A Young Woman’s Unpopular Decision
to Get on Family Planning

Raised in a community where family planning is shrouded in myths, a 14-year-old mother of one opts to use contraceptives to prevent a second unplanned pregnancy

At age 13, Sandra Angom (not her real name) gave birth to her son in northern Uganda. Young and alone, without a partner’s support, Sandra embarked on motherhood. This stark, new reality eclipsed her childhood, all prospects of school, and plans for the future. 

I was very sad and scared,” recalled Sandra, who spent most of her time in isolation as she tried to keep the pregnancy a secret.

For months, she stayed hidden at home with only her mother and a few family members aware of her pregnancy. As a result, she missed several critical antenatal care visits, and suffered several bouts of malaria. Luckily, Sandra gave birth safely at the health facility, albeit with great difficulty.

Sandra with her son at the borehole fetching water. Photo by Malaika Media, for JSI

Motherhood has been hard for Sandra because she is still a child herself. 

“After what I endured during the pregnancy and the near-death experience of childbirth, I am not ready for another baby,” she said.

So, at 14-years old, when her baby was one, Sandra decided to use family planning after hearing about it from one of her peers. This was during a gathering for young people in a community safe space, organized by girls in the DREAMS program. 

 I attend the DREAMS Stepping Stones sessions where we are taught different social, life, and financial skills. During one of the sessions, we were told about family planning – the methods, the benefits, and the possible side effects,” said Sandra.

The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) is a strategy that the USAID Regional Health Integration to Enhance Services-North, Lango (RHITES-N, Lango) project uses to reduce HIV incidence and pregnancy among adolescent girls and young women in northern Uganda. 

DREAMS layers family planning as a service for adolescent girls and young women. Participants have made it clear that they prefer learning about family planning from their peers, as opposed to in a health facility, where they often feel judged for being immoral.  The RHITES-N, Lango project trained DREAMS peers to provide family planning counseling and information about short-term methods at the DREAMS safe spaces. The DREAMS peers are supported and supervised by midwives at health facilities to which they are attached.

Upon learning about the possibilities of family planning, Sandra went home and told her mother that she would like to begin using a short-term family planning method.

“I was shocked at first when Sandra broached the subject of family planning with me. You see, even while she was pregnant, I couldn’t bring myself to talk to her about boys, sex, and children,” said Harriet, Sandra’s mother. 

Sandra walks in her village in Uganda while holding her son.

Sandra walks to the borehole while carrying her son. Photo by Malaika Media, for JSI

Sex is not a subject we openly discuss with our children. When she told me she wanted to try family planning, I encouraged her to go for it. I am already conversant with family planning since I am already using it myself.”

Discussing sex or family planning with young people is taboo in the community that Sandra comes from. Instead, young women are left to discover for themselves about sex, which has led many to have sex early and eventually becoming pregnant. 

The 2016 Uganda Demographic and Health Survey shows that the unmet need for family planning in the Lango sub-region is highest among sexually active, unmarried young women, 15 to19 years old, at 17.2 percent. Only 6.6 percent of women in Lango have discussed family planning with a health worker. 

The USAID RHITES-North, Lango project is working to increase access to and use of family planning services among adolescent girls and young women. The project uses a mix of approaches to increase the uptake of family planning including leveraging the DREAMS platform, integrating family planning services with other health services, and providing family planning services in the community. Through the project we are working with districts, local partners, and institutions to increase access to high-impact sexual reproductive health services.

Harriet plays with her grandson. Photo by Malaika Media, for JSI

One of the greatest barriers to family planning uptake among adolescent girls and young women in Lango is the lack of support from family and friends. There are many myths and misconceptions associated with family planning, including that it will lead to bearing children with missing limbs, becoming barren, and more.

For Sandra, the idea of family planning was not easy, but having been hurled into motherhood at a young age, she wanted to take charge of when to have her next child. Her mother accompanied her to the DREAMS safe space where they were both counseled on the options for short-term methods by a DREAMS peer.

While she has not revealed her daughter’s decision to her neighbors, Harriet believes family planning is the best decision for her daughter and she encourages parents to talk to their children about sex. For parents of teenage children who are already mothers, she encourages them to support their daughters to use family planning to space their subsequent children.

“As a widow and mother of five children, who has been struggling to raise them on meager resources, I want my daughter to have the chance to do child spacing and have children she can ably take care of.”

After six months of family planning, Sandra has no regrets. She says she has not had any side effects and is happy with her decision.

Written by Angela Kateemu, Communications Advisor, USAID RHITES-North, Lango Project