Source: The Observer
Margaret Mutetere has seven children. From her stature, one can tell that parenting woes are wearing her down.

She says she tried using Depo-Provera for birth control but stopped after realising the contraceptive increased her heart rate, yet she already had high blood pressure.

Because her periods took a while to resume after her last child, she decided to breastfeed for a year using natural methods of family planning. She wishes there were other available methods of birth control, but every time she goes to the local government health facility, she is offered only Depo-Provera. Mutetere is one example of the many women at pains of contraceptive choice, despite the existence of many other methods of family planning.

The 2011 Uganda Demographic and Health Survey reported a modest improvement in the national contraceptive prevalence rate over the previous years from 23 per cent to 30 per cent. The survey also revealed unequal access to contraceptives by age, marital status, education level, socioeconomic status and geographic location.

The number of people who cannot access family planning stood at 34 per cent. According to Esther Nakiyingi, a mother of two from Kiboga town, women need to have a wide range of family planning methods so that they can choose what works best for them.

“I tried using Depo-Provera but I got heavy bleeding and decided to opt for implants which haven’t had any side effects,” she says.

Sister Agnes Kibombo of Bukomero health centre IV in Kiboga, says they have spent almost two years without getting contraceptives pills.

“We have been consistently receiving Depo-Provera despite the fact that we have it in plenty and have been placing orders for orals,” she says.

“National Medical Stores should monitor the monthly reports submitted to them as regards to the usage of contraceptives, because it would help realise that Depo-Provera is in excess supply in certain districts and give a rationale for the supply of alternative methods like pills, implants or IUDs.”

Depo-Provera is so much in stock that an official from the same health centre who preferred anonymity says they last made an order for it in the 2014/2015 financial year.

Prossy Namusoke, a midwife at Lwamata HCIII, Kiboga, says some of the mothers who come for alternatives to Depo-Provera because of its side effects like heavy bleeding and nausea are not able to access them. The best they can do is refer clients to Kiboga district hospital or tell them to wait for outreaches done by NGOs including Marie-Stopes.

She says while other clients prefer long-term family planning methods such as Implanon or Jadelle, they are not always available especially at the HC-II and HC-III levels. Implanon is for three years while Jadelle lasts for five years.

“All these long-term methods are mostly provided by NGOs when on outreach.”

Prima Kazoora, the head of training and capacity building at HEPS Uganda, a coalition NGO promoting equitable access to essential medicines, urges government to ensure proper distribution of family planning commodities to curb the rampant stock outs.

“Access and availability of family planning is still a big challenge due to delays in delivery which leads to rampant stock outs,” she says.

The Kiboga district health officer, Dr Micheal Musiitwa, decries the infrequent contraceptives supply.

“Out of the six cycles of medicines delivered, three of them will contain contraceptives. Our procurement plan contains condoms, COC, Progesterone only, emergency pills and Depo-Provera. Implants and IUD’s are rarely delivered,” he says. Depo-Provera, condoms and some orals are delivered inconsistently.

According to Musiitwa, the rural women use Depo-Provera because it is easy to conceal from their husbands. A 2016 scorecard report on selected health facilities in Kiboga and Isingiro districts published by HEPS Uganda indicates that low male involvement is one of the major deterrents of contraceptive uptake.

The lack of contraceptive choice is worse in Isingiro district. Health centres have only been receiving Depo-Provera and condoms. Kasana HC-II, recently upgraded from a HC-II, still receives commodities suited for a HC-II.

Aisha Mutamuhiza, the in-charge, says a HC-III should be able to administer all the family planning methods except for tubal ligation and vasectomy. She says if the mothers at the Health Centre had a choice, many would go with Implanon which they only have access to about twice a year when Maries-Stopes does an outreach in the area.

Dr Placid Mihayo, the assistant commissioner, reproductive health at the Ministry of Health says family planning is crucial in efforts to reduce maternal mortality rates, although inconsistent supply of contraceptives undermines the undertaking.

“There has been a shortage of some pills for the last three months; however, the mothers have been having access to other methods like Depo-Provera, condoms and through partnerships with development partners like PACE and Marie-Stopes, long term methods and permanent methods.”

Uganda’s poor distribution of family planning products as stocks pile up in the National Medical Stores (NMS) came under scrutiny at the international conference on population, health and environment in Addis Ababa in 2013.

Stacks of family planning commodities remain undistributed at NMS, which in turn has blamed district health offices for not requisitioning for them. Dan Kimosho, the public relations officer at NMS, said pills were out of stock for a while, because the ones they had expired, as they were not being requested for by health facilities.

According to Kimosho, mothers felt pills were too short-term (taken daily) and preferred long-term injectable methods where their husbands would not know about their usage, as most men in rural areas do not support their wives using family planning methods of any kind.

The ministry seeks to reduce unmet need for family planning to 10 per cent by 2022. Uganda has one of the fastest-growing populations in the world with the growth rate at 3.2 per cent per annum.

• Uganda