Uganda’s fertility rate is currently estimated at seven children per woman. It therefore comes as no surprise that Uganda is said to have the highest total fertility rate in Africa, which means that women in Uganda produce the highest number of children than any other in Africa.
The country’s Reproductive Health sector management has constantly faulted this overwhelming and unreasonable reproduction rate on the high unmet need for contraceptives. Dr Peter Ibembe, the sector’s national programme manager, also adds that even in cases where contraception is accessed and used, there are also instances of incorrect use or failure of contraception that has ultimately yielded in unplanned, unwanted and thus more pregnancies per woman.
What the policy makers don’t seem to have picked on yet however is the growing mistrust of the contraceptives among Ugandan women, that has seen many shun them, which usually yields in more children than they plan to have. In these cases, the family planning is accessible but rather not used. Some women don’t know which one to use or trust either because they have been disappointed, been misinformed or fail to access any more proper wholesome information than the existence of the said methods.
Nabiryo’s experience with pills
Hanifah Nabirye, 36, started using the contraceptive pill after she had her two children now aged 15 and 13 years old. A second hand clothes vendor in Wandegeya with barely any formal education, Nabiryo only relied on the information she’d heard from friends before zeroing in on the pill because it sounded “easy and uncomplicated”. She assumed, she’d be advised accordingly at Mulago hospital where she chose to seek the service. To her surprise, she was only asked what method she wanted to use, she said pills and pills she was given. No explanations, inquiries or guidance from anyone.
Soon after she started using the pills however, Nabiryo started to suffer severe headaches. “Fellow women said it could be due to the pills. I thought the headaches were really bad but the staff at Mulago simply said it was expected and I should take a lot of water. No one had told me about this all the times I had come for the pills,” she recounts, disappointment apparent in her voice. She continues that although she started to take a minimum of three litres of water a day, it didn’t help much. Not even the painkillers could relieve it yet medics at Mulago continued to treat the issue mildly.
Four years down the road however, just when she thought she could live with the inconvenience of the headaches, her periods became irregular and quite clotty and heavy when they showed. “At some point I was in my periods for about a month and I’d go through about seven pads a day!” This time, Mulago referred her to a fertility clinic in Bukoto where she says she was given about a week’s supply of numerous medicines and the “problem” passed. “I was told I’d taken the pills too long and needed to halt them for at least six months. No one told me what to use in the meantime however so I thought I wouldn’t get pregnant, but I did.”
With her baby now seven months old, Nabiryo finds herself at a crossroads sure she’s not ready to have another baby but scared of the pills and the other hormonal methods. “I hear worse things about other methods,” she says, “my sister says the kaweta (IUD coil) would be okay but she says she can touch it with her finger when she is cleaning her privates! That doesn’t sound normal.”
Nabiryo is unfortunately one among many women suffering silently with the anguish of disappointing family planning methods and an uncertainty about whether they are worth it.
Implants made Ana gain weight
Ana (not real name), 27, walked into a prominent family planning clinic and asked for a convenient method to use. She was inserted with implants in her left upper arm and sent on her way, without any education on what to expect of the method. She was a relatively small girl then, but that’s all history as she could comfortably be placed with the overweight for her age today. “I was confused at first but then I started to hear people talk about the effects of the implants and when I read up I realised it could have been the only explanation for my sudden weight gain,” she says.
The worst bit about her case is that when she went back to inquire about why she had not been informed of the possible side effects, she was told that the doctor responsible no longer worked with the clinic and they suspected she had fitted her with some of the stock the clinic had wanted to get rid of. It’s been four years since but she still simmers in the anger of the disappointment and says she’d rather go by her menstrual cycle predictions than trust family planning methods.
Experience with using the injecta plan
Yet, about two other corporate women in their 30s who hear her stories group her with the lucky few to survive with her fertility intact as she’s since had a wonderful now one and a half year old son. The two women agree that for every woman they have known to use the same method as she did, they have struggled with fertility issues afterwards, either failing to conceive again or taking forever. “Just like the injection,” adds one, expecting her second born now.
To explain her sentiments she tells, “I used the injection (injecta plan) three times after my first born and even though I’d been told it would take at most six months to conceive again after stopping to use it, it took me two and a half years and a respected gynaecologist told me it could even take years for the hormones to stabilise enough again for me to conceive! I can never use contraception again until I have had my four desired children.”
When methods fail
For some women it is the failure to have children that they suspect is due to the family planning method they used, yet for others it is a case of a failed method to prohibit a pregnancy. “My matron was convinced that the Intra Uterine Device (IUD) would be the safest method as she could be sure not to conceive with it but she ended up having her second born before her first’s birthday! And she only discovered the pregnancy at seven months since she is naturally fat and thought the period delay was an after birth effect,” recounts one woman.
Another mother of two tells of her experience with the IUD, “I had urine tract infections all the time. Then I heard about someone else who had become barren from the coil because the copper had apparently leaked into her uterus or something like that and I was scared off the method, which the doctors had told me was the safest and surest birth control method!” she adds, “I’m using pills now but from what I hear about them, I’m not so sure about them. But then, what else can I use?”
At crossroads too is another 25-year-old mother of one, who says she started using injecta plan after giving birth to her daughter and for certain reasons, developing mistrust towards her father. Like the other women, she was only told about how convenient it would be since she would only renew her dose every three months and she took it up confidently. “Besides, I’d known a friend who used pills and was spitting all the time. So I was sure I didn’t want them.” While she didn’t get any weight gain issues or headaches, her periods became heavy and clotty, lasting more than a week at a time from her usual three days. Then after about a year of using it, she didn’t see her period for about three months. “The doctor only told me it was expected and I wondered why he hadn’t told me in the first place. Now I wonder what other effects he may not have told me and I’m scared to use it again or any other method,” she says.
The list of women with similar tales is endless, all pointing to the fact that there are women who even though they are well aware of the need to use birth control methods are opting not to use it because they don’t trust them anymore. As a result, some are having more babies and sooner than they would want to, which greatly undermines the policy makers’ efforts to get the contraceptives to the people. It would probably help better if they planned a way of educating women about them too, either at the dispenser centres or at national level.