KAMPALA – Family planning (FP) has a range of definitions by different people but according to the World Health Organization, it is the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births (World Health Organisation, 2008). The World Health Organisation – WHO further emphasizes that FP “exercises a positive influence on health, development, and well-being.” Therefore, advocating for children to be born by choice other than by chance.
Family planning is one of the five key pillars in accelerating the opening of the window of opportunity to the harnessing of the demographic dividend. It is a key dimension of reproductive rights, alongside the right to attain the highest standard of sexual reproductive health, and the right to make decisions concerning reproduction free of discrimination, coercion, and violence (UNFPA, 2013a). According to the Uganda Vision 2040, Uganda needs to invest in solutions to accelerate fertility and mortality decline in order to harness the benefits of the Demographic dividend.
However; even with the above benefits. Uganda still lies behind in its commitment to provide free, affordable, and accessible FP services and reduction of the unmet need for family planning. A recent population report revealed that Uganda was among the countries with the highest population growth rates, at 3.32%. This is attributable to the country’s high fertility rate of 4.87 births per woman. This situation calls for concern given the demerits of increased population growth which include; rapid urbanization, poor waste management, high poverty, unemployment, environmental degradation, inadequate infrastructure, loss of biodiversity, and wetland drainage among other challenges. Furthermore, increased population growth is set to increase pressure on land, which in turn has a negative impact on productivity.
In Buikwe District, research conducted around the Lake Victoria Basin (LVB), indicated Ssi Bukunja among the communities within the basin where a multitude of factors converge to affect the health status of the people, poor sexual and reproductive health (SRH) outcomes, and substantial environmental degradation. In a Survey conducted by Regenerate Africa with partners; Rapid Advisory and Solid Options Ltd in July 2022, in Zitwe Parish, Ssi Bukunja Subcounty in Buikwe district. Results revealed that only 37% of the participants had ever received training on family planning, while ONLY 32% indicated that at least a family member had used FP services. The average household size was 7.6 with about 37% of the respondents aged between 18-35 years, the age category of youth. 44% of the respondents earned between UGX10,000 and UGX50,000 per month, an average of UGX600,000 per year. Furthermore, an increasing occurrence of climate risk factors like droughts and strong winds was reported, posing threats to agricultural production which was the major source of livelihood and sustenance for about 91% of the respondents. This is in line with the NPC report which confirmed that a large family size makes it difficult for individuals, families, communities, and Government as a whole to make the required investments in education, health, and socio-economic reforms needed to develop high quality human capital (NPC, 2018).
To respond to this, In 2017, Uganda renewed its commitment to allocate US$ 5 million annually for the next five years for procurement and distribution of a range of FP supplies and RH commodities to the last mile; Raise US$ 20 million annually to bridge the funding gap in the Family Planning -CIP through continued partnership with development agencies, private sector; Support a robust Social Behaviour Change Communication Strategy to increase demand and linkage to family planning services; Expand the cadre of skilled workforce for provision of quality FP services including and Permanent methods; Reduce the unmet need for FP amongst adolescents from 30.4 percent in 2016 to 25 percent in 2021 through operationalizing the National Adolescent Health Policy and Framework for sexuality education; and Increase the deployment and retention of critical cadres (such as midwives) in hard to reach areas (NPC,2018). However; despite all this. There is still a gap in closing the barriers to access and uptake of SRHR/FP services in rural areas which are evidenced by the high fertility rate and low livelihood standards.
In addition, the low budget allocations to Local governments to cater to health sector needs worsens the already taxing situation, for example, the 2021/2022 Buikwe district budget indicated that the health sector was allocated 7,291,799 compared to 348,328 allocated to Natural resources. This gap in resource utilization is directly reflected in the gaps in the implementation of these interconnected programs. Prioritizing lowering fertility rates through access to family planning information and contraceptive supplies would present both macro and microeconomic benefits. Just as national governments are able to spend more per capita on social welfare when population growth slows, parents can invest more in health and education costs for each child if they have fewer children.
We commend the actions of Civil society movements and Non-Governmental Organisations like Regenerate Africa, GAIA initiatives, Preston Werner Ventures among others for their efforts to increase awareness and ensuring that the information reaches the last mile. However; these need to be backed up by commitments by different inter-governmental bodies. SRHR challenges cut across all sectors in Health, climate, gender, and agriculture among others.
Therefore; attempts to incorporate family planning with sustainable environmental management practices are a great way of recognizing the interconnections between people, their health, and the environment, hence the alarming need to holistically address changes affecting the ecosystems and the communities dependent on them. For example, focusing on having a manageable family, in a good hygienic neighborhood that you can plan and prepare for. While there are few distinctions, the interconnectedness between these indicators promises a chance to achieve better outcomes for handling health and environmental issues without isolation.
The author, Nakalanda Maria is a Project Lead: Gender, Health & Environment Regenerate Africa; P.O. Box 107466, Kampala Uganda