Family planning must go beyond regular systems to reach women

In Uganda, women give birth to an average of six children. James Kityo reports on different attitudes and opinions that prevent family planning.

In Uganda, statistics show that women give birth to an average of six children. The country’s population is now clocking 34 million and it is one of the fastest growing populations in the world.

This almost supersonic birth rate gives a glimpse of the burden of child bearing for Ugandan women. And it indicates the challenges they face in accessing contraceptives and family planning services.

I recently met two people, a man and a woman, from completely different economic backgrounds, who told me about their opinions on family planning.

Husband refuses access to contraceptives

The man said: “I have deliberately forbidden my wife from taking famile.” Famile is how family planning is locally known in Uganda among people who have not been formally educated. This attitude is not surprising, as the man lives in Bwaise, a suburban area known for low levels of education and economic hardship. But what is most amazing are the reasons he gives for not allowing his wife to use contraceptives.

He said: “That would necessitate me marrying another woman. I hear that when a woman is put on famile she stops having sex. I cannot stay with a woman who cannot play sex. Much as I would not like to have more children – seven children are already so many, I still need sex in my life.”

This is a view I had never heard from any one. It makes me wonder how many men in this part of town see family planning and contraceptives as an avenue for women to deny them sex.

Gender relations and family planning

The woman I met is a secondary school teacher and a mother of two. Her husband is a project officer. When she recently enrolled at university her husband threw away all her contraceptives. The order was simple: “Get pregnant and produce a child.”

She was facing a hard time deciding on this issue, considering that she periodically travels about 200 kilometres from Western Uganda to Kampala to attend lectures at Makerere University. But it was clear that she was close to submission, she said: “Let me succumb and produce a child for this man who married me, I have no choice at the moment.”

These scenarios present two issues: one is ignorance of what family planning and contraceptives are all about and the second is women submitting to men because they feel powerless.

Women’s right to contraceptives

African men seem to wield a lot of power on women but it is important to show women that much as they are married, they have their own rights. They have the right to say, “If you throw away my pills, I am going to have them again or I shall go and have an injectable contraceptive.” Of course that is easier said than done and I do not seem to see this with most rural Ugandan women.
Men should be educated to understand family planning and to recognise women are individuals like them, who have right to decide and choose. Although men still pay a bride price to the woman’s family, she needs to remain in control of her own body.

Family planning education in schools

I propose that family planning be initiated in all schools, especially for girls. This would involve working with school matrons and female teachers to ensure extensive family planning education is conducted and emergency contraceptives are provided for girls who need them.

I am being modestly Ugandan here and suggesting this education is started in secondary schools, although really primary schools would be the best place to begin as Ugandan girls are already sexually active from the age of 12-15. Currently in Uganda no comprehensive contraceptive provision is available for teenage girls even in colleges, universities and technical colleges.

I would also target women with contraceptive advice after birth, while they are still at the health facility. This approach is plausible, since it would involve women more than the men. A similar approach is currently being used in testing pregnant women for HIV and enrolling them on an appropriate program for antiretroviral therapy. This strategy brings the men on board at a later stage.

Saving women’s lives

Unfortunately, when men feel their wives are not listening to them, they resort to having many sexual partners, whom they believe are more submissive. Of course, the more sexual partners, the more risk of HIV and unplanned children.

Since we are looking at contraceptive with a functional use as that served by vaccines, all avenues should be explored in ensuring women get the awareness and contraceptive supplies that will save their lives.