Family planning advocates in Uganda have scored some major financial and policy wins this year, but experts remain concerned that inadequate political commitment and poor health services will continue to impede women’s and girls’ access to contraceptives.
At a global family planning summit in July, Uganda's President Yoweri Museveni announced that his government would increase its annual expenditure on family planning supplies from US$3.3million to $5million for the next five years. He also pledged to mobilize an additional $5 million from the country's donors.
"Efforts will be placed on creating an enabling policy environment to allow women to exercise family planning choices, increasing financial investment in health, human resource development and management, increasing commodities and supplies and effective delivery to reduce stock-outs," Christine Ondoa, Uganda's Health Minister, told IRIN. "These proposed investments in health and family planning will significantly reduce maternal mortality, child mortality, and... accelerate Uganda's progress towards the Millennium Development Goals and middle-income country status."
With an annual growth rate of 3.4 percent, Uganda has one of the world’s fastest growing populations, and experts say the country’s public services are unable to cope.
In response, the Ministry of Health has laid out a roadmap for providing universal access to family planning, involving the integration of family planning into other health services. The government plans to reduce the 'unmet need' for family planning from 40 percent to 10 percent by 2022; women are considered to have an unmet need if they wish to space their children’s births or limit childbearing but are not using contraception.
Although almost all adults in Uganda can name one method of family planning, just 30 percent of married women of reproductive age use any form of contraception, according to the 2011 Demographic and Health Survey.
A need for change
Experts have welcomed the new funding and the government's apparent enthusiasm, but say the promises must be met with real changes, at both the political and the health facility level.
"The top leadership - political and cultural leaders - in this country have caused confusion. President Yoweri Museveni says he does not see population explosion as a problem. He thinks the problem is under-development. He says a big population is a good market," said Michale Bayiga lulume, the opposition's shadow health minister.
"These pronouncements are encouragement for people to produce as many children as possible," he added.
The country's health services, already overburdened, are struggling to meet the demands of a rapidly growing population. The average Ugandan woman will have six children in her lifetime, while an estimated 16 women die in childbirth every day, according to statistics from the Ministry of Health. Experts are concerned that the new policies and funding may encounter hurdles at health centres.
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"I think what is weak is the unfriendly environment at the service delivery points. The policy environment is supportive, but service delivery needs to be strengthened through training, monitoring of policy and service delivery," Robina Biteyi, national coordinator of the Uganda chapter of the White Ribbon Alliance for Safe Motherhood, told IRIN.
The need for contraception is particularly high among teenagers - one in four girls will give birth before the age of 19.
"We must increase contraception services to teenagers. It's only at 11 percent," said Anne Alan Sizomu, advocacy officer for the development NGO Deutsche Stiftung Weltbevoelkerung. "They should increase the number of service provides across the country and recruit more personnel to offer these valuable services to women and teenager girls... Let's aim at those who want and are unable to access."
Members of parliament also recently rejected an attempt by the Ministry of Finance to subject health commodities - including condoms and other contraceptives - to 18 percent value-added tax and 6 percent withholding tax.
"Why tax family planning commodities? They play a key role in combating HIV and controlling maternal deaths. The government needs to waive taxes on these commodities," said Chris Baryomunsi, a legislator on health, HIV and social services parliamentary committees, told IRIN.
According to government officials, the uptake of family planning services is increasing, albeit slowly.
"The good news is that more women are accepting modern family planning methods," Betty Kyaddondo, head of the family health department in Uganda’s Population Secretariat, at the Ministry of Finance, Planning and Economic Development, told IRIN. "There is now a shift from short-term to long-term family planning methods. Women are moving from pills and injectables to implants and IUDs [intrauterine devices].
"We need to bring men on board to support their women in this effort. The women are secretly going for these services because their men don’t support contraceptives," she added.