Cultural norms pressure women to shun family planning in Bugisu, Sebei

This is because the use of birth control methods is still viewed as evil and against the cultural norms of various communities in regions found in the eastern part of the country.
But still, some women are determined to embrace birth control, seeing it as a pathway to a better life for themselves and their families.

Ms Mary Nakiso is a mother of four from Bukyabo Sub-county in Sironko District. Ms Nakiso’s story is not unique. Like many other women in Bugisu, she faces resistance from her husband and also clan leaders for choosing to use contraceptives or any other birth control methods.

The prevailing belief is that family planning is unnatural and goes against traditional values, a sentiment echoed by community elders.

“I informed my husband of the need for birth control after I delivered a fourth child but he was bitter. I decided to do it on my own. He has kept threatening me. Now even the clan leaders say I am a bad mother for using birth control, but I can’t afford to have more children when I am struggling to feed the ones I have,” she said.

In Bugisu and Sebei sub-regions, the use of birth control is often seen as a rejection of cultural norms that promote having large families.
For generations, having many children has been seen as a source of pride and a symbol of a woman's strength and fertility.

Yet, times are changing, and many women are caught between these traditions and the realities of raising large families with limited resources.
Ms Janet Nagami, a resident of Makudui Village in Northern City Division, said her husband abandoned her with six children after she found out that she had gone for a contraceptive injection at Namanyonyi Health Centre III.

“My husband is a peasant and I’m a housewife. We are struggling to raise the six children we already have but he doesn't see that. He wants more children despite our condition,” she said.
Joan Nabwire, an 18-year-old resident, said it took her time to embrace family planning. “I started using an implant after giving birth to my first child. It’s not easy because my husband warned me about using birth control because of the side effects,” she said.
Fatima Nambuya, a youth from Busamaga Ward, Northern City Division, noted there’s a lot of pressure against using contraceptives.

“My family believes it’s wrong. I often feel like I have to hide my decisions, and that secrecy can be stressful,” she said.
Irene Chemutai, 16, from Kapsinda Ward, Central Division in Kapchorwa Municipality, said young people in Sebei find challenges in accessing reproductive health services.

“In our community, talking about contraception or family planning is questioned because of religious, cultural, or societal beliefs. This makes it hard for us and many others to get the information and services we need to make informed decisions about our reproductive health,” she said.

Ms Chemutai urged the government to engage communities, especially the elders to abandon some of the cultural beliefs that she said are outdated.
The taboos surrounding family planning have continued to put girls and women at risk of high rates of unintended pregnancies, which at times results in high rates of preventable deaths from unsafe abortions as well as a higher rate of infant deaths.
Ms Eveline Cherono, a mother, said women face not only physical discomfort but also emotional isolation when they decide to embrace family planning methods.

“The stigma we face surrounding the use of family planning contributes to a culture of silence and shame. It’s the reason most women do not go for it,” she said.
Ms Cherono added: “There is a need for sensitisation about family planning so that women feel empowered and supported when using it.”
T

he Police Spokesperson for Sebei Sub-region, Mr Fred Mark Chesang, said the misunderstandings between couples over the usage of family planning have also contributed to several cases of domestic violence in the homes.
“Gender based violence (GBV) is also common in our region, especially the physical, where families fight mostly between husbands and wives. We register about two to three cases of GBV daily ,” he explained.

Dr Agnes Masaba, a reproductive health expert based in Mbale, said: “Many people here think that birth control methods like implants or pills can make women infertile or cause serious health problems.”
She added: “Some even believe that contraceptives encourage promiscuity. These misconceptions create a lot of fear and resistance.”
According to Dr Masaba, efforts to counter these beliefs have been slow, but some progress is being made through education and dialogues.

“The most commonly used contraceptives in Bugisu include injectables, which offer protection for three months, and implants, which last several years,” she said.
Dr Masaba added that oral contraceptive pills are available, but they require strict adherence, making them less popular among women who cannot easily access health centres.
“Some women experience side effects, such as weight gain or changes in their menstrual cycle, others find these methods life-changing,” she said.

Dr Masaba said family planning is important in promoting women’s health but also for economic stability.
“When women can space their pregnancies, they are more likely to work and provide for their families. It also reduces the risk of complications during childbirth,” she noted.
Ms Beatrice Kagoye, who has worked as a nurse at Namatala Health Centre IV in Mbale City for more than five years, said although there is interest in birth control, many women are hesitant.

“We see a lot of women asking about injectables and implants because they are long-lasting. But they often stop using them after hearing about side effects like irregular periods and weight gain,” she explained.
The nurse said some women also use contraceptives without telling their husbands or families because they fear being judged or even abused.

The health centre’s records show that, of the 500 women who sought reproductive health services in the past year, only 150 chose a birth control method.
Most of these opted for injectables or implants, methods that can be administered discreetly. However, the gap between those who need these services and those who use them remains significant.

Ms Sandra Nambozo, an enrolled nurse at the same health centre in Namatala, said women prefer short-term contraception (around three months) over long-term options (three to five years), often due to fears of complications like heavy bleeding.
Additionally, she pointed out a troubling connection between family planning and domestic violence. “Many women seek these services discreetly to avoid backlash from their husbands, and some face violent confrontations when their choices are discovered,” she said.

Despite these challenges, the overall uptake of family planning remains low, indicating a need for education and support to address health concerns and domestic violence.
According to data from Namatala Health Centre IV, only 30 percent of women who start using birth control continue beyond six months, reflecting ongoing challenges on the usage of family planning.

A 2023 report from Reproductive Health Uganda, a non-governmental organisation, highlights the challenges in Bugisu and Sebei, noting that only 10 percent of women use modern contraceptive methods, compared to 35 percent in urban areas like Kampala, Uganda’s capital city.

This disparity is attributed to cultural resistance, lower levels of education, and limited access to health services. The report called for more targeted interventions to address these gaps.
The Uganda Ministry of Health recently launched a campaign to educate communities about the benefits of contraceptives.

Ms Sophie Wachaya, a village health team (VHT) member and mother of six in Bukonde, said there is a need for community awareness programmes to educate both men and women about the benefits of family planning.

“I started using birth control because I wanted to ensure I can provide for my children. It’s all about timing. Not all family planning methods are bad; you just have to find what suits you. Many men don’t understand how complicated this can be, and it often falls on women to take care of the children,” she said.

Ms Lina Khanakwa, a teacher at Manafwa High School in Manafwa District, said using the implant has been a game changer for her.
“I can focus on my work without worrying about getting pregnant. It feels empowering to have control over my body and my future,” she says.
Ms Edith Nambale, a resident of Namabasa Cell in Mbale, said she took her 16-year-old daughter for an injection to help her stay safe while completing her studies.

“My daughter had joined some peer groups and I consulted a nearby doctor who recommended the injection and I went for it,” Ms Nambale, said.
Local NGOs like HOPEMbale and Women with a Mission have stepped in to fill the gap, by providing education and free contraceptives to rural communities.

Ms Betty Byanyima, the executive director of Women with a Mission, said:“We are working to make birth control accessible in several areas, but the stigma is a major barrier. Many people need to be convinced that family planning is in their best interest,” she said.
Mr Benard Wasike, the executive director of HOPEMbale, said they are dedicated to providing education about family planning and reproductive health.

“Our goal is to empower individuals, especially women and young people, to make informed choices about their health and futures. By increasing access to resources and information, we aim to reduce unplanned pregnancies and improve overall community well-being,” he said.
Dr Stephen Masai, the Namisindwa District health officer, attributed the low uptake of family planning to several myths and misconceptions, which include contraceptives reducing a woman’s libido.

“Many families still aspire to have large households...To combat this, we have integrated outreach programmes within the communities and provide health education during antenatal care services. These efforts aim to engage and inform our community members about the benefits of family planning, encouraging them to consider it a viable option for their families.”
Dr Richard Mugahi, the commissioner of reproductive health at the Ministry of Health, said family planning uptake among married women is currently 38 percent, while the government’s goal is to reach 50 percent.

“Meanwhile, the unmet need is at 22 percent, indicating a significant portion of married women who would like to access family planning but are not yet using it," he said
Dr Mugahi emphasized that addressing the unmet need could help improve overall health outcomes, and empower women to make informed reproductive choices.
However, Mr Fagilina Wopukha, an elder from Namisindwa District, said the use of contraceptives has led to moral degeneration in the communities.

“We are facing a challenge of decayed morals because of embracing foreign things like family planning. In our cultural norms, marriage is for reproduction and children are gifts from gods and more you have in your marriage means blessings,” Mr Wopukha,87, said.
Ms Joan Namono, a retired primary teacher in Manafwa District, however, said women could be developing complications because of using family planning methods, something medics should investigate.