FAMILY PLANNING IN UGANDA

By Reproductive Health Supplies Advocacy Network
WHY IS FAMILY PLANNING IMPORTANT?
I. Every year Uganda loses about 6,000 women as a result of pregnancy related complications.
II. A significant proportion of these deaths occur because women are not able to have healthy planned pregnancies. In Uganda, according to the Uganda Demographic and Health Survey, 41% of married women wish to space their pregnancies or want to stop child bearing altogether but are not using family planning methods.
III. Women may have unmet need for family planning because of various reasons including fear of side effects, lack of knowledge and lack of access to family planning supplies.
WHAT HAPPENS WHEN FAMILY PLANNING SUPPLIES ARE NOT AVAILABLE?
I. Many women bear children before they are ready to and have more than they can care for.
II. About 755,000 women get unintended pregnancies each year, many of which end up in abortion.
III. Every year about 297,000 women have unsafe abortions and 85,000 suffer from complications
IV. Uganda has a high teenage pregnancy rate about 25% of adolescents are already mothers or pregnant with their first child.
V. The country has a high maternal mortality rate; 435 deaths for every 100,000 Live Births. This is the equivalent of about 6,000 women dying each year.
VI. High Total Fertility rates, which contribute to high population growth rates. Uganda has a total fertility rate of about 6.7. Children per woman and a population growth rate of 3.2%. If current trends continue. Uganda’s population will reach 130 million by 2050.

WHY IS IT IMPORTANT FOR WOMEN TO ACCESS FAMILY PLANNING?
I. At individual level, access to family planning allows women to space their birth and have more manageable families.
II. Having fewer children can reduce the economic burden on women and their families and allow them to spend more on each individual child, thereby improving nutrition and health in general, access to education and better living standards.
III. Access to family planning frees women from the burden of looking after several children and enables them to access employment in formal and non – formal sectors, thus contributing to increased income at household level,
IV. At national level, if all women in need of supplies were able to access them this would reduce unwanted pregnancies and prevent 84 to 85% of unsafe abortions.
V. Increasing allocations to family planning would reduce expenditure on social services because the resultant low population would decrease the demands on government for clean water, food, education, healthcare and employment.
VI. Research shows that one third of all maternal death could be prevented through family planning.
VII. Studies show that addressing the unmet need in Uganda could be expected to prevent 16,877 maternal deaths and about 1 million child deaths by 2015.
VIII. Investing in contraceptive commodities and services to fill all unmet need would result in savings of US$ 112million (194 billion shillings) over what would be spent on costs associated with unplanned pregnancies and births.
IX. For every dollar spent, more that three dollars would be saved, thus contributing to national development and attainment of Millennium Development Goal 4 & 5 of reducing child mortality and improving maternal health.

CRITICAL ISSUES AFFECTING ACCESS TO FAMILY PLANNING
I. Limited access to sexual and Reproductive Health Information and Services.
II. Early sexual activity among young people.
III. Inadequate information and knowledge on Sexual Reproductive Health.
IV. Negative attitude and beliefs on Reproductive Health Services and Supplies.
V. Limited Male involvement.
VI. Unsatisfactory quality of care in Reproductive Health service delivery.
VII. Inadequate political support and funding for Family Planning Services.

REPRODUCTIVE HEALTH UGANDA
Plot No. 2 Katego Road Off Kira Road, P. O. Box 10746, Kampala - Uganda,
Tel:256-414-540665, 256-414-540658, Fax:256-414-540657,
Email:rhu@rhu.or.ug/ fpau@fpau.or.ug

WORLD POPULATION DAY

Reproductive Health Uganda (RHU) formerly Family Planning Association of Uganda (FPAU) joins the rest of the world to mark World Population day.
World population Day is marked globally every 11th of July to reflect upon and highlight population issues that need urgent intervention in order to improve the quality of life of the population.
A quality population is one that is educated, healthy, and skilled and is engaged in activities that generate wealth.
As we mark this day, we need to reflect on the theme of the day which is to "Promote and Invest in Family Planning for National Development" and note the progress made, challenges and chart the way forward.
The theme highlights one of the principle SRH services offered by RHU, FPAU having been the first organization to introduce family planning services in Uganda in 1957.
We are concerned that the unmet need for Family Planning in Uganda currently is high at 41 percent and the population growth rate is among the highest in the world at 3.3 percent.

Between the two fires: A project being carried out by Reproductive Health Uganda to promote Sexual and Reproductive Health and Rights among internally displaced people in Gulu District
The rapid population growth rate arises from High fertility rate, Short birth intervals and High teenage pregnancies. If the demand for family planning was addressed total fertility rate could be reduced.
To this end promoting and Investing in Family planning for national development is urgently needed and calls for recognition of FP as a human right.
There is need to focus on the existing attitudes towards FP. Policy Makers and those in the decision making domain like the men in the family unit, need to contribute in drumming a wake up call towards Family Planning and SRH Rights.
There is also need to access SRH services and information currently limited by availability of supplies in the existing health centers.
If done, we will be in compliance with the International Conference on population and development held in Cairo in September 1994 that called for universal access to quality and affordable Reproductive Health services including Family planning, sexual health, significant reduction in infant, child and women mortality, broad based measures to ensure gender equality and, women empowerment and provision of comprehensive integrated
RH services by the year 2015.
As a Civil Society organization, Reproductive Health Uganda which pioneered family planning services in Uganda, has played a leading role in ensuring that Family planning services including information are accessed by Ugandans especially the poor.
RHU has used community radio to raise awareness, knowledge and understanding of SRH issues among the poor and has also engaged policy makers through advocacy to incorporate SRH and family planning as primary initiatives for national budget allocation, as well as participate in the debate to promote SRH and rights.
In keeping with the recommendations of the ICPD program of action, family planning services have increasingly become integrated with other sexual and reproductive health services.
The integrated service approach adopted by RHU has enabled service providers to concurrently address clients’ concerns on HIV/AIDS, other STIs and cancers of the reproductive system besides family planning.
Access to SRH services is a fundamental right. RHU has promoted Access to SRH information and services in a gender sensitive manner through its static clinics and out reaches in several districts across Uganda using an integrated service approach that includes a holistic SRH service package.
As we mark the day it is also important to reflect on the Millennium Development Goals (MDGs) and focus on the linkage between poverty alleviation, women empowerment and good governance as cornerstones for better health outcomes, family planning and human development.
It is also important to reflect on the concern that, as we raise awareness, knowledge and understanding hence increasing the public response to SRH services at different service points, how much of the RH supplies are available to meet the increasing demand?
Population issues impact greatly on the development of the country and all stakeholders need to embrace this responsibility collectively.
Thus, recognition of FP as a human right by policy makers and opinion leaders and a call for male involvement as well as advocacy for innovative initiatives that increase access to FP services to rural and vulnerable groups is a critical need.

FAMILY PLANNING FACTS
KEY POINTS
I. Family planning helps keep women and children healthy.
II. People have the right to decide how many children to have. They also have the right to decide how much time to wait between pregnancies.
III. Most methods of family planning are used by women. Women have the right to privacy and confidentiality about their choice of methods.
IV. Men can also participate in family planning decisions and should have access to information.
V. There are many methods of family planning. A woman should decide which one is best for her by discussing the choices with a health worker.
VI. Family planning clients should have:
1) Information: on the benefits of and availability of family planning.
2) Access: to services regardless of gender, age, religion, ethnic group, marital status, nationality or location.
3) Choice: with enough information to make an informed decision.
4) Privacy: during counseling and services.
5) Confidentiality: of all information and decisions.
6) Courtesy: consideration and attentiveness in treatment.
7) Comfort: when receiving services.
8) Continuing: services and supplies for as long as they want.
9) A chance to express their opinion: on the quality of service.
VII. Types of Family Planning include:
1. Natural method (calendar, rhythm)
2. Barrier methods (condom, spermicide)
3. Hormonal method (pill, injection)
4. Intrauterine methods (IUD)
5. Surgical methods (tie tubes)
VIII. Emergency contraceptive pills can be given within three days of unprotected sexual intercourse.

FAMILY PLANNING IS GOOD BECAUSE:

CHILDREN
i. Can receive more care from mother and father.
ii. Can have more food and other things.
iii. Can grow strong.
iv. Can do well in school.

ADOLESCENTS
i. Can wait until older before getting pregnant.
ii. Can stay in school longer
iii. Can have work opportunities

WOMEN
i. Can have better health.
ii. Can choose when to get pregnant.
iii. Can prevent STD/HIV/AIDS.
iv. Won’t need an abortion.
v. Can give more care to each child.
vi. Can have more time.

MEN
i. Can choose when to have children.
ii. Can prevent STD/HIV/AIDS.
iii. Can give more care to each child.
iv. Can have less worry about money.

FAMILIES
i. Can have more choices.
ii. Can have better education.
iii. Can do more in the community.

NATURAL METHODS OF FAMILY PLANNING

NOTE: A man withdrawing his penis before ejaculation is NOT an effective method of family Planning.

Effective natural methods of family planning include:
1. Abstinence from sexual intercourse.
Effectiveness:
It’s very effective. If a man and a woman do not have sexual intercourse, the woman can become pregnant.
Side effects: None
2. Not having sexual intercourse during the woman’s fertile time.
Names of these methods: Periodic abstinence, Fertile Awareness, Rhythm, Calendar, Mucus, Billings, Temperature).
Effectiveness: Some what effective if used correctly.
Side effects: None
Other points:
a) This method requires cooperation between the man and woman.
b) It can take several months to learn to use this method correctly.
3. The breast feeding method of Family Planning
Good for six months after child birth.
Effectiveness:
There are three requirements for breastfeeding to be effective for family planning:
a) The baby is aged 6 months or less.
b) Since delivery, the mother has not yet seen her menstrual period.
c) The mother breastfeeds fully (no other food for her baby) and frequently (no more than 6 hour between feeds even during the night).
Side effects: None
Other Points: If any of the requirements is not met, the couple should use another method for child spacing.

BARRIER METHOD OF FAMILY PLANNING
1. Condom – male or female
Effectiveness: effective if used correctly every time.
Side effects: Some people experience irritation from the latex used to make the male condom.
Other points:
a) Condoms are the only method that is effective both to prevent pregnancy and to prevent disease transmission (STD/HIV/AIDS).
b) To be effective condoms must be used with every act of sexual intercourse.
2. Spermicide
I. Lubricants/gels
II. Foam/foaming tablets
III. Pessaries/film
Effectiveness: Most effective when used with a condom
Side effects: Some people experience irritation.
Other points:
a. This method is controlled by the woman.
b. Used with each act of sexual intercourse.
3. Diaphragm
Effectiveness: Effective if used correctly every time.
Side effects: Some people experience irritation from the latex used to make the diaphragm.
Other points:
a) Effectiveness is improved when the diaphragm is used with a spermicide.
b) To be effective, the diaphragm must be used with every act of sexual intercourse.

HORMONAL METHODS OF FAMILY PLANNING
Hormone is the name of certain chemicals that are produced by the body. Family planning medicines contain the samehormones in special amounts.
1. Combined Oral Contraceptive Pills (COC)
Take one pill everyday.
Effectiveness: Very effective when used correctly.
Side Effects: Safe for almost all women. Serious side effects are rare.
During the 1st three months of use, some women experience:
i. Irregular menstrual bleeding
ii. Missed menstrual periods or
iii. Upset stomach.

Other points:
a) The woman who uses pills for family planning should swallow one pill each day.
b) Combined Oral Contraceptive Pills can be used by a woman of any age, whether or not she has children.
c) This method is not recommended for a woman who is breastfeeding it can reduce the amount of milk she produces.
d) Combined Oral Contraceptives can be used in a special dosage for emergency contraception within three days after unprotected sexual intercourse.


2. Progestin – Only Pills (POP)
Take one pill at the same time everyday.
Effectiveness: Very effective when used correctly.
Side effects: Safe for almost all women. Serious side effects are rare.
It is common for women to have:
i. Spotting or light bleeding between menstrual periods
ii. Missed periods or
iii. No periods.
The side effects are not dangerous.
Other points (about Progestin – Only Pills
I. The woman who uses Progestin – Only Pills for family planning should swallow one pill at the same time each day.
II. Progestin – Only Pills can be used by a woman of any age, whether or not she has children.
III. The Progestin – Only Pill is safe to use during breastfeeding. A nursing mother can start using Progestin – Only Pills six weeks after child birth.
IV. Progestin – Only Pills can be used in a special dosage for emergency contraception within three days after unprotected sexual intercourse.
3. Injection (Depo – Provera)
Take one injection every three months.
Effectiveness; Very effective
Side effects: Safe for almost all women. Serious side effects are rare.
It is common for women to have:
i. Spotting or light bleeding between menstrual periods.
ii. Missed periods or
iii. No periods.
These side effects are not dangerous.
Other points:
a) This method is very private. Other people cannot tell that a woman is using it.
b) The woman comes for an injection of Depo-Provera every 3 months. (There are other family planning injections which are taken one time a month or one time every 2 months).
c) This method can be used by a woman of any age, whether or not she has had children.
d) Safe to use during breastfeeding. A nursing mother can receive an injection six weeks after child birth.
e) After stopping injections most women will be fertile again within six months.
4. Implants (NORPLANT or NORPLANT 2)
Lasts for up to five years
Effective: Very effective.
Side effects: Safe for almost all women. Serious side effects are rare.
It is common for women to have:
i. Spotting or light bleeding between menstrual periods.
ii. Missed periods or
iii. No periods.

These side effects are not dangerous.
Other points:
a) Six (two in NORPLANT 2) small (matchstick)-size) soft plastic capsules which release Progestin are inserted under the skin of the woman’s upper inner arm. To provide this method a health worker must be specially trained and work in a clean setting. To remove the implants a health worker also requires special training.
b) The implant can be used by a woman of any age, whether or not she has had children.
c) Safe to use during breastfeeding. A nursing mother can receive the implant six weeks after childbirth.
d) The implants can stay in place and remain effective for up to five years.
e) A woman can have the implants whenever she wants. After they are removed she will be able to become pregnant again.

INTRAUTERINE METHODS OF FAMILY PLANNING
Intrauterine Device (IUD, IUCD, Coil, Sterilet)
Depending on type of device can last up to ten years
Types of IUD:
I. Copper –releasing (TCu-380A, Multi load)
II. Progestin releasing (Progestasert)
III. Inert plastic (Lippes loop)

Effectiveness; Very effective
Side effects: Some women experience heavier menstrual bleeding the first few months after insertion.
Other points:
a) The ‘TCu-380A’ IUD can remain in place and be effective for 10 years. A Multiload ‘MLCu-375’ IUD can remain in place and be effective for 6 years.
b) A woman can have her IUD removed whenever she wants. After it is removed she will be able to become pregnant again.
c) To provide this method, a health worker needs special training and a clean setting.
d) Can be inserted the first day after childbirth by a provider with additional special training. The IUD has no effect on breastfeeding.
e) This is NOT a good method for a woman who has a high risk of STD.