Knowledge and Perception about Family Planning by Women in Uganda

Blog post by Sylvester Nnyombi, Content Guru, Reach A Hand, Uganda

Phoebe Nabaweesa* was 22 years when she decided to try a family planning option mid last year. She zeroed in on the injection primarily because she had observed its impact on her best friend for quite some time. Most of which was positive- at least as far as she was concerned.

Phoebe’s friend had a good appetite, gained weight and was having sex without getting pregnant. Phoebe went to a clinic in Konge, one of the suburbs of Kampala, with a preset mind to receive the injection. Parting with 4,000UGX (Approx. $1) she received it, and that’s when all hell broke loose.

“I had a constant flow of blood from the time I got the injection. It was like having my period every day for three months!” the 23-year old factory worker in Konge narrates.

Having seen the blood flow for a month, she returned to the health facility, this time seeking medical attention. The attendants tactfully told her that the body needed time to get used to the hormones injected in it. Unfortunately, this was to span over 3 months. She also suffered constant illness over the next month after the injection-prescribed time had elapsed.

“When I saw my friend having the injection work for her, I believed it would work for me too, so I didn’t bother seeking advice from a health worker” she added.

That was her most painful miscalculation. Her biggest regret. Choosing a family planning method without the advice of a medical practitioner is not only improper, but also risky, heralding several complications to the body that may be fatal at worst.

The importance of involving a health personnel when choosing a family planning method is very cardinal to its effectiveness, and the story of Juliette Nawungu* is just another of the many testimonies that go a long way in demonstrating that  fact. Across the hill from Phoebe’s work station, Juliette, then 21, decided to opt for family planning after having her second child.

“I went to a Marie Stopes clinic and after the health worker had taken me through the very many available options, we agreed that the implant was the best for me” she said.

The method cost her 50,000 UGX ( about 13 US$) and it was carefully inserted by the medical staff at the facility. Lodged in her arm, it would last 3 years. It was removed  last week at the #Voices4Health community outreach in Kansanga. She is now 24 years, and is proud of the decision she made.

Dennis Sessanga, the Marketing and Public Relations Officer at Marie Stopes Uganda further re-echoes the importance of involving a doctor or midwife when choosing a family planning method.

“Our bodies are not the same. How one may react to one family planning method is not the same way another would react to the same option. Discussing with an expert helps you to identify which one would work best for you, so you don’t regret the decision” he explained.

Phoebe has since stopped using family planning because she deems the time right to have a child. She however says that if she ever chooses to take another go, she would go to the health worker first, having taken lessons from the #Voices4Health outreach. The health personnel’s advice is the most important part in choosing an option, endeavor not to miss this step.

*All names with asterisks have been changed to enhance the privacy of the women interviewed.

Men Must Be Part of the Solution – Sharing Realities from Uganda to the United States

By Priyanka Ghosh, Manager, Communications and Marketing, EngenderHealth

The annual Social Good Summit is always an event I’d catch online, but this year was different because I had the opportunity to attend in-person, and it did not disappoint. One of the great sessions that I attended was the Social Good Master Class, which offered some great insight into the role of men and boys in family planning.

The class is an opportunity for global bloggers and development practitioners to learn from thought leaders who “defied norms to make a difference.” The session was entitled “Family Planning: Not Just for Women” and focused on the need to engage men and boys as clients, partners, and agents of change to achieve global sexual and reproductive health goals and equality. Here are some highlights:

Elman Nsinda, journalist, citizen activist, and member of the White Ribbon Alliance from Uganda, sparked the conversation by sharing a recent incident in Uganda when a man refused to pay a medical center 50,000 Ugandan shillings (around $20 USD) to help his wife, who was in labor. In the absence of skilled medical care, his wife died—a tragic and needless death. According to Nsinda, in most families men are the decision makers when it comes to sexual relations and reproductive health, including whether or when women can seek health care. He said, “In Africa, men decide. It is therefore important to reach out to them, as they exercise control over critical decisions.” Nsinda recommended that social and health programs be more welcoming to men and boys, who need to play constructive roles in promoting health.

Jenifer DeAtley, Director of U.S. Programs and the Adolescent Sexual and Reproductive Health Advisor at EngenderHealth, shared her experiences from the Gender Matters (Gen.M) project in Travis County, Texas. This state currently has the third highest teenage pregnancy rate in the United States, with more than 73,000 girls becoming pregnant each year. The project works toward preventing teenage pregnancies by engaging young people in discussions around healthy relationships, consent, gender, sexually transmitted infections, and contraceptive options. Jenifer shared a key takeaway from EngenderHealth’s long-standing work with men, which is that synchronizing programs to focus on both men and women, girls and boys, increases the likelihood of success and leads to better health outcomes. She added, “It is important to make young people see where gender norms come from in their daily lives, recognize these influences, and empower them to redefine who they want to be as young men and women. When we engage them in such conversations, it helps them to build more stable homes inside their own relationships.”

To date, however, reaching young men has been challenging: “Young fathers [have] often been one of the hardest communities to tap into. There are few services designed for young men, particularly young fathers. Young men are hesitant to go to health clinics because there is fear and stigma associated with accessing health care services. It’s understandable, because often advertisements for clinics are designed in a way that gives the impression that it is a woman’s space. It is important to have messaging that’s welcoming, particularly for young men. They should be able to walk into these spaces and not feel that they are in the wrong spot. It is important to have a human-centered approach that puts young people first.”

Jenifer DeAtley, Director of U.S. Programs and the Adolescent Sexual and Reproductive Health Advisor at EngenderHealth, shares her perspective at the Social Good Master Class 2016, New York. Image credit: Staff / EngenderHealth

The moderator, Alencia Johnson, from Planned Parenthood Federation of America, wrapped up the session by asking Elman and Jenifer what they hoped would be the impact of their work involving men and boys. Elman reinforced that since men are often the decision makers in his community, it is important that they are encouraged to be responsible and held accountable for their behaviors. Jenifer mentioned that she hopes EngenderHealth’s work in sexual and reproductive health and rights will help move the needle on many of the Sustainable Development Goals.

Based on the recurring theme throughout the session, it was evident that in the future, countries and donors must increase investment in and create programs that focus on engaging both men and women as part of the solution to achieve health and equality.

An Interview with Wale Adeleye, a Youth Champion for RMNCH in Nigeria

Rise Up is pleased to launch our Impact Blog Series for the Women Deliver conference in Copenhagen, Denmark. This series highlights the work of two Champions for Change (C4C) leaders in Nigeria and one Youth Champions Initiative (YCI) leader from India. C4C’s Champions in Nigeria are working together to save the lives of mothers, children and young women through innovative advocacy and leadership development. YCI’s Champion in India is working to lead the sexual and reproductive health and rights (SRHR) movement for the next generation.

This series brings a diversity of perspectives to the table to discuss their critical work in driving the progress in maternal, sexual, and reproductive health and rights, as well as sharing the impact they have made through partnerships, awareness raising, and innovation.

We are featuring an interactive discussion with Francesca Adeola Abiola of Action Health Inc., an NGO in Nigeria dedicated to promoting young people’s health and development to ensure their successful transition to healthy and productive adulthood; Wale Adeleye of Civil Society for Family Planning, an NGO in Nigeria dedicated to addressing various aspects of reproductive, maternal, newborn, and child health advocacy, with a special interest in family planning; and Gayatri Parameswaran of Love Matters, a global platform about love, sex, relationships, and everything in between for young adults in India.

In the first part of this series, Rise Up speaks with Wale Adeleye, National Coordinator, Civil Society for Family Planning, Abuja, Nigeria and C4C Champion, Rise Up.


Headshot - Adewale AdeleyeRISE UP: As we know, there are many international non-profit organizations working in Nigeria. Why did you opt to be part of the PHI/RISE UP program specifically? What skills do you hope to acquire and what do you intend to do with this new knowledge and skills?

Wale: I am involved in the PHI/RISE UP program because it is going to build my capacity to really become a champion and push for the reproductive health rights of women. It will also well position me to advocate for necessary policies. I hope to acquire a strong set of advocacy skills which I intend to use to further the work of improving the lives of mothers in Nigeria.

RISE UP: Why are you a champion for women’s and children’s health issues in Nigeria?

Wale: I once worked for a health reform advocacy organization, which gave me insights into what women face in terms of their sexual and reproductive health rights. I vowed to become an advocate for women’s rights because reproductive health must be valued as a “best buy” by the Nigerian government and as a vehicle for improved maternal and child health. The area I am most passionate about in RMNCH is women’s sexual and reproductive health rights.

RISE UP: What is the biggest challenge you face as an advocate for women and children’s health?

Wale: The biggest challenges I face in this work are religious and cultural factors which inhibit our advocacy efforts.

RISE UP: What success are you most proud of in your professional career?

Wale: One major success was the recent approval for the enlistment of Emergency Contraceptives on Nigeria’s Essential Drug List (EDL) and of course the signing into law of the National Health Act.

RISE UP: What’s your vision for the future of health care in Nigeria?

Wale: My vision for the future of Nigeria’s health system is such that health is not only equitable, but accessible and affordable to all, irrespective of status. When women, newborns, and children have adequate access to good quality health services and information there will be new life and new possibilities.

RISE UP: What has been the impact of your work?

Wale: Since the beginning of implementation, 11 women (ages 20-50) who are leaders of various CSOs were trained on policy advocacy using AAFP SMART tool. Indirectly, at least 22 women will benefit from step down training from the 11 trained CSO leaders’ (women) organizations. By the end of the project, 30 Female CHEWs will be impacted directly by this project when task shifting policy is adopted by Gombe state. Through this project, 11 women from CSOs who are our allies were trained in policy advocacy. Currently 2 women are working on the project directly. All these put together will impact 43 women directly.

We invite you to follow us on Twitter at @RiseUp_Together and use the hashtag #WD2016 to engage more closely with the Impact Blog Series for Women Deliver, the work of the three leaders whose work is being highlighted, and the larger conversation surrounding reproductive, maternal, newborn and child health in Nigeria as well as sexual and reproductive health and rights in India.

Champions for Change is a Bill & Melinda Gates Foundation-supported program of Rise Up and improves the lives of women and children in Nigeria by empowering local leaders and organizations to advance reproductive, maternal, newborn, adolescent and child health through advocacy, education, storytelling and strategic partnerships. Champions for Change leverages a program model developed by its sister initiative, Let Girls Lead, which contributes to improved health, education, livelihood and rights for nearly 40 million girls globally. This powerful model drives change through the passage of laws and policies, implementation of programs and distribution of funds to ensure access to quality healthcare, education and economic opportunity. Rise Up is headquartered at the Public Health Institute in Oakland, CA, a leader in global health and development for 50 years.

Follow Champions for Change on Twitter



How Activists and Organizations are Using Social Media to Promote Family Planning

When Imali Ngusale hosts social media discussions about sex and family planning, to inform people about subjects they are not exposed to at home or in school, she often uses numbers and codes to keep the conversation under wraps.

“We do this because when it goes to social media … somebody may need to find out where they can get youth friendly services — and if their parents or relatives are following them, you want to make it discreet,” Ngusale said of the online chats, which usually consist of more than 100 curious youths who use Twitter to talk about reproductive health. “It is an innovative way to be discreet but also cool.”

Ngusale, a 27-year-old social media strategist who works for the Centre for the Study of Adolescence in Nairobi, Kenya, said she has to do “some very good ground work” before each discussion, emailing people to inform them when conversations will occur and what code words will be used.

“You can create meaning through different trends,” she said.

Ngusale was one of dozens of young people at the fourth International Conference on Family Planning in Bali, Indonesia, in late January, who uses social media to better connect with and provide information to people seeking sexual education.

At the Planned Parenthood of New York City, Judith Gomez works with about 10 teenagers to create relatable online content for youths as a way to teach them about sex and their organization.

“We really need to meet young people and teenagers where they are — and in New York City, that’s online,” she said during a presentation at the conference. “An important part is that the content is created by teens, for teens.”

Gomez, a 23-year-old Dominican woman from the Bronx in New York City, said one the best way to connect teenagers to family planning is through memes and videos. She showed examples of this at the conference, which included a meme of Ash Ketchum from the Japanese animated cartoon “Pokémon,” with the caption, “Protection. I choose you!”

Another was an image of the Simpson family from the American sitcom “The Simpsons,” walking down the street with the caption, “Going to PPNYC with squad.”

“Social media is a vital source to how young people communicate,” Gomez said, adding that it is “a free or low cost way to reach out and show young people that their health is important.”

In countries where young people are not as acquainted with social media, advocates use other means of communicating to reach the general public, such as radio and television.

Desmond Nji Atanga, a young leader at Women Deliver, said in Cameroon, a country in central Africa, radio reaches the largest amount of people, especially in rural regions where some don’t have ways to learn about reproductive health.

“All we can do is to further encourage young people in the area to join social media” so they can get information quicker and easier,” Nji Atanga said.

Patrick Segawa, who founded Public Health Ambassadors Uganda, a youth-led community organization that seeks to address sexual and reproductive issues, said he tries “to provoke discussion online and discuss issues on reproductive health” through social media. His organization, which has more than 2,100 followers on Twitter and likes on Facebook combined, produces short videos and shares catchy phrases in the hopes to educate people on the Internet.

Segawa, who holds a bachelor’s degree in public health from the International Health Sciences University in Kampala, Uganda, said he met people at the conference who already knew him through various online networks. “People tend to associate your name with what you post,” he said. “So by the time you get to see them, they know your face and are like, ‘Oh … I’ve seen your posts — you do great stuff.”

As Maureen Odour, a 30-year-old young leader at Women Deliver in Kenya, put it: “A young person in the U.S. can tweet something and in Africa they can see something about it. Social media connects youth beyond the border.”

Cover Photo is of Maureen Odour, credit to authors. This story was supported by funding from the Pulitzer Center on Crisis Reporting.