The Unmet Need for Family Planning In Rural Uganda

The Unmet Need for Family Planning In Rural Uganda

The Unmet Need for Family

Planning In Ssembabule,


Analysis of Baseline & Midterm Evaluation of a Community-Based Family

Planning Program in Uganda

Sweta Shrestha

Public Health Symposium

May 7 th , 2010



Uganda Child Spacing Program

• Results

• Discussion

• Conclusion

Global Burden

ore than 500,000 women in the world died during

pregnancy, childbirth or in the first 6 weeks following

delivery. 1

50,000 preventable maternal deaths occurred in 2000. 2

dult lifetime risk of maternal death. 3

• 1 in 7300 in developed regions

1. UN MDG Report, 2008

2. Cleland et. al, 2006

3. Fortney, 2009


•Population: 32,369,558 (2009)

•85% of the population live on

less then 1 dollar a day

•Total Fertility Rate: 7.1 per

woman 4

•Maternal Mortality Rate:

880/100,000 live births 4


th highest maternal death

rate in the world 5

4. WHO, 2006

5. Hogan et, al. 2010


• Minnesota International

Health Volunteers (MIHV)

• Operating in Uganda since


Uganda Child Spacing


• Ssembabule District

• Mubende District

Photo: Philip Bowen

The Uganda Family

Planning Program

MPH Field Experience

• Midterm Survey Implementation

• Training

• Process monitoring

• Data collection

• Dissemination of preliminary data

Evaluation Methods

• Knowledge, Practice and

Coverage (KPC) survey

• USAID Flexible Fund

Family Planning Survey

• Women of reproductive age

• Core indicators of family


• Focus Group Discussion

• Men, women, health


Baseline Results

• 99% of women knew of at least three methods of

family planning.

• 60% of those interviewed were not using a modern

method of family planning.

• 55% of women have less then 24 months gap

between the birth of consecutive children.

• Out of 120 women of reproductive age, 79 wanted

to delay or avoid pregnancy, only 35 were using

modern family planning.

Bowen et. al. 2007

Unmet need for Family


• Barriers & Themes

Family planning counseling

• Accessibility of family planning services

• Distrust in government health systems

• Decision making dynamics between genders

• Conflicting messages

• Cultural barriers

Translation to Practice

• To date

• Men as family planning community health workers

• Counseling services

Injectable contraceptive

• Education

• Considerations for future programs

• Alternative contraceptive methods

• Access

• Gender issues


Broad impacts of family


•Poverty alleviation



•Gender equality

•Environmental preservation 2

Focusing on family

planning is essential to

improving population

health in developing


Cleland et al, 2006

Lessons learned

• Cultural humility/ sensitivity

• Time lines in different context

• Availability of resources

• Flexibility

• Logistics

• Persistence

• Patience


•Capstone Committee

WellShare International

Ugandan Staff

•Laura Ehrlich

•Jennifer Bentley (MPH student,

social support)

•Dr. Cynthia Haq (Chair)


Diprete Brown (Advisor)


Lukolyo (Preceptor)

•Center for Global Health

•MPH Program

•Friends and Family

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