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Family Planning: the right to health for all women/girls

A mother rises up her baby to the attention of this reporter at Kiwata in Bugobero sub-county, Manafwa district (PHOTO /Courtesy)

MBALE —A picture of a haggard mother rising up her baby to my attention at Kiwata village, Bugobero sub-county in Manafwa district brought tears to my eyes.

Olivia Wakooli, 29, a mother of six who looks frail seems to be getting weaker every day but says she is well with a twinge of poverty and sadness written on her face.

She has six children but needs a quality life for herself and her children because she can no longer support them in these hard economic times.

Wakooli says her husband has abandoned them to take to drinking, with other women and only comes back at night to demand more children; “I was born alone, I need more children, God will take care of them up,” the husband reportedly reasons.

“My elder children are not at school because they have to wake up to go and work for people to earn a living, it is a sad situation and my husband just comes back at night,” said Wakhooli before breaking down into tears.

Wakooli is married in the rural area of the Bugisu sub-region where the number of children a man has is an indicator of his wealth and where it is taboo for a woman to talk about family planning.

But the overburdened mother made a decision to use contraceptives. She approached her mother and her mother-in-law and confided in them that she would seek family planning services in order to have a manageable family.

She made this deal with her mother-in-law that she would not continue having more children when her husband no longer provided for the family and so “I want to focus on raising the six” added Wakhooli.

But her mother-in-law leaked the secret o the husband and the man gave her two options: Adopt family planning and quit the marriage or continue giving birth and remain his wife. She chose to remain.

Wakooli is not alone, there are many women, whose access to family planning has been denied, especially in rural areas, many are struggling to raise children on their own while husbands have taken to drinking alcohol and only come back at night to sleep.

Many of these women in rural areas in the Bugisu sub-region have lost their bid to plan for unmanageable families.

And despite the poverty around them, they continue giving birth in silence, this is either due to ignorance, retrogressive cultural practices that shun family planning, or, most, unfortunately, lack of access to family planning.

CONTRACEPTIVE

Dr Jonathan Wangisi, the DHO Mbale says that there really should be no reason for anyone, woman or man, not to access contraceptives in this day and age.

He explained that it is the duty of medical workers to ensure that every woman is empowered to plan her family, and life, through family planning if she wants it.

“There should be no debate about whether to go for family planning or not because access to this is for the well-being of women and girls. Ugandan women and their partners have to access sexual and reproductive health services to have the families that they will manage,” said Dr Wangisi.

He added that men especially in rural areas should know that family planning is a woman’s reproductive health right that must be respected.

Dr Muhammad Mulongo, a gynecologist said studies have shown that access to sexual and reproductive health services, including family planning, helps in cutting maternal and child deaths, eases the burden of post-abortion care as well as new HIV and STI infections.

He added that for the sake of Ugandans, especially the underserved, remote, and low-income communities, it is important that the government directs more investment to sexual and reproductive health services.

According to Dr Mulongo, the fundamental right of individuals to decide, freely and for themselves, whether, when, and how many children to have is central to the vision and goals of Family Planning 2020 (FP2020)

The international community also agrees that the right to health includes the right to control one’s health and body, including sexual and reproductive freedom.

A report released by the United Nations Population Fund (UNFPA) titled “The Power of Choice: Reproductive Rights and the Demographic Transition 2018.” Indicates that family size is closely linked with reproductive rights, which, in turn, are tied to many other rights, including the right to adequate health, education, and jobs.

The report reveals that more than 28% of the women in Uganda have an unmet need for family planning services and that because of this unmet family planning need, Ugandans are having more children than they want.

The 2011 Uganda Demographic and Health Survey (DHS) reveals that more than four in 10 births are unplanned and the figures from the Uganda Bureau of Statistics (UBOS) show that Ugandan women, on average, give birth to nearly two children more than they want (5.4 vs. 4.2).

It is clear that such grim figures can be avoided if women like Ms Wakhooli were free to decide on the number and spacing of their children.

Dr Mulongo said educating people on having manageable families will deter them from having big families that they can’t manage.

He explained that the government in order to reduce the problem of teenage pregnancies affecting most parts of the country must also allow girls to freely and openly access family planning information to help them make better decisions later in life.

Dr Mulongo revealed that globally, the health community has recognised the importance of contraception in reducing the burden of unplanned pregnancies, encouraging smaller families, and empowering women as a move to sustainable development in developing countries.

He added that Research shows there are significantly positive links between contraception and maternal and child survival, household well-being and women reaching their career goals and participating in nation-building.

The doctors revealed that there was a need for political will to not only empower women, girls and the youth to access their sexual and reproductive health rights but to also invest in family planning.

“This includes access to information, policies, and services that prevent unplanned pregnancies and to have a say on the number of children to have, how to space them and when to have a child,” said Dr Mulongo.

According to a paper published by www.ncbi.nlm.nih.gov/pmc/articles/ on obstacles to family planning use among rural says, more than 50 percent of women are scared of discussing family planning issues with their husbands and even their mothers-in-law.

According to o RHU, contraception, or family planning, allows women, men, and couples to choose if and when to have children by way of voluntarily and intentionally delaying, spacing, or limiting pregnancies

RHU Projects Officer Mr Nathan Tumuhamye said they found that most of the men do not want their women to use family planning methods, blaming it on misconceptions such as over bleeding. Consequently, many men are more comfortable discussing FP issues with their male peers.

Mr Joseph Waninda, a behavior Change Communication specialist says in Uganda contraceptive use is still low at only 24 percent and that there is a high unmet need of 41 percent, meaning one in four women don’t want to get pregnant but lack access to family planning services and information, and nearly half of the poorest women say their most recent pregnancy was unplanned.

Ms Waninda says more remains to be done to ensure that human rights are in fact treated as the cornerstone of any family planning effort: from global initiatives to national programs to community-based projects.

The AFP advance family planning magazine by John Hopkins Bloomberg School of public health published in 2017 says 28% of Ugandan women have an unmet need for family planning, a decline from 34% in 2011.

Dr Gideon Wamasebu, the former DHO Manafwa [now retired] says that one-third of adolescents (15-19)—and women ages 40-44—have an unmet need, compared to about 36 percent of women between the ages of 20 and 39.

FAMILY PLANNING

Dr Wangisi says the government must take the lead in removing barriers to empowerment, education, and progress of women and girls in rural areas like Wakooli.

“Let all know that family planning not only prevents unwanted pregnancies but also protects mothers’ and children’s lives,” said Dr Wangisi.

The Country Representative of UNFPA Mr Alain Sibenaler, while speaking to PML Daily said the population in Uganda can be reversed if family planning services are made available and women are empowered to make choices.

“In Uganda, there is a very clear indication that there is an unmet need for family planning methods. That means people would want to have contraception but they don’t have access to it and thus end up with more children than they wanted,” Mr Sibenaler said.

While launching Uganda’s Family Planning Costed Implementation Plan, 2015–2020 (FP-CIP), the minister of state for health [General duties] then Ms Sarah Opendi said the Government is committed to scaling-up family planning programs to create demand, especially in hard to reach areas like Karamoja.

She revealed that in 2017 the government revised its original commitment of 2012 to reduce the unmet need among adolescents from 30.4% in 2016 to 25% in 2021.

She added that such grim figures can be avoided if women are free to decide on the number and spacing of their children. That is why propagandists, hypocrites, busybodies, and self-seeking politicians who seek to dictate to women what to do with their bodies must be called out.

Ms Opendi explained that by improving the number of health structures in hard-to-reach places, the Government of Uganda strives to expand its reach and provision of services and method mix, including long-acting, reversible, and permanent methods.

“And all these commitments will contribute to the nation’s ambitious goal to reduce unmet need for family planning to 10% and increase the modern contraceptive prevalence rate to 50% by 2020,” said Ms Opendi.

Reports from the ministry of health also indicate that the Government is planning to scale-up access to family planning services up to at least 50% as one way of improving the quality of the Ugandan population and reducing unwanted pregnancies.

“Family planning is essential to achieving all of the Millennium Development Goals and among the core issues discussed that deserve the greatest attention are policies that address unmet contraceptive needs; consistent and correct contraceptive use; contraceptive technology that makes adherence easy and cost-effective; and increased service delivery so that all who wish to receive FP have access to it.

About Family planning;

Family planning is the practice of controlling the number of children one has and the intervals between births, particularly by means of contraception or voluntary sterilization.

Family planning methods include; the use of condoms, diaphragm, contraceptive pills, implants, IUDs (intrauterine devices), sterilization, and the morning-after pill.

The benefits of contraception

-Contraception is more than fertility control. It empowers couples and women to take charge of their fertility and to decide and schedule the number of children they have.

-This not only has far-reaching benefits for individuals and couples, it also impacts their households, communities, and society at large.

-A review of the socio-economic benefits of contraception also shows it benefits men as it gives them more disposable income, allows better health outcomes for their households, mothers, wives, and colleagues, and results in more satisfying and longer-lasting relationships with their partners.

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