Women with unmet need are broadly defined as those who want to postpone their next birth for two years+, or not have any more children, but they are not using contraception.
Living in the UK for the past 9 years, access to contraception and sexual health clinics wasn’t something I thought twice about. It was always close by places I lived and the services were free of charge. I could consult my GP or indeed get all the suite of services at the sexual health clinic. While I was aware of the high fertility rates and difficulties in accessing family planning services in developing countries, living in Uganda has made me fiercely aware of the magnitude of this problem. I have also touched this subject previously in my post what do Ugandan women want?
Unintended pregnancy is common in Africa and Uganda isn’t an exception. This leads to high levels of unplanned births, unsafe abortions, and maternal injury and death. As high as 4 out of 10 pregnancies here are unplanned and Ugandan women, on average, give birth to nearly two children more than they want (6.2 vs. 4.5). This difference—which represents one of the highest levels of excess fertility in Sub-Saharan Africa—illustrates just how difficult it is for women to meet their fertility desires. As you can imagine the level of unmet needs is much higher in rural areas than urban areas. Given 84% of the population lives rurally.. well, you get the picture.
Another grim statistics regarding unmet needs: about 56% of Uganda’s population is below 18 years of age and 70% below the age of 24 years. Teenage girls constitute the largest proportion of these age categories. Sadly, only 11% of them have access to reproductive health information, services and family planning services.
Teenage pregnancy is not just a health issue, it is a development issue. Why? When girls marry and have babies young, they drop out of school. The result is poor health, lost potential, lack of opportunities and often poverty.
Given such a high ration of unintended & teen pregnancies: why is the contraception use so low?
The reasons are many. Lack of access to family planning services and information is often a barrier—especially for rural women. Often, the male partner is against his wife/girlfriend using contraceptive (read a bit more on spousal intricacies in family planning in my previous post). Some believe that contraceptives can cause health problems, such as infertility and cancer, while others felt that contraceptive use might cause women to have extramarital affairs. We also shouldn’t forget the stigma around sex outside marriage often for religious and cultural reasons.
There’s a lot to be done in the sphere of reproductive health and family planning in developing countries. First and foremost we should dig deep (data!) and understand the key causes and problems in a given country to better tailor aid programs.
Some of the crucial next steps to be taken in Uganda and beyond:
- EDUCATION and once again EDUCATION – a fundamental and most crucial aspect in preventing teen and adult unwanted pregnancies. Not only sexual and health education but education from the early age as a whole. The more educated the girls are, the more likely it is they’ll take informed choices about their lives.
- We’re not talking about just the girls: we should reach out to women and their partners at multiple stages in their reproductive lives to better satisfy changing needs.
- Making family planning priority for the government: it 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.
- The quality of post-abortion care services needs to be improved, and the scope of such services needs to be expanded.
- Let’s not stop only at that – we got to seize the opportunities. Child survival programs, community health programs, and HIV services among others should also be integrated as a all-round service available to women.
I support the work of Family Planning 2020 – a global movement that supports the rights of women and girls to decide – freely and for themselves – whether, when and how many children they want to have. Access to family planning should be a basic human right.