LILIAN NUWABAINE: Choose when and how many children to have

OPINION: According to the United Nations (UN) Contraceptive report of 2019 and the World Health Organisation (WHO), an estimated 190 million women of reproductive age (15-49 years) do not use contraceptives worldwide and most of these (83%) are found in Sub-Saharan Africa. 

Research studies show that contraceptive non-use among women of reproductive age in Sub-Saharan Africa accounts for nearly 14million unplanned pregnancies annually and majority (66%) of the maternal deaths amidst geographical variations. Uganda in particular continues to present undesirable fertility rates (5.4 births per woman) and maternal mortality ratios (336 maternal deaths per 100,000 live births) according to the Uganda Demographic and Health Survey (UDHS 2016). These are said to be associated with contraceptive non-use. Interestingly, in Uganda, over 99% of everyone in the community has knowledge on contraceptive use. Unfortunately, this knowledge is not equitable to the current contraceptive use. In 2018, the World Bank reported that Uganda had a contraceptive prevalence of 41.8 %.

Annually, 26th September has been designated by the World Contraception Day to bring focus to the rights of all couples and individuals to decide freely and responsibly on the number and spacing of their children. This is also clearly indicated in the 2030 Agenda for Sustainable Development (SDG) under target 3.7 which states that “by 2030, ensure universal access to sexual and reproductive healthcare services including family planning, information and education, and the integration of reproductive health into national strategies and programmes.”

Improved access and availability to low-cost contraception and its uptake through family planning programmes has reduced high-risk pregnancies, teenage and unplanned pregnancies, maternal, neonatal and child mortality and improved child health and nutrition. Modeling activities show that contraceptive use may have reduced maternal mortality by over 40%. It is therefore vital that all stakeholders globally work together to maintain these hard fought gains and further drive new ones. 

It is very important for us to acknowledge and note that the impact of family planning is beyond health. It goes as far as multi-sectoral and even inter-generational. It is even well documented that improved child health and nutrition has the potential to positively influence academic performance and behavior. In turn, education is a key determinant of the uptake and consistency in use of family planning services. Globally, estimates for the economic impact of family planning have found that $3.6 billion a year spent on providing contraception to all those who want them has a potential of an annual return of $432 billion. A return of $120 for every dollar spent. Isn’t this interesting!

Some of the methods of contraception include artificial ones like oral contraceptive pills, implants, injectables, patches, vaginal rings, Intra uterine devices, condoms, male and female sterilization and natural ones such as lactational amenorrhea methods (obtained through frequent breastfeeding), withdrawal and fertility awareness based methods.

I applaud the Ministry of Health Uganda, all relevant non-government organizations and institutions nationally for their efforts in the promotion and pushing for the utilization of family planning methods. However, with the contraceptive prevalence of only 41.8% in Uganda, I recommend these entities to further strengthen and expand family planning services as core to maternal and child health.

The author is; Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s’ Health Specialist working with Aga Khan University as the Continuous Professional Development Coordinator