BY IDD BASAIJJA
Limited access to family planning services in Bughendera County, Bundibugyo district, is contributing to the rising cases of early pregnancies, shattering the dreams of young women.
Health experts in the area emphasize that the low utilization of family planning plays a significant role in influencing the fertility pattern and population growth rate in the district. It also negatively affects the development of young women and adolescents, impacting their education, livelihood, and health.
Globally, in 2021, an estimated 14 percent of adolescent girls and young women gave birth before the age of 20. In Uganda, a staggering 24.8% of women aged between 15-19 years have already begun childbearing.
The complications arising from giving birth are a primary cause of maternal mortality, with 368 deaths per 100,000 in Uganda (UBOS, 2021). Furthermore, adolescent mothers often face grave abuses of their human rights, along with serious societal issues such as child marriage, intimate-partner violence, and mental health concerns.
Development partners and healthcare providers attribute the limited access to critical health services, such as family planning, to the remoteness of the area and the scarcity of health facilities.
Bughendera County is characterized by its incredibly mountainous terrain, with some communities being almost entirely isolated. These villages are so remote that they may go weeks without any access to individuals from outside their community.
Young women in the county express their desire to take charge of their reproductive health, but the absence of services forces them to make difficult choices. For instance, Lillian Vumulia from Bugombwa in Busaru Sub County dreamt of becoming a nursing officer after completing her education. However, her dreams were cut short when she experienced an unwanted pregnancy and was subsequently abandoned by her partner at the age of 18.
Vumulia was aware of family planning but could not travel over 20 kilometers to the nearest health facility to access the services. Today, she is a single mother working odd jobs to support her child. She reflects, “I became a mother when I was very young, and when I got pregnant, I was too scared to tell my parents. I had to run away from home, gave birth at a friend’s place, and my boyfriend abandoned me. If I had access to these services, maybe I could have pursued my dream of becoming a nursing officer.”
Agnes Namara’s story mirrors Vumulia’s. She gave birth to her first child while in primary seven on her journey to complete senior four and become a nurse. Due to the absence of family planning providers in her village, she had to walk long distances to the main hospital to access the services. She emphasizes the need for these services to help young women exercise their right to choose and maintain their and their children’s health.
Jackline Kabugho, aged 19, is a mother of two who attributes her early motherhood to limited information, lack of access to planning services, and poverty in her family. She explains that despite being in a sexual relationship at a young age, she feared going to the health facility in her area to get family planning services. She calls upon the government and partners to create friendly points for young people where they can access such services without fear. Kabugho laments, “If the services were closer to me, I would have accessed them, and I wouldn’t have had children at my age. I might have become a school teacher, as that was my dream during my school days.”
Racheal Kabugho had to sell her retail shop in Ntandi town council after experiencing complications while giving birth in 2022. The 20-year-old, who became pregnant through a possessive relationship, now lives with her elderly grandmother as she struggles to raise her child. She recounts, “I never intended to give birth at 19, not at all. But, as you know, men often take advantage of girls, and that’s what happened to me. I tried to get family planning, but our facility didn’t have short-term methods, and I feared the long ones because he could find out.”
Sarah Kabagenyi, working with Bundibugyo Women with Disabilities living with HIV Association, raises concerns that persons with disabilities (PWDs) have never been prioritized when offering family planning services. Those with hearing impairments and mobility challenges find it challenging to access these services and are often sexually exploited by men. PWDs’ limited access to family planning means they have little control over the number of children they want to have, and many struggle as single parents.
Winnierose Masika, in charge of family planning services at Bupomboli HCIII in Harugale Sub County, cites shortages of contraceptives, a lack of healthcare workers to provide them, and unfriendly service providers as additional barriers. She explains that most medical distribution systems in Bughendera are not digitized, exacerbating the geographical challenges. Additionally, the village health teams (VHTs) lack motivation to do this work.
Peace Muhindo, a health worker at Bukangara HCIII in Bukonzo Sub County, notes that the number of young mothers seeking family planning services remains low due to limited male involvement. However, she acknowledges that the limited access is due to her sub-county, which serves other remote sub-counties of Kirirumya and Mbatya.
Annah Kukundakwe, a senior program officer at the Center for Health Human Rights and Development (CEHURD), observes that although nearly a third of all women in Uganda become mothers during adolescence, the country is unwittingly jeopardizing the future of young girls.
She emphasizes the importance of providing young people with access to family planning services to enable them to exercise their reproductive rights effectively. Research and evidence show that without support in the form of contraceptives or family planning options, adolescent girls are likely to experience repeat teenage pregnancies, further impacting their educational and economic prospects.
Because young women lack access to reproductive services like family planning, Kukundakwe argues that the country is raising a population that is highly dependent, uneducated, and lacks employable skills, which, in turn, hinders the overall national development agenda.
She calls for government enforcement of laws on sexual violence to protect young girls and women and improve their access to reproductive health services. Kukundakwe concludes, “We need to be flexible and understand that in many cases, families have become dangerous spaces for young girls and women. We need to support families and parents. We need everyone involved.”
