The conflict broke out when Esther attended a reproductive health class at the community health center and came home with family planning pills. Ms Nyakech and thousands of refugee women in the settlement need to access family planning services but are prevented by their partners.

As a result, more than 40 percent of women who want to use birth control in their settlement cannot obtain this method. While the government states that refugee services should be fully integrated into public/host community services, where refugees and host communities can freely access the same services, the use of family planning methods remains extremely low. Differences in unmet family planning need exist by age, education, socioeconomic status, and rural-urban geographic location.

Of the approximately 850,000 South Sudanese refugees currently in Uganda, 83,000 are in the Palabek Refugee Settlement. Nearly 75 percent are women or children. The Uganda Demographic and Health Survey (UDHS 2022) reveals that two in 10 married women in Uganda want to use contraception but do not have access to necessary services. This situation is exacerbated by deep-seated gender inequality, harmful practices and limited access to services.

According to the United Nations Population Fund (UNFPA), the unmet needs of women living in rural areas are 30.1 percent, 22.8 percent higher than those living in urban areas. At last month’s commemoration of World Contraceptive Day, UNFPA acknowledged that stigma and misinformation around contraception were not helping the problem.

“Our goal is to see zero maternal deaths among refugee mothers and their children, including in host communities, but it’s really hard to see zero deaths when you’re expecting a woman in labor to travel 60 kilometers to have a caesarean section,” she said. Juliana Lunguzi, sexual reproductive health integration officer at UNFPA, says:

UNFPA increased the use of sexual reproductive health (SHR) services under the UN Joint Program to End Gender-Based Violence (GBV), reducing the proportion of women with unmet contraceptive needs from 39.5 percent (2018) to 20.3 percent (2024) . . This triggered an increase in the number of family planning users from 416,882 (2022) to 719,725 (2024).

This goes without saying, given that Uganda loses approximately 4,032 mothers every year due to complications related to pregnancy and birth. While maternal deaths have fallen from 336 deaths to 189 deaths per 100,000 live births, UNFPA says the target is to reduce this number to 70.

“No woman should die because she is pregnant. Anyone under the age of 18 is a child. We should not see them get pregnant,” Ms Lunguzi told Sunday Monitor.

The government has recently intensified efforts to increase access to sexual reproductive health and rights, with a special focus on family planning services across the country. Uganda has a health structure that has expanded over the years from the national level to the community level in terms of its capacity to provide access to health services, including family planning. In 2019 alone, close to 73 percent of the 2.8 million women receiving various forms of contraception accessed services at lower-tier health facilities (HCIII and HCII).

Lamwo District Health Officer Dr. Ocula Omoya notes that although refugees are free to leave the settlement to access family planning services at facilities in the host community, many remain reluctant to do so due to “communication gaps” and the influence of “traditional relationships.” Norms and culture.”

Refugees are taught how to best manage their family size to avoid some burdens. Despite evidence of early onset of sexual intercourse among adolescents, contraceptive use is low; Only 9.4 percent of youth ages 15-19 report using a modern method.

Men’s limited participation and support in family planning did not help the problem. As a result, Uganda’s average ideal family size has remained unchanged from 4.8 children per woman since UDHS 2001. The desire for a large family is said to be supported by cultural practices such as polygamy, bride price, high child mortality rates, the security of having many children, and gender preference.

The 2017 Uganda Family Planning Cost Implementation Plan 1 (FP-CIP 1) outlines strategies to reduce unmet family planning need by 10 percent.

As of the end of 2020, Uganda recorded a 30.5 percent unmet need for modern family planning among married women and a modern contraceptive prevalence rate (MCPR) of 38.7 percent, according to data from the Ministry of Health’s 2020 Consensus Conference on Family Planning.

In the same year, the government introduced FP-CIP 2 (2020/21-2024/25), which aims to complete the unfinished work, taking into account learned experiences and emerging global evidence to accelerate the increase in MCPR and reduce unmet needs.

Uganda’s current estimated population of 45 million is projected to reach 55 million by 2030. Low birth control use resulted in a very high rate of unintended pregnancies (44 percent); Almost two-fifths of recent pregnancies were intended later or not at all. By subregion, the percentage of women aged 15-19 who begin childbearing varies from a high of 15.5 percent (in Kigezi) to a high of 31.4 percent (in Teso). In the north, Buganda (30.3 percent), Tooro (30.3 percent), Bukedi (29.5 percent), Bunyoro (29 percent) and Bugisu (28.2 percent).

The 2021 report FP-CIP 2 (2020/21-2024/25) reveals that current national use of FP methods among people living with HIV/Aids is an estimated 24 percent.

“The unmet need for modern contraception, especially among vulnerable groups, remains a critical issue. The government needs to implement comprehensive awareness campaigns to dispel myths about contraception and family planning, as well as invest in health infrastructure to provide quality contraceptive services,” he says.

Documentation coordinator Mr. Aldon Walukamba believes that solutions to achieve a healthy population are based on the principles of rights and empowerment. It is particularly important to invest in youth, who make up more than 75 percent of Uganda’s population, and the population of 24 million women working in health, he says.

Reproductive Health Uganda (RHU) states that reducing teenage pregnancies will result in greater educational and economic opportunities for young people. It is imperative that young people’s reproductive rights and needs are met through education, outreach and access to services.

Commissioner responsible for Reproductive, Maternal and Child Health, Dr. Richard Mugahi says the impact of FP-CIP2 has not yet been studied, but a positive trend has been noted across the country, indicating an increase in the uptake of contraceptives.

“The government is allocating much more funds to family planning services, which is very positive because even if the donor wakes up one day and refuses to fund us, we will still be delivering some supplies to our people. “A total of Shs5 billion has been allocated to family planning services this financial year,” he says.

Dr Mugahi blames socio-cultural factors hindering contraceptive consumption among Ugandans. In many cultures, men believe that women should not be involved in family planning because a man is defined by the number of children he has.

“There are a lot of cultural myths against family planning, and to dispel that stereotype we now call it healthy child spacing,” she says. Monitor“Religious leaders, especially Catholic leaders, have come out forcefully and said family planning is infanticide, but that’s not true because the sperm cells in your groin are not babies. Unfertilized eggs are not babies.”

Dr Mugahi explains that every woman produces an average of two million eggs from the time a woman starts menstruating, from the age of 14 to the age of 49, “so our religious leaders tell us that all two million eggs will make a baby?” According to him, the practice of donating food to starving communities across the country, including refugee settlements, is increasingly motivating uncontrolled pregnancies in Karamoja, where women with more babies receive more food and therefore the fertility rate is highest.

“In Ishaka (refugee settlement) in Western Uganda, refugees are given food according to the number of people in the family. “They give you money and family support depending on the number of people in your family, we were there last week too,” said Dr. Mugahi adds that 38.8 percent of women use modern family planning methods, which corresponds to the national target of 50. percentage. While the proportion of women experiencing unwanted pregnancies has fallen to 22 percent from 28 percent five years ago, more women in urban areas are using modern family planning than those in villages.