newborn deaths: Thirty out of every 1,000 infants will die before they are a month old; and more than 6,000 women die every year during pregnancy or childbirth, while countless others experience debilitating health problems.


Further, many thousands of women decide they are not in a position to care for a child, or another child, and thus risk their lives by having an unsafe abortion. Nearly 300,000 abortions are performed every year in Uganda, most of them by an untrained provider as the procedure is highly restricted. Not only do these unsafe and clandestine procedures endanger women, they also pose a serious challenge to the public health system, which treats about six in 10 women who receive postabortion care. In other words, Uganda’s already strained health budget now devotes precious resources to treat complications from unsafe abortions. This is the reality today in Uganda, but it doesn’t have to be.

The payoff of robust and sustained investment in quality family planning programmes would be enormous. If all Ugandan women needing modern contraception were able to obtain an appropriate method, unplanned births and induced abortions would each drop by as much as 85 per cent and maternal and infant deaths by as much as 40 per cent. This would improve the health and economic well-being of women and their families and the benefits would extend to the nation as a whole.

This message should resonate not just with public health advocates in Uganda, but also with those in charge of public finances: Every dollar spent on family planning saves more than $3 that would otherwise be spent on health costs associated with unplanned pregnancies. What these numbers make clear is that funding for family planning programmes is an investment, not a cost. For Uganda and other countries in the region and around the globe that are looking for ways to enhance their economic growth, expanding the reach and quality of national family planning programmes is one of the most cost-effective and developmentally sound investments they can make.

Dr Musinguzi is the regional director of Partners in Population and Development, Africa Regional Office. Ms Sharon L. Camp, president and CEO of the Guttmacher Institute, an independent policy and research institute in the field of sexual and reproductive health, contributed to this article.