Kampala, Uganda – A comprehensive study conducted by researchers in Uganda has revealed that religious leaders, cultural leaders, and mothers-in-law stand as the primary barriers to contraceptive usage in the country.
Amid the backdrop of ongoing progress, the study identified religious leaders and mothers-in-law as significant obstacles, as they discourage the adoption of modern contraceptive methods. This influence is intertwined with cultural norms that prioritize larger families, exerting a strong impact on rural communities and shaping their decisions regarding contraception.
In the same study, the researchers have found out that health workers and young peers have more influence to positive adoption of contraceptives in the country.
In the qualitative study titled: A qualitative study of influences on the uptake of contraceptive services among people of reproductive age in Uganda and published in the BMC Women’s Health Journal, the researchers recommend that
The researchers: Cissie Namanda, Lynn Atuyambe, Sarah Ssali, Aggrey Mukose, Nazarius Mbona Tumwesigye, Frederick E. Makumbi, Ritah Tweheyo, Andrew Gidudu, Carole Sekimpi, Catherine Verde Hashim, Martha Nicholson and Peter Ddungu.
They are affiliated to Makerere University School of Public Health, Makerere University School of Gender and Women studies, Marie Stopes Uganda and Marie Stopes International, London, UK.
Conducted with support of the Foreign, Commonwealth, and Development Office (FCDO) of the United Kingdom, the study was conducted in four of the seven regions of the country based on an earlier desk review that highlighted underserved regions or those with poor Family Planning indicators. The regions are Karamoja, Eastern, East Central (currently divided into Bugisu, Bukede, and Teso), Central 1 (currently known as South Buganda), Central 2 (currently known as North Buganda), Western (currently divided into Bunyoro and Tooro), and West Nile.
From these, the districts of Moroto in Karamoja, Mbale from Eastern (Bugisu) Mubende from Central 2, and Kibaale for Western (Bunyoro) were purposively selected. Mubende and Kibaale provided a semblance of rural districts while Mbale is a semi-urban district. Moroto represented areas that are remote with challenges of Family Planning service delivery and unique cultural settings.
A recent study conducted in Uganda sheds light on the complex factors influencing contraceptive usage, revealing that religious leaders, mothers-in-law, and cultural norms are pivotal barriers. Despite ongoing progress in family planning initiatives, religious leaders and mothers-in-law have emerged as primary obstacles, discouraging the adoption of modern contraceptive methods. This influence is deeply entwined with cultural norms that emphasize larger families, significantly shaping decisions on contraception within rural communities.
The comprehensive qualitative study, titled “A Qualitative Study of Influences on the Uptake of Contraceptive Services Among People of Reproductive Age in Uganda,” offers insightful recommendations for program implementers to navigate these challenges. Health workers and young peers have been identified as influencers with positive impacts on contraceptive adoption in the country.
Conducted by researchers affiliated with Makerere University School of Public Health, Marie Stopes Uganda, and Marie Stopes International, the study was supported by the Foreign, Commonwealth, and Development Office (FCDO) of the United Kingdom. The researchers focused on four regions—Moroto, Mbale, Mubende, and Kibaale—to examine the dynamics of contraceptive choices and the various influencers affecting them.
The findings
The study reveals that health workers hold significant sway over contraceptive decisions, particularly among individuals aged 20-34 years.
Health workers provide counseling, advice, and sensitization on family planning in health facilities and communities.
Village health team (VHT) members were identified as influential figures in promoting contraceptive methods within communities.
VHTs supplied information and contraceptives like condoms, conducting door-to-door visits to foster open discussions about family planning.
While their personal touch was valued, VHTs’ limited knowledge of certain methods constrained their ability to provide comprehensive guidance.
“However, the impact of health workers varied, with some instances of discouragement for unmarried adolescents and those not in unions due to affordability issues and biased guidance,” the researchers conclude.
Friends and peers were found to strongly influence contraceptive decisions, especially among adolescents. Those who had used contraceptive methods encouraged their peers to follow suit.
“Sharing experiences and information about family planning contributed to shaping decisions in this demographic,” the researchers observe.
Family dynamics also emerged as influencers. Parents, mothers-in-law, and grandparents exerted various influences, with some encouraging contraceptive use to address economic difficulties and others discouraging it due to traditional beliefs or the desire for larger families.
“Mothers-in-law particularly played a significant role, sometimes forcing their daughters-in-law to avoid contraceptives,” the researchers report.
Religious leaders, especially in rural areas, were identified as negative influencers due to their association of contraceptives with sin and abortion. Cultural leaders also played a role, with cultural norms promoting larger families as a symbol of wealth and pride.
“However, some religious and cultural leaders supported contraceptive use, highlighting the nuanced landscape of influence,” the researchers observe.
Additionally, the study found that housing challenges in urban areas, such as the Mbale district, influenced women’s decisions to use contraception to avoid eviction due to having many children.
What the study means for reproductive health in Uganda
In a 2022 Family Planning Performance Update by the Ugandan Ministry of Health, there’s a positive note in the growth of Implant usage, contributing to the expansion of the country’s method mix in family planning. Additionally, the positive growth in Implant use and institutional deliveries demonstrates progress toward the program’s goals.
Thus, this study’s comprehensive insights have significant implications for Uganda’s family planning initiatives, emphasizing the importance of understanding and addressing these varied influencers.
By empowering health workers, fostering awareness, and engaging communities, Uganda can bridge the gap between awareness and adoption, paving the way for informed family planning choices and a healthier future.
“We recommend program implementers identify and work with religious leaders who are positive about the uptake of modern methods. These can act as change agents for their colleagues,” the researchers write.
Uganda’s investment in family planning initiatives has garnered global attention.
However, a deeper dive reveals that the uptake of modern contraceptive methods doesn’t match the surge in awareness.
In response, a pioneering program was developed to enhance awareness, access, and acceptance of modern contraceptives. Yet, prior to its launch, the School of Public Health embarked on a mission to unravel the complex web of influences shaping contraceptive choices.
Thus, the study that encompassed four Ugandan districts, where the new program was poised to roll out, was able to uncover the hidden forces guiding contraceptive choices, through an array of focus group discussions, interviews, and key informant interactions.
The findings underscore the pivotal role health workers play in bridging the divide between knowledge and action. Recognizing health workers as potential champions of change, the study urges their deeper integration into community engagement efforts.
Beyond Uganda’s borders, the study’s implications resonate globally. As family planning programs evolve worldwide, understanding the intricate tapestry of influences can herald a transformative shift. The call to action is crystal clear: devise interventions that account for these influences, empower health workers as catalysts, and equip communities with informed choices.
The path to informed family planning choices is a collective endeavor. The study extends an invitation to policymakers, healthcare providers, and communities to unite in erasing the gap between awareness and adoption.
With Uganda pioneering a comprehensive family planning program, the nation enters a new chapter guided by profound insights. Empowered by health workers and communities alike, the future promises a realm of understanding, informed decisions, and a healthier populace.
The study by Makerere University School of Public Health sets the stage for a holistic approach to family planning that’s bound to redefine Uganda’s health landscape.
For more details about this study, follow this LINK
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