What do Ugandan women want?

If you’re hoping to hear all about their secret dreams – I am sorry to disappoint! In this post I’d like to touch upon a very important in the communities I work with but not only – it touches majority of developing countries. The world’s population is still growing. Nearly all of this growth is concentrated in the developing nations of the world. I’ve read recently that the average number of children in Sub-Saharan Africa is around 6.5 births per woman.

The benefits of planned and/or spaced births are countless: better child’s nutrition, more years of schooling, less maternal deaths. Many women that I talked to want to at least have more years in between ‘producing’ children (an expression widely used for giving birth) or wants to stop having them all together. When most of men desire nearly three times as many additional children as their wives and possess most of the decision-making power in the household you can imagine what outcome this produces. To name a few: excess fertility and worse health for women.

I was intrigued reading a World Bank’s guest post written by Aine McCarthy on the spousal intricacies in family planning. In her research in northern Tanzania, which has a fertility rate of 8.1 births per women, women, on average report desiring an additional 1.4 children and men report desiring an additional 4.5 children. Women also report avoiding contraception due to their husbands’ desires. Interestingly, women who consulted with the community health worker alone reduced their pregnancies by 16 percentage points (relative to the control group), while women in the couple’s treatment group did not significantly reduce pregnancies. This can be down to the former group likely taking advantage of the private information about contraceptive options and, most probably, they may be using contraception discretely.

Where I currently work in Uganda, I have come across only those women who had support and encouragement from their husbands to take up contraception (most likely an implant for 3 years) or to at least space out births. However, most of them already have on average 4 children. The contraception is free and can be obtained in local health clinic and to take it out earlier than necessary (in the case of implant) woman has to pay money. So the incentive is to keep it until it needs changing. Simple and it works.

In 2012, the United Nations declared access to contraception to be a “universal human right.” It doesn’t look like this right is being realised for millions of women around the world which has serious consequences for women in developing nations. No doubt, the success of family planning programs depends on many factors, including strong political net, well-designed and implemented programs, adaptation to local conditions, and adequate funding. There are many challenges ahead to support the nations with unmet needs in family planning. Sustainability is another major issue. Programs might need to develop more diverse sources of funding and possibly charge a small fee from consumers so that they continue to become easily available.

What we take for granted in our big rock is quite often the opposite in this part of the world. We just need to remember that.

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