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July 05, 2012

Family Planning Faces Hurdles in Uganda

by Hilary Heuler

KANUNGU, Uganda — As world leaders prepare for this month’s Global Family Planning Summit in London, many developing countries are struggling to control their population growth. Local authorities say they are trying to bring down the birth rate for the sake of the country’s future.

Hight birth rate

Last year, Editha Tumwebaze became pregnant with her ninth child. In her village in the western part of Uganda, a country with the world’s second highest birth rate, her case is not unusual. The average Ugandan woman will give birth to about seven children during her lifetime.

But during the difficult delivery, Tumwebaze developed an obstetric fistula, a tear in the birth passage that has caused her to leak urine ever since.

​​She says that now she rarely leaves home because of her condition. Tumwebaze says her husband Wilson cannot look for work because he has to take care of her and the new baby.

Women's health

Wilson says women who have many children often develop medical problems.  If they had had access to family planning services, he says, they would not have had so many children.

This is something the Ugandan Ministry of Health and the United Nations Population Fund are working to change.

In the town of Kanungu, hundreds of women and a scattering of men gathered around a health clinic to learn about family planning methods. These “camps” are held several times a year.  And according to local doctor Seth Tibenda, they have been a resounding success.

“In April, we were overwhelmed," said Tibenda. "Very many people were turned back after the four-day camp, and we thought we would come back here and finish up those. Now those who are taking methods for controlling birth are many.”

Authorities in Kanungu say that because of this family planning drive, the size of families in the district has declined during the past decade. At about six children per woman, the birth rate is below the national average.

Family planning

On July 11, World Population Day, a global summit will be held in London to help raise awareness and money for family planning around the world.

Babatunde Osotimehin, executive director of the United Nations Population Fund, says high birth rates can take a serious toll on a country’s development and the lives of women.

“They have children that they cannot look after as well as they’d like to," said Osotimehin. "And in a good number of them [i.e., countries], they start having children early in life, so they are not as educated and as skilled as they probably would like to be. You would have intergenerational poverty in those kinds of circumstances. And that, of course, tells of the country itself, because the country would then have to provide infrastructure to sustain that population.”

Population growth

Uganda’s population is growing at more than 3 percent a year. The Ugandan government predicts that the population will likely triple by 2050 - from 34 million to more than 100 million people. The country’s public services are already struggling to keep up, says Jennifer Wanyana of the Ministry of Health.

“When you compare the population growth rate with the number of facilities that have been constructed, they are not proportional to the rate of growth," said Wanyana. "As for the health workers, the number of patients they have to attend to has grown. The supplies are not really as sufficient as they used to be.”

Access to family planning is not the only problem, says Wanyana, who adds that many Ugandans oppose contraception for cultural reasons or they associate family planning with promiscuity.  

Experts say that beliefs like this might be the most difficult challenge.

Niwagaba's story

​​Savio Niwagaba and his wife Chrisente were among those waiting for family planning counseling outside a Kanungu clinic last month. Chrisente says she was happy with the four children the couple already had, but that Niwagaba wanted to have more.

Niwagaba says his father died before he could have more than three children, and that neighbors looked down on his family as being small and weak. He says that even if he cannot afford to educate his children, a big family is a strong family. Niwagaba adds that if Chrisente does not agree to have more children, he will leave her and marry another woman.

After counseling, Niwagaba eventually agreed to allow Chrisente to receive a three-year contraceptive implant inserted under the skin of her arm - a procedure that took only five minutes.

Niwagaba might still find another wife, but Chrisente says she is prepared to take that risk. With or without her husband’s help, Chrisente says she is determined to have only as many children as she can support.

Local authorities say they hope more Ugandan women will be able to make the same decision.