By Exposed Uganda
Reproductive Health experts warn that the Contraceptive Prevalence Rate (CPR) in Uganda, especially amongst women, is taking a nose dive, after most losing trust in several contraceptives.
Contraceptive prevalence rate is the percentage of women who are practicing, or whose sexual partners are practicing, any form of contraception. It is usually measured for women ages 15-49 who are married or in union.
The matter has been worsened by the ongoing case against Life Guard condoms, which was filed by some consumers who suffered unwanted repercussions after using the condoms.
Condom brands like Life Guard, which are supposed to be the primary contraceptive measures for couples, often turn out to be faulty by breaking or leaking during sex, which often ends up in unexpected circumstances like unwanted pregnancies or infection with STDs.
This has brought about a sense of lack of faith in condoms amongst the youth, which makes them feel as if it is useless whether they use protection or not, because after all the condoms will either break, tear or leak.
The Contraceptive prevalence, any methods (% of women ages 15-49) in Uganda was reported at 41.8 % in 2018, according to the World Bank collection of development indicators, compiled from officially recognized sources.
But recent reports indicate that Uganda’s CPR has since reduced from 2018 and by the end of 2019 it has dwindled by a considerable percentage.
This is however attributed to several factors and chief among these are the following;
The Defective Lifeguard Condoms
Uganda has of recent registered several cases of defective condoms, yet they the primary contraceptive measures amongst both married and unmarried couples.
The latest study case is the defective Lifeguard condoms, thousands of which were called off the market by the Ministry of Health and National Drug Authority (NDA) early this year, after consumers complained about them being defective, whereby many people whose used them ended up with unwanted pregnancies while others complained of having contracted Sexually Transmitted Diseases(STDs).
For that reason, whereas Life Guard condoms and their distributors Marie Stopes have since been dragged to court over the matter, several youth who would have looked up to condoms as the primary contraceptive measures are increasingly shunning the rubbers, after losing trust in them.
Biased Religious Teachings
Reproductive Health experts contend that religious teachings against the use of condoms, pills and other contraceptive measures has over the years contributed to reduced CPR among Ugandans, especially adolescent girls and young women. This is because some religions vehemently condemn the use of contraception to the extent that they liken it to a grave sin punishable by God.
Most religions also teach against contraceptive measures like Safe Abortion, which has led to an increased number of women carrying unwanted pregnancies, which in most cases forces them to dump babies ta garbage bins, in toilets or bushes.
Teachings in some religious books like ‘Go forth, produce and fill the word’ have been misconstrued by some men mean that they are supposed reproduced children with their women year to year, even when it is against the women’s wish conceive.
According to the 2011 Uganda Demographic and Health Survey (DHS), more than four in 10 births are unplanned.
Experts also reveal that there are some cultural norms and practices that discourage youth from seeking contraceptive measures.
There are for instance cultures which teach that it is an abomination and a curse of the family to use contraception of any kind, including condoms.
There are also cultural practices that like Female Genital Mutilation (FGM) that make it impossible for women to use some contraceptive measures.
Researchers contend that as a result of reducing CPR, unwanted pregnancy is common in Uganda, which leads to high levels of unplanned births, unsafe abortion, and maternal injury and death.
Lack Of Accessibility
It should be noted that Ugandan women who belong to socioeconomic and demographic backgrounds experience unintended pregnancies, and thus have abortions. Their experiences, however, vary considerably.
Compared with their poorer counterparts, women who are well off generally have access to a wider range of providers, and are more likely to be able to visit doctors, nurses and clinical officers, some of whom may be trained and able to provide safe contraceptive procedures.
But poor and rural women, whose access to skilled health service providers is limited by financial constraints and geographic distance of services, often must resort to obtaining abortions performed by untrained providers using unsafe methods or attempting to self-induce an abortion.
The situation has since been worsened by the COVID-19 pandemic, which not only worsened the poverty levels but also made movement to and from Family Planning service providers more difficult.
In 2010, the Ugandan Ministry of Health estimated that unsafe abortion accounted for 8% of the country’s maternal deaths.
The high levels of unintended pregnancy and unplanned births in Uganda can be attributed primarily to nonuse of contraceptives by women who do not want a child soon, according to reproductive health experts at the Ministry.
Information from the Ministry indicates that married women’s use of modern contraceptives has increased significantly since 2000, nearly doubling (from 18% to 26%) between 2000 and 2011. However, modern contraceptive use remains too low to address the high rate of unintended pregnancy.
During the same time period, contraceptive use among sexually active unmarried women did not change—44% were using a modern contraceptive method in 2000, and the same proportion was doing so in 2011
However, use of modern methods varies greatly according to women’s social and economic status. In 2011, only 13–16% of Uganda’s poorest and least educated married women used modern contraceptives, compared with 38–39% of the wealthiest and most educated women. A greater proportion of urban married women used modern contraceptives compared to their rural counterparts (39% vs. 23%).1
High Need For Contraceptives
In 2011, the proportion of married women who had an unmet need for modern contraception—that is, they did not want a child soon or wanted to stop childbearing altogether, but were either not practicing contraception or were using a traditional method—was one in three, among the highest levels in Sub-Saharan Africa.
Despite their higher levels of contraceptive use, sexually active unmarried women have even higher levels of unmet need for modern contraception (43%) than do married women (34%), which may reflect unmarried women’s stronger motivation to avoid pregnancy.
Unmet need is higher among rural, less educated and poor women than among women who live in urban areas, have at least a secondary education or are better off economically, respectively, hence the need for the government to step in through the Ministry of Health to close this gap.
There are many reasons why women do not use contraceptives. Lack of access to family planning services and information is often a barrier—rural women with unmet need for contraception are more than twice as likely as their urban counterparts to cite lack of access as a reason for not using contraceptives.
It most cases, male partners also may influence whether a woman will practice contraception or not. One qualitative study found that some Ugandan men believed that contraceptives can cause health problems, such as infertility and cancer, while others felt that contraceptive use might cause women to have extramarital affairs, hence they don’t women to use them.
Lack Of Sensitization
The study also found that among sexually active married women, commonly cited reasons for not using contraceptives include personal or partner opposition to use (27%), breastfeeding or having recently given birth (26%) and concern about side effects or inconvenience (40%).
These reasons suggest that many women lack accurate information about family planning, including its mechanisms of action, safety, side effects, efficacy and ease of use, hence health workers need to come in and sensitize them about them.
Lack of availability of a range of contraceptive methods, or of any at all, also makes it difficult for a woman to use a method continuously and to obtain a method that is appropriate to her needs.
One of the most common reasons that unmarried, sexually active 15–24-year-old women cite for not using a method is that they are not married, which underscores the impact of the stigma surrounding sex outside of marriage.9
But all the above notwithstanding , it should be noted that according to a 2009 study by the Guttmacher Institute, contraceptive use in Uganda averts approximately 490,000 unintended pregnancies and 150,000 induced abortions each year, hence it is vital if the country is to achieve the Vision 2040 Middles Income status.
According to the 2009 study, the cost of providing pregnancy-related medical care would fall by US$81 million if just half of unmet need for modern contraception were met. It would decline by US$162 million if all unmet need were eliminated.
This means that for every additional dollar spent providing family planning services in Uganda, more than three dollars would be saved in pregnancy-related medical care.
The cost of providing postabortion medical care is five times the average annual cost of providing modern contraceptive services.
In addition to the financial savings, significant societal benefits would also result if all women had the ability to plan and space their pregnancies as desired. For example, women’s educational opportunities, as well as their ability to enter the workforce and thus contribute to family income, would be enhanced.
It is thus apt to note that eliminating barriers to family planning services will reduce unmet need for contraception. The government should ensure that free or affordable public-sector contraceptive services reach all women, especially those who are poor, are young or live in rural areas.
Policies and programs should prioritize youth-friendly services that offer confidential reproductive health counseling and information as well as provision of family planning methods.
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