Ugandan Girls Overcome Barriers to Family Planning
October 10th, 2023 | Story
October 10th, 2023 | Story
The group of young women in northern Uganda from the Obanga Twero group. Photo: Angela Kateemu/JSI.
On a hot afternoon in northern Uganda,16 young women sat in the shade of a mango tree. They were members of Obanga Twero, one of more than 3,400 village savings and loans associations (VSLAs) that the USAID Regional Health Integration to Enhance Services-North, Lango (RHITES-N, Lango) project supported. Many members had dropped out of school due to financial constraints, often exacerbated by early marriage and pregnancy.
Another way that RHITES-N, Lango supported young women was by working with the Determined, Resilient, Empowered, Mentored, Safe and AIDS-free (DREAMS) initiative, a key PEPFAR strategy for HIV prevention among adolescent girls and young women (AGYW), their sexual partners, and families. In Lango, as in so many places around the world, AGYW lack economic opportunities and are stymied by social norms that increase their likelihood of experiencing gender-based (including sexual) violence and contracting HIV. USAID RHITES-North Lango provided a package of HIV-prevention interventions including youth-friendly sexual reproductive health services, post-violence care, and life and business skills and financial literacy training, including VSLAs.
As we commemorate the International Day of the Girl Child this month, we celebrate the efforts of three young women to access family planning and reproductive health services in Uganda.
Eunice is chair of Obanga Twero VSLA. Before her involvement with DREAMS, she did not discuss family planning with her husband because she was afraid he would become violent.
“I conceived my second child before the first one even made a year, and because of that, my two children are like twins,” Eunice said.
In an effort to overcome cultural and institutional barriers to family planning information and services, RHITES-N, Lango trained DREAMS peers and ambassadors to offer family planning services to women in their homes. Their counseling and support enabled Eunice to talk to and convince her husband about the benefits of family planning after speaking with a peer. Now, a DREAMS peer delivers injectable contraception to Eunice every three months.
Sharon, who is 24 and has a 5-year-old daughter and an 11-month-old son, is an advocate for family planning in her community in Chegere sub-county in Northern Uganda. Her journey as an advocate started when she got involved with DREAMS and learned about the benefits of family planning, particularly how birth spacing allows parents to better care for their children.
Sharon’s work is vital to the many young women who want to delay or prevent pregnancy but lack knowledge and decision-making power to do so. So far, she has helped more than 1,000 of her peers by conducting group meetings and one-on-one counseling sessions, and providing short-term contraceptives at the safe space.
Sharon’s commitment to dispelling myths and misconceptions, reinforced by her husband’s involvement as a male champion, increased acceptance and uptake of family planning, and reduced pressures associated with child welfare in her community.
“Family planning has accorded me respect among my peers and in my village, and love from my husband,” Sharon said. “Because I can care for my children comfortably, they are healthy, my husband is healthy, and I am healthy.”
Apac District in Northern Uganda has a persistently high pregnancy rate among adolescents and young girls. Long distances to clinics, health worker stigmatization of adolescent girls, economic challenges, and a general lack of information about family planning contribute to this problem. Health facility staff, meanwhile, burdened by financial constraints and commodity stockouts, struggle provide what little demand for family planning services there is.
When the DREAMS initiative trained young women to become DREAMS peers to administer short-term family planning methods, adolescent girls were able to avoid stigmatization from facility-based health workers. Rebecca, a trained DREAMS peer, praised the initiative’s provision of family planning boxes, which made commodities more accessible, and said, “The family planning service will contribute a lot in improving the health condition and economic status of my family because now I can control birth. Girls can meet their basic needs and gain freedom to work in gainful employment.”