Unmet need for family planning in Uganda is third highest in world

Submitted by Kintu about 3 months ago

The quality of antenatal care (ANC) is poor because health facilities are short of supplies. The Sexual and Reproductive Health Policy Guidelines for Uganda recommend that women visiting health centers for ANC receive, among other things, supplements of iron and drugs for intestinal parasites, are weighed, their blood pressure measured and urine and blood samples analyzed.

Many women do not get this minimum package because they cannot afford it or because supplies are simply not available. For instance, only about half of pregnant women (51%) receive the recommended two tetanus toxoid (TT) immunizations. Essentially, ANC services are below standard.

Reproductive health care is vital for improving the well-being of men and women and achieving development. The use of modern contraceptives, for example, helps couples avoid unintended pregnancies and protects both the mother and child’s health. Other reproductive health care helps women have healthy pregnancies and helps protect people against sexually transmitted infections (STIs) and HIV/AIDS.

The links between reproductive health and socio-economic development were first clarified at the landmark International COnference on Population and Development (ICPD) held in Cairo in 1994 and have since been cited by the UN and World Bank.

The ICPD programme of action made reproductive and sexual rights a priority and explicitly stated that it is the right of all men and women to be “informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, as well as other methods of choice for regulation of fertility, which are not against the law,” and that they have “the right of access to health care services that will enable women to go safely through pregnancy and childbirth.”

In addition, national legal instruments and policies oblige the state of Uganda to ensure all Ugandans realize their fundamental rights, including the right to health. The Constitution gives government the responsibility to fulfil the fundamental rights of all Ugandans to social justice and economic development. This requires government to do everything in policy, law and action to ensure people can access health services.

For instance, the National Population Policy (2008) recognizes that all couples and individuals have the basic right to decide freely and responsibly the number and the spacing of their children, and to have access to information and education in order to make an informed choice; and the means to do so. It recognizes that health, in particular reproductive health, is a basic human right, and specifically points out the importance of commodity security and increased budgetary allocation for reproductive health.

Uganda has policies and guidelines that guarantee access to reproductive health services and commodities to enable all Ugandans realize their sexual and reproductive health rights, but disinterest among political leaders and policy makers has undermined implementation. Basing on the findings of the Ministry of Health’s reproductive health commodity analysis of December 2008 and a June 2009 case study report of reproductive health supplies by Population Action International, this paper outlines the current challenges in accessing essential Reproductive health commodities and the need for stronger commitment to change the situation.

Secure and sustained access to quality and affordable reproductive health (RH) commodity supplies is a critical driver of reproductive and sexual health. The concept of reproductive health commodity security (RHCS) requires that every person should be able to choose, obtain and use quality contraceptives, medicines and other medical products for prevention and treatment of STIs, and to ensure healthy pregnancy and delivery whenever they need them.

The potential health impact of availability and access to essential reproductive health commodities is the foundation for the wellbeing of individuals and families. Simple iron folate preparations can reduce maternal and child mortality from pregnancy-related anaemia and family planning can reduce the rate of unintended pregnancies and risky abortions.

Guaranteed access to these commodities is therefore necessary if Uganda is to make visible progress on the Millennium Development Goals (MDGs) and the goals set in the Programme of Action of the 1994 UN International Conference on Population and Development (ICPD).

It is important to emphasize that it is impossible to have commitment to reproductive health without commitment to RHCS. Such commitment is empty and deceptive. The Ministry of Health underscores the critical role of RHCS in attaining better reproductive health status and sustaining services, as stated in the Strategy to Improve Reproductive Health in Uganda (2005-10), and the National Family Planning Advocacy Strategy.

The second Health Sector Strategic Plan (HSSP II) targets an increase in contraceptive prevalence rate (CPR) to 40% from the current 23%; full availability of condoms (100%); eliminate drug stock-outs, including RH commodities in 80% of health units; and provide emergency contraceptives in 60% of health units – all by end of June 2010.

In spite of these and other policy commitments and promises, stock-outs of all drugs, including RH commodities, occurs regularly. According to the Annual Health Sector performance report 2005/06, 73% of health units had a monthly stock-out of one or more tracer RH commodities and availability had actually deteriorated over the last two years, as the unmet need for reproductive health commodities continues to rise.

The annual tracking of essential drugs found that the availability of Depo-Provera, an injectable contraceptive, has varied widely in recent years, with 16% of facilities having a monthly stock-out in 2006/07. Even though the stock level of RH supplies at central level is officially described as adequate, National Medical Stores (NMS) experiences stock-outs. For instance, in February 2009, NMS was stocked out of one brand of implants and had an inventory of less than two weeks supply of Microgynon, an oral contraceptive, with the next shipment not expected until two months later. The stock levels of four other methods (condoms, a second brand of implants, IUDs and a second brand of oral contraceptives) were lower than the recommended six months of supply.

What is more, Joint Medical Stores (JMS) is not an alternative when RH commodities stock-out at NMS, as it is for other essential medicines, because it is Catholic founded and the Catholic Church is opposed to “artificial” family planning methods. These supply problems translate into access problems.

According to the Uganda demographic health survey (UDHS) of 2006, contraceptive prevalence rate (CPR), which refers to the percentage of married women who are using any method of family planning, is a dismal 24%.

At 41%, Uganda’s unmet need for family planning is the third-highest rate in the world. Less than half of women (47%) make the recommended four antenatal care visits.

Government must translate national and international commitments into concrete action by increasing and guaranteeing financing, improving the logistics systems, procurement, and effective service delivery to enable Ugandans realise their reproductive health rights.

Ensuring access to high quality reproductive health information, products, and services requires commitment, not only in policy but also in action.

The existing policies and guidelines, are sufficient to improve access to RH commodities, and are being strengthened with new strategies for commodity security. But these policies and strategies count for nothing when they are not implemented and this lack of attention is counterproductive.

Keywords: antenatal care family planning FamilyPlanning2009 HIV/AIDS Reproductive health SRH STIs

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