In the last 10 years, the fertility rate in Uganda has remained persistently high, averaging 6.7 births per woman. Uganda has one of the world’s fastest growing populations with the annual growth rate of 3.2 per cent and experts say the country’s public services are finding it hard to cope.
According to the Uganda Demographic Health Survey 2006, 41 per cent of the women in Uganda would like to delay or stop having children but are not using modern family planning methods, and therefore, have an unmet need.
Besides ignorance about family planning and the lack of access to contraceptives, the campaign against family planning is accentuated by skewed cultural myths such as gender preference and looking at children as a source of labour and wealth. Some people have more children as an insurance scheme of sorts against child deaths.
Some women have expressed fear of spousal desertion when they stop giving birth. This situation has been exacerbated by the inconsistent political support for the family planning movement.
Such ambiguity can be reflected in two government reports. For example, whereas Uganda’s Population Secretariat report (2006) appears to show that a growing population could serve as a demographic bonus for economic growth, the same thinking peddled by our leadership, ministry of Finance has noted the limited progress of family planning in Uganda and that Uganda’s traditionally large family sizes are now becoming an impediment to the speed of economic growth, and social and structural transformation. (MOF-2004)
What is more worrying is that Uganda has failed to honour the health commitments of the Abuja declaration made by the African Union in April 2001, to allocate a minimum of 15 per cent of national budget to addressing health issues. In the financial Year 2014/15, the health sector’s share of the total budget reduced from 8.6 per cent to 8.4 per cent.
Yet this sector which superintends over all government family planning efforts. More so, whereas essential medicines are not taxed in Uganda, since the beginning of 2012, the Uganda Revenue Authority now treats contraceptives as taxable. This makes the cost price of contraceptives prohibitive and inaccessible to most Ugandans.
Although family planning is primarily about health and human rights, the right to choose when and how many children to have, Uganda must adopt and promote a deliberate action plan that will reverse the debilitating economic and health effects that we currently experience due to lack of an explicit family planning policy.
For example, one in every four children living on the streets or in child care institutions across the country has a parent who is unable to provide for them. Social safety nets such as extended family support to orphans and other vulnerable children is waning because of poverty.
A mother’s risk of dying from pregnancy related complication is about 250 times greater in a developing country than in a developed country.
In developing countries, pregnancy and childbirth and their consequences are still the leading causes of death, disease and disability among women of reproductive age.
New born deaths are 40 per cent of all child deaths in developing countries yet research shows that satisfying unmet family planning need can directly contribute to reductions in maternal and child mortality—averting an estimated 16,877 maternal and 1.1 million child deaths worldwide by the year 2015 according to US Agency for International Development Health Policy Initiative, 2006.
The government should expedite the implementation of its roadmap for providing universal access to family planning so as to reduce the ‘unmet need’ for family planning from 40 per cent to 10 per cent by 2022.
The current demographic trend shows that inaction will lead to a population explosion with severe social, economic and health effects that will be insurmountable to reverse.
Mr Oramire is a child rights advocate working with Centre for Children’s Rights.