The Unmet Need for Family Planning In Rural Uganda

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The Unmet Need for Family Planning In Rural Uganda

The Unmet Need for Family

Planning In Ssembabule,

Uganda

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

Planning Program in Uganda

Sweta Shrestha

Public Health Symposium

May 7 th , 2010


Overview

Introduction

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


Uganda

•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

•16

th highest maternal death

rate in the world 5

4. WHO, 2006

5. Hogan et, al. 2010


Introduction:

• Minnesota International

Health Volunteers (MIHV)

• Operating in Uganda since

1982

Uganda Child Spacing

Program

• 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

planning

• Focus Group Discussion

• Men, women, health

workers


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

Planning

• 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


Conclusion

Broad impacts of family

planning:

•Poverty alleviation

•Health

•Education

•Gender equality

•Environmental preservation 2

Focusing on family

planning is essential to

improving population

health in developing

nations.

Cleland et al, 2006


Lessons learned

• Cultural humility/ sensitivity

• Time lines in different context

• Availability of resources

• Flexibility

• Logistics

• Persistence

• Patience


Acknowledgments

•Capstone Committee

WellShare International

Ugandan Staff

•Laura Ehrlich

•Jennifer Bentley (MPH student,

social support)

•Dr. Cynthia Haq (Chair)

•Lori

Diprete Brown (Advisor)

•Heather

Lukolyo (Preceptor)

•Center for Global Health

•MPH Program

•Friends and Family

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