Inside Uganda’s Pandoras Box-Inhibitors of Low Contraceptive Prevalence in Uganda.

How I wish to walk from one village, to a town, a district to the capital in pursuit of creating awareness and advocating for realisation of Sexual and Reproductive Health and Rights. That is not it for now, but trust me to have a few relations of Ugandans both men and women in Kenya that are going to make this post a success. Contraceptive behaviour change in Uganda is scarce, yet it remains the epitome of high fertility, maternal and neonatal mortality rates in Africa. The prevalence of modern family planning is recommended as the most cost effective manner of combating population boom estimated at 46 million (World Bank, 2020). Only 30% of married women utilise modern contraceptives citing the role played by sociocultural inhibitors. Studies link sociocultural expectations and values attached to women, marriage and child bearing as a major hinderance in utilising modern contraception. This demographic boom has had notable development implications.

Insufficient information, societal attitudes and contraceptive change behaviour are burdening women with prevalent burdens

My view of modern contraceptive is a freedom to my opinions, liberty to life, period for child development, physical and mental health rejuvenation, a room for child-parent bonding. That’s not all, I got the perception of myriad non-health benefits from public and domestic decision making to participation, better education to women empowerment, economic growth to a sustainable population. These conclude to the fact that access to contraception is convenient and foolproof for family planning. Low prevalence of contraception in Uganda regardless of the rigorous efforts and continued strategies has become a matter of public health concern.

Choices to use contraceptives are influenced by cultural inhibitors, socioeconomic status, health status, personal aspirations &individual values.

Thou Shall Not -Religious Beliefs

Meet Geoffrey- a strong, hardworking, friendly father of nine. Works on a farm as a dairy cattle farm worker known in the neighbourhood as MuUganda wa Maziwa kwa Baiskeli. He has been delivering milk from one house to another for so many years. My elder son cannot pronounce his name at all, instead refers to him as girlfriend; you should hear him burst into laughter. Anyway, Geoffrey tells me contraceptive use in Uganda has not been low because of inaccessibility but also as a result of sociocultural inhibitors. I think of his eleven children, their age gaps and how he is managing life with what he calls meagre earnings.

Be fruitful and multiply and fill the earth, and…Genesis1:18. Some faithfuls have abided by this scripture when making contraceptive decisions.

My wife Grace, is a Catholic to the core. For her, children are gifts from God, each of them comes with a platter meaning God will cater for their needs. Remember according to the teachings we are taught to disconnect sex for intercourse from for conceiving or reproduction. She is an ardent believer that any modern contraception is the killing of innocent unborn children. I have my sexual needs, she is better positioned to manage the sex disconnection. It been unsuccessful, so, have such a big family that is not well taken care of. She started feeling the burden before the birth of the 6th born, it was too late. She insists on “we can use the natural methods such as abstinence, withdraw or rhyme and body function. Too much try and error; honestly, these are really hard work. This is one of the reasons I left Uganda, because here I am assured of work and better pay.”

Low education levels and illiteracies

I had known Grace for almost two years before she returned to Uganda. We had our many chit-chats on this and that. Grace never sat in nobody’s classroom and poverty really affected how she made her decisions. Grace for instance argued that modern contraceptives are foreign, and she has heard lot of their side effects such as she will be too wet or dry to satisfy her husband sexually, women who use modern contraceptives birth unhealthy children or contraceptives are bad for women’s health such as destroying the womb. “Contraceptive is also a concern for men, I have a friend who is constantly beaten by husband citing she is unfaithful because she does not get pregnant for other men as much as she cheats”. Grace exclaimed.

I wonder why its women carrying the heavier burden of contraception than men. Engaging both men and women in family planning outreach and service/programs is significant for normalizing the concept of men as users and advocates of contraceptive adherence. Consequently, education is key on how women and men reach to such a decision.Under the most likely scenario is how do they get the information, say, from the local media, health care facilities or community organization. What do they do with it? How accessible are the services, and do they have the knowledge to make contraceptive decisions? Are both men and women empowered to have a discussion with healthcare givers in case of side effects, a change of choice , misinformation, ideal family size? Are they bold enough to challenge gendered norms that stem inequality? Think of the deliberations on different gender sexual needs that are mostly perceptions.

Utilising contraceptives alleviates maternal&neonatal deaths, unintended pregnancies, unintended births, unsafe abortion, postpartum depression, strained resources, distructed curriculums, population growth, economic stagnation…

Hustle and Bustle -Occupation

Mary was my house assistant for over six months and a mother of two children who she had left in Mbale-Uganda after a separation with her husband. Here is a story, “not every woman in Uganda has many children. Women with good jobs or those working away from home are able to have a small neat family and decide when to have the next baby, if at all. A working woman do not want to have a baby without proper arrangement with her employer for the fear of disabling her work. I guess most of them also are more career oriented than child bearing. Maybe, they also have a lot of information shared amongst themselves that help them settle on the best contraception method. Again, rural areas are away from the capital city and towns where information and services are easily reachable. This is a hurdle for many women in the villages, sometimes they don’t have fare or money to pay for the services. Also there is a lot of work in the house or farms”.

Exploring the gaps between women’s socioeconomic variables and contraceptive should be top priority towards access

The UGX- Cost Factor

“For a fact, the cost of available contraceptives for Ugandan women is a hindering factor. Most married women even those who are low income earners or have no income opt for long-term family planning methods. You see, a 3months injection cost up to 3,000-10,000 UGX, the Intra-Uterine device (IUD) costs between 50, 000-80,000 UGX and Depo-Provera is roughly . This rates are are unaffordable. Some Districts such as Soroti have highest concentration of people living below the poverty line, and have recorded zero progress for almost two decades. This is not just a manifestation of poverty, women in Soroti are not just poor; they lack basic education, are primitive pastoralists whose large families are vulnerable to dysentery, malaria, HIV&AIDS, bandits attacks and cattle rustling that was once a cultural practices but now a deadly organised crime.

Condom and pills are more utilised because they are not only cheap but also given for free by the government and Non-Government Organizations. Men want to forego condoms because of myths such as a condom can disappear into a woman’s vagina to her stomach or condoms interferes with the sexual pleasures, lowers libido and causes impotence. Some men also complain of not finding the correct size of condoms because their penis are too big or condoms are best for those with more than one sexual partner”. Mary explained. It is noteworthy that condoms are best family planning method, they are a perfect barrier for pregnancy and sexually transmitted diseases. More so, condoms are convenient for unmarried couples who have not started having babies yet. Slipping or tearing of a condom is a result of incorrect use. Lastly, condoms sizes are available for all penis sizes, should be tight but not uncomfortable.

Cultural Norms- Does She…Does Not?

Both men and women are responsible for family planning. The variety of birth control ranges from natural practices, devices (condoms, sponges, diaphragm and cervical cups), injections, and pharmacuetical types (Pills,intrauterine devices and vagina rings among others).

Non comformity with ones cultural norms in most African societies means wrestling with trouble, from ostracisation, stigma to curses. Thus, it should not sound absurd if Ugandan women tell you she is not utilizing contraceptives for cultural reasons. While cultural beliefs and practices are they are not per se a hinderance to modern contraceptives, some sorrounding conditions force women to underutilise modern contraceptives. Such are competition amongst co-wives, few to no boy child sired. This aspect is still affecting even the modern-day parents. Women give birth continuously in ‘search’ of a boy child who should be the husband’s heir. Extending the family lineage- according to Ugandan traditional societies a woman should have many children so that the lineage is bigger. It also shows she valued her dowry, is submissive, loving and respective to the husband. Failure to this, a woman is sent back to her parents home, given undesirable names or the dowry is returned.

Culture has a lot to do with utilising modern contraceptives especially among the illiterates, marginalised and families in rural areas.

Replacement of the dead-this is seen in communities that name their new born after a dead person in the family and is meant for clan’s continuity and existence. The births of twins meant that a woman should continue giving birth. It was obnoxious to have twins as last borns for some communities such as Mpigi District. Parents to twins are taken with lot f accord. Clan members organise for special cultural occasions characterised by dances, rhymes and provocative sex. This myth has been an obstacle to contraceptive use because most women feel they are coerced to having more children, while some women get unintended pregnancies during the mock events.

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