Access to family planning in Africa is good but the uptake is slow

Saturday December 29 2012

By DICTA ASIIMWE

The United Nations Population Fund (UNFPA) launched the State of World Population report on Dec 12.

The report focused on the provision of family planning as a way to improve the quality of life for those living in developing nations. Dicta Asiimwe spoke with the UNFPA assistant representative in Uganda Wilfred Ochan, about his views on issues surrounding family planning methods, accessibility and use in Africa. 

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What is the extent of use of contraceptives in East Africa? Which countries are doing well?

Family planning use has been changing significantly. In the 1980s and 1990s, Kenya was one of the best performing countries in terms of family planning because of the programmes that had been put in place. The country had community-based and facility distributers.

Recently however, Rwanda has made one of the most significant advancements in family planning. Immediately after the genocide in 1994, family planning use in Rwanda was low, but recent studies show the uptake has increased from about 14 per cent to 45 per cent.

In your assessment what could be the reason for this increase?

One reason could be the political leadership that came out boldly and clearly to recognise that family planning was needed to assist in the social development of the country. There has also been harmonisation of donor support towards a central and nationally-owned programme, which is run and managed by the government.

Donor support has ensured the constant supply of family planning methods in both the urban and rural areas. Ease of accessibility has also increased acceptance and use of family planning in the country.

Earlier research carried out in Africa showed that men and boys do not play a significant role when it comes to increasing the use of family planning methods. What has changed now for UNFPA to include men and boys in the family planning campaign?

Emerging evidence from programmes and practices shows that male involvement could be essential in increasing uptake and continuity of family planning use.

In Uganda, for example, you will find that women will choose methods that they feel they can hide from their men. You find women using injectables because they cannot be seen.

But family planning is not just an individual decision, is also a couple’s decision.  Programmes carried out in Zambia, Tanzania, Kenya and Uganda that involve men show better family planning use.

Men’s involvement ranges from using a family planning service such as condoms or a vasectomy to offering financial or moral support, giving advice, or even taking their partner to a health facility. Men are also increasingly changing the mindset that pegged a man’s status on having many children.

Many government health workers in rural facilities complain that they receive more contraceptives than they need. So then how do you come up with such a high figure for the unmet need, which for family planning is defined as the percentage of women who do not want to become pregnant but are not using contraception?

Every five years, the Uganda Bureau of Statistics, conducts a demographic health survey (DHS) where they sample households and go through a rigorous research process in determining a number of indicators in both the health and demographic profile of the population.

UNFPA and other partners supported the Uganda Bureau of Statistics to compile data in 2010/2011. There is a standard manual and the same DHS is done in almost all countries in Africa, it helps with data for planning, for information and for policies and to also track the progress of development .

The report gives different indicators, with one of the indictors being the unmet need for family planning and the contraceptive prevalence rate.

The report found that only 30 per cent of the eligible population in Uganda is currently using contraceptives, meaning that 70 per cent are not on any method of contraceptives.

The Uganda Bureau of Statistics also found that 34 per cent of the eligible population would like to be on a family planning method but are not able to get it. Of that 34 per cent, some would like to use contraceptives in order to space their family, while others want to stop having children completely. 

So how does this relate to the over-stocking at health facilities yet the demand is there? Has the population been mobilised to a point where couples are aware of the different methods of family planning available to them? Has adequate information been provided?

My take on it is that the mobilisation has not been effective in matching the provision of services.

There is a need to mobilise the service providers, so that they do not just sit back and wait for clients at the clinic, but to instead understand the need to engage, educate and mobilise the population so that they utilise their services. This would generate enough demand to match the supply.