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  • Title: The realities of unmet need in Uganda.
    Author: Okwero M, Ssempebwa B, Okwero P, Kipp W.
    Journal: Plan Parent Chall; 1994; (1):17-9. PubMed ID: 12345733.
    Abstract:
    Family planning (FP) was introduced in Uganda in 1957, but Uganda's birth rate of 52/1000 remains among the highest in the world, and the average age at marriage remains low. However, the 1988-89 Demographic and Health Survey revealed that 20% of women want to space births and 7% to limit family size. Therefore, a program was started in 1991 in a rural area of western Uganda where FP services had been provided only at a clinic and 2 government hospitals in district towns and at a few health centers. 67% of sampled women wanted FP services, but 52% had no idea where to go for them. In order to increase FP accessibility and acceptability, the program attempted to 1) provide services in each of the district health units and train all levels of health unit staff in FP, 2) establish community-based distribution (CBD), 3) mobilize the community through the provision of information and education, and 4) provide FP services through private clinics. Problems encountered in the health units included a shortage of midwives to be trained which necessitated training of nurses and nurse-aides, the reluctance of health workers to integrate FP services into their work load, the tendency of health workers to emphasize FP risks instead of benefits, and inadequate support supervision. These problems are being addressed, and the number of units offering FP services has increased to 41/51. CBD was instituted in 1992, and initial efforts were strengthened by the development of Ministry of Health guidelines, extending the training period, improving supervision, and providing better renumeration for distributors. By the end of 1993, the CBD program served 27% of acceptors. Community mobilization has been difficult due to the opposition to FP on the part of some religious and community leaders and because of a lack of appropriate women's groups to target for peer education. School-based education has also been stymied by the opposition of parents and teachers. Finally, only a few private clinics are offering FP services because of the constraints imposed by record-keeping requirements and because of the small profit margin involved in the sale of contraceptives. Although the program has increased the contraceptive prevalence rate from 1 to 7.5%, several challenges remain including developing a viable remunerative strategy for CBDs, devising ways to reach women and youth, promoting FP in the community, and developing collaborative strategies with the private sector.
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