ACCESS TOFAMILY PLANNING SERVICES BY WOMEN WITH DISABILITIES IN MUKONGORO SUB COUNTY, KUMI DISTRICT

Background to the study

Having a disability places one in the world’s largest minority group. An estimated 10 percent of the world’s population lives with disability. The World Bank (2004) estimates that 20 percent of the world’s poorest people have some kind of disability, and tend to be regarded in their own communities as the most disadvantaged.

Globally, Disabled people comprise approximately 10% of the world’s population, 75% of whom live in developing countries, and constitute one of the most poor, marginalised and socially excluded groups in any society. Disabled people, irrespective of where they live, are statistically more likely to be unemployed, illiterate, to have less formal education, and have less access to developed support networks and social capital than their able-bodied counterparts (Munene, 2012).

According to the World Health organization-Department of Reproductive Health and research (WHO, 2007), there is a global concern about Reproductive Health Programmes/ Care (Family planning Services) for all women irrespective of their reproductive age and disability. It further suggests that Family planning remains unfinished.

Family planning refers to practices that help couples to avoid unwanted child birth, to regulate the intervals between pregnancies and to determine the number of children in the family. It is also the process of controlling the number of children you have by using family planning methods. According to Bankole et al. (2006), the role of family planning methods is to help women and men reconcile their sexual lives and their desire for children. There are several methods of family planning such as an implant, or an intra-uterine device, the pill, the injection and vaginal ring, condoms and diaphragms, fertility awareness, vasectomy and tubal ligation.

According to Alcala (2013), in developing countries today, particularly in Africa, couples have concluded that it is in their best interest to plan and limit the number at birth. Unfortunately, in situation particularly in Sub-Sahara Africa, extreme poverty, profound inequalities between men and women, and early marriages, severely limit women’s ability to achieve their child bearing goals.

Uganda, like any other developing country has challenges in making Family Planning Services accessible by all women (Uganda Service Provision Assessment – UPSA, 2007).  Despite USPA’s struggle to make Family Planning services accessible by women, 6.9% of Ugandan women still have about 7 children average.According to United Nations (2015) the government support for long term and permanent methods of Family Planning has been present since the time of introduction of services in Uganda. The feasibility of this government support through media and community based advocacy events has been limited.

Women with disability often cannot obtain even the most basic information about sexual and reproductive health (SRH). Thus they remain ignorant of basic facts about themselves, their bodies, and their rights to define what they do and do not want. They may have little experience relating to and negotiating with potential partners. Women with disability may be denied the right to establish relationships. They fit the common pattern of structural risks for HIV/AIDS and other sexually transmitted infections – e.g. high rates of poverty, high rates of illiteracy, lack of access to health resources or information, and lack of power when negotiating safer sex (Tonny, 2015).Women with disability face many barriers to care and information about SRH. There is the frequent assumption that persons with disabilities are not sexually active and therefore do not need SRH services. However, research shows that persons with disabilities are as sexually active as persons without disabilities (World Bank, 2004).

Uganda has several laws and policies that it has put across to ensure that women with disabilities have access to health services just like any other woman for example the PWD Act (2006) which stipulates that the government shall provide special health services required by PWDs including providing access to reproductive health services which are relevant to women with disabilities. However, family planning services are often inaccessible to women with disability for many reasons, including physical barriers, the lack of appropriate clinical services, and stigma and discrimination. In many situations, barriers to health services include: lack of physical access, including transportation and/or proximity to clinics and, within clinics, lack of ramps and adapted examination tables; lack of information and communication materials (e.g. lack of materials in Braille, large print, simple language and pictures, lack of sign language interpreters); health-care providers’ negative attitudes and; providers’ lack of knowledge and skills about persons with disabilities(Mosha, 2015).

Mukongoro is a sub county in Kumi district in Eastern region in Uganda. It has about 16 parishes and 46 villages. Kumi district has 2 hospitals, 1 health IV,5 health centre IIIs and 8 health centre IIs with a total of 16 health facilities. Access to health facility has increased slightly to 85% and the general service delivery and primary health care in the district has improved over the years. Mukongoro has 1 health centre III and 2 health centre IIs (Mukongoro NGO and Agaria), these are accessed by both women with and without disability (Kumi Local Government Statistical report, 2012).It’s upon this background that the study will be carried out in MukongoroSub County to investigate the access to family planning services by women with disabilities.

Problem statement

There are still challenges in accessingfamily planning services by women with disability. However, women with disability, like all people, should enjoy human rights that are secured by laws and policies in Uganda for example the PWD Act (2006) which stipulates that the government shall provide special health services required by PWDs including providing access to reproductive health services which are relevant to women with disabilities.

Despite, the Government of Uganda, being a signatory to international laws and policies (such as the CRPD, UNDHR) to ensure that women with disability enjoy their rights, there is still low number of women with disabilities accessing family planning in Mukongoro health III and II.Thus, the study will be carried out in Mukongoro Sub County to assess the access to family planning services by women with disabilities.

Purpose of the study

The main purpose of the study is to investigate the access to family planning services by women with disabilities in Mukongoro Sub County, Kumi District.

Objectives

1. To find out the social-economic factors that influence the access tofamily planning services by women with disability in Mukongoro Sub County, Kumi District.
2. To assess the challenges faced by women with disabilities in accessing family planning services in Mukongoro Sub County, Kumi District.
3. To suggest strategies to improve family planning services offered to women with disabilities in Mukongoro Sub County, Kumi District.

Research questions

1. What social-economic factors influence the access to family planning services among women with disability in Mukongoro Sub County, Kumi District?
2. What challenges are encountered by women with disabilities in accessing family planning services in Mukongoro Sub County, Kumi District?
3. What strategies can be adopted to improve family planning services offered to women with disabilities in Mukongoro Sub County, Kumi District?

Scope of study

Content scope

The study will investigate accessibility of family planning services by women with disabilities. Specifically, the study will identify family planning services offered to women with disabilities, challenges faced by women with disabilities in accessing family planning services and suggest strategies to improve family planning services offered to women with disabilities.

Geographical scope

The study will be carried out in Mukongoro Sub County, Kumi District. This is due to the easy access to the area. The study will be carried out in four parishes out of 16parishes in Mukongoro sub county and these will include; Agaria, Akadot, Kachaboi and Mukongoro.

Time scope

The study will be carried out for a period of four months in 2017.

Significance of the study

To policy makers, the study will provide relevant information for them to put more effort on improving on the methods of family planning and increase their accessibility to women with disabilities.

To health care providers, the study will enable them realize the factors that hinder the accessibility of family planning services by women with disabilities.

NGOs will benefit from the findings of this study since it will provide them with relevant information that they can use to act upon improving health of women with disabilities.

Women with disabilities will be availed with information on what family planning services they can use.

The study will be relevant to the scholars in that it will add more literature base on the existing body of knowledge.

Limitation of the study

Financial resources will be inadequate since the University will not be in position to facilitate the resources to the researcher for typing, binding and other expenses like transport fees when using the area of investigation. However, the researcher will obtain fund from family members i.e. parents and guardians plus friends to solve the problem of limited financial resources.

Unrealistic expectation from the respondents is also another problem the researcher will face. It is argued that very many people will expect too many things from researcher for example money etc, yet the researcher is totally student who does not have money. However, the researcher will use the local leaders to convince the community members that researcher is here to gather information on the given problem which will help  in future use but don’t expect many things like money from her.

CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.0 Introduction

This chapter presents review of related literature by other researchers and educationalists on topic about the access to family planning services by women with disabilities.The related literature presented under this topic is based on the three of objectives.

2.1 Factors that Hinder Women with disabilities from Accessing FamilyPlanning services in Uganda

According to Byarugaba (2009), Family Planning services are available both in private clinics and government health centres but there are some challenges faced by women with disabilities in accessing it, hence some reasons for low turn up of women with disabilities for services like they have worries of the side effects. For example injecta-plan method, many women with disabilities suffer the consequences of chronic bleeding without ceasing or at times it cause obesity. Other beliefs such as religious affiliation for example Catholic have a negative attitude about Family Planning methods; they don’t use it but prefer bearing children till it is no more. The duration of the methods such Norplant method which after insertion, lasts for 5 years to expire and another one like Copper T-coil some expire after 10 years. Hence hinders the turn up of women with disabilities for services. Ignorance of both spouses is a challenge to access the service in the area.

Byarugaba further noted that some health centres have the services but they do lack skilled personnel for example, he once missed clients in his private clinic (Kireka Medical Centre), who had come for Norplant method and was away and all the nurses were unskilled to take on the procedure. However, perceptions of both community level and individual level quality could provide key insights for developing effective and efficient Family Planning programs.

World Health Organization (WHO, 2009) further stated that, reasons for unmet need are many and they are attributed to limited services and supplies, fear for social disapproval of partner’s opposition pose formidable barriers, worries of side effects and health concerns hold some people back, others lack knowledge about contraceptive options and their use.

In the traditional understanding, Family Planning was not an issue to be considered because a large number of children were seen as a blessing, security for the future and guarantee for continuity of lineage and clan. The more children a man had, the more he was respected and the more children a woman had, the more she was valued in the clan. If she is married to therefore the introduction of the new Family Planning practices was concerned as a plan to stop women with disabilities from bearing children which is interference to the plan of God as seen in some Kiganda expression, like “Muzaalemwale” meaning you can produce as many as possible.

Kumi district health service report (2010), pointed out that, in Uganda, though there is an effort to provide this Reproductive Health Programme, it is very weak because of the challenges it is still facing for example, the stereo type thinking and ignorance among the local people. Most women with disabilities have stereo types which have been constructed by the society in which they live. For example, they meet so many challenges and most often men, they are also ignorant of the importance of reducing Family sizes through Family Planning. This problem is worse when it comes to Mukongoro Sub County whereby women with disabilities are always in great fear to take up the services because they feel that they will get serious complication in the future. This problem leads to under development and the low socio-economic development of Mukongoro sub county.

According to International Conference on Family Planning (2009), an estimated 41% of Ugandan Women with disabilities who would like to stop having children have no access to Family Planning Services. However, this has resulted into unintended pregnancies and bigger families. It further stated that in Uganda a woman will give birth to an average of 6 – 7 children in her life time. Such large families in developing countries are linked to poverty, poor nutrition, low education levels and even health dangers, for example a woman is at risk of maternal mortality increase with each birth.

According to the Uganda National Family Planning strategy (2005 – 2010), March, 2005, Development by the Ministry of Health over two thirds of Ugandan women with disabilities and men say that they want to space children or limit children bearing (71% of women with disabilities and 67% of men). However, they face many challenges which include the social, cultural, religious values which have strong influence on reproductive choices for women with disabilities in Uganda. Early frequent child bearing and large Family size reflect long standing societal norms among most segments of population.

According to the 1980’s law, further controversy emerge when social and religious conservatives began alleging that the very availability of Family Planning services promoted promiscuity and abortion, and that the provision of confidential services to teenagers encouraged the disrespect of parental authority (The Development Office of the Kenya Catholic Secretariat). The Catholic Church and some societies have always preached against use of Family Planning Services saying that it’s a sin and against Gods command that is to say “Go, subdue and fill the world”. These controversies initiated a big challenge to the delivery of Family Planning Services in most societies for example Mukongoro Sub-county where so many women with disabilities have bared   children as commended by the churches, their spouses, among others.

According to the MoH, (2009), the levels of understanding and acceptance of Family Planning Services is also a big challenge. According to the study of working women with disabilities and non-working women with disabilities in Bargladesh 59% of the working group who had acquired some education were employing contraceptives compared to 41.4% of non working group who had acquired less or no education at all. 45.1% of the non working group had never used contraceptives compared to 23.9% of working women with disabilities. 55.9% of the working women with disabilities participated in Family Planning decision making with their spouses as compared to 23.5% of the non workingwomen with disabilities. The level of understanding here influences acceptance that is to say the more people understanding the importance of Family Planning, the more they will be lured to adopt. In Mukongoro Sub-county, the level of understanding of Family Planning services is still very low and therefore acceptance to embrace it is still low.

The rising costs of some contraceptives and of state of the art medical technology complicated the delivery of Family Planning Services to the existing and at the same time, Family Planning Services (methods are inadequate). Also contributed to inaccessibility of Family Planning services by women with disabilities in Mukongoro Sub County. They’re just few (2 – 3) methods only in per Health centre out of different methods available in hospitals.

According to the Family Planning Global Handbook for providers (2008), some women with disabilities find it very hard to discuss their desires to use condoms or any other method of Family Planning. (To access the Family Planning Services). Men give different reasons why they           stop their women with disabilities to access Family Planning Services, therefore you find out that women with disabilities with low bargaining power end up being oppressed and exploited by their partners through convincing them to access Family Planning methods. This situation can be clearly seen in Mukongoro sub county where women with disabilities often have inferiority complex with in them and always feel ashamed to talk about it hence leaving the decision to be made by men.

African Union Commission (2009), states that high fertility is directly related to child and early marriages. Other factors related to this are unmet needs for contraceptive services, lack of sexuality information and lack of Family Planning Services for the prevention of pregnancy. All these conditions make birth spacing difficult to manage and increase incidents of unwanted pregnancies. Hence may lead to MMR is IMR.

According to Ministry of Health, (Dr. Stephen O. Malinga), in the second National Health Policy of promoting people’s health to enhance socio-economic development Speech (July, 2010), he said health resources such infrastructure has grown from 1979 in 2004 to 2301 in 2010. However, inequity exists in the distribution of health facilities and most facilities are in a state of despair, inadequate transport is a major limitation especially newly created districts. He further said that rehabilitation of buildings and maintenance of medical equipment is not regularly done. Other challenges are shortage of basic medical equipment accommodation of staff, and transportation remains major challenges. He further stated that inadequate financial and human resources, only 30% of the essential medicines and health supplies required for the basic packages are provided for in the framework for medium expenditure.

This has increased dependency on the private sector and therefore most patients often find that medicines are not affordable. For that reasons, many mothers mentioned that the few Family Planning methods which are cheap have bad side effects and other best alternatives are two expensive for them to use.

2.2 Challenges encountered by women with disabilities in accessing family planning services

Women with disabilities often encounter physical, attitudinal, and policy barriers in seeking to meet their health care needs. Physical barriers include the unavailability of transportation; stairs and narrow doorways into clinics, doctors’ offices, etc.; written information, such as intake forms and patient education materials, not available in alternative formats (i.e. Braille, tape, large print); high examining tables which prevent transfer by women using wheelchairs; mammogram machines which require patients to stand; and lack of personal assistance to women who need it during clinic visits. These barriers may be remedied through accessibility planning and modifications; availability of written materials in alternative formats; obtaining “adaptable” equipment such as tables which can be raised and lowered, and provision of trained, appropriate assistance in mobility and other personal care needs.

Higher rates of poverty and housing stress and lower levels of education and employment are experienced by women with disabilities, compared with men with disabilities, or women without disabilities. Women living with disabilities are more likely than those without disabilities to experience social and economic disadvantage and poverty. Contributing factors include lower levels of education and employment (46.9% compared with 59.9% for men with disabilities and 64.9% for women without disabilities). Lower income contributes to significantly more housing stress, food insecurity, poorer nutrition and higher rates of obesity and chronic disease (Beer and Faulkner, 2009).

Policy barriers may be imposed by hospital or clinic regulations; by insurance companies; or by other third-party payers such as Medicare and Medicaid. Some insurance providers discriminate against individuals with disabilities, by barring coverage for “preexisting conditions,” or by cost-capping services which may be essential for managing a disability. Another major barrier is that some necessary services — such as in-home personal assistance services, prescription medications, durable medical equipment, holistic health services, assistive technology, preventive care, certain therapies, or abortion services — may not be covered by private or government-funded insurance plans. Government and private policies may also have an “institutional bias” — i.e., they offer services primarily in nursing homes, rehabilitation hospitals, and other large long-term care facilities; but not in the disabled woman’s own home, where she can be part of her family and community. Ending this institutional bias, and securing more support for independent living (IL) and community-based rehabilitation (CBR), is a major focus of disability-rights advocates in many countries (Laura, 2000).

Lower levels of health knowledge among some women with disabilities may contribute to delays in obtaining treatment and lower participation in health promotion and prevention services. Lower levels of literacy and education also impact directly on health. It results in a poorer understanding of the way the body functions and the relationship between prevention and disease and early access to health services for treatment. This may be exacerbated by psychological factors e.g. low self-esteem, depression; cognition problems such as memory and organizational skills (Broughton & Thomson, 2000).

Health information is not provided in a range of accessible formats for women with disabilities. Proactive development of health information is needed using a range of formats (including print and emerging electronic technologies). The delivery of education / information must be paced to match the specific disability needs women have. Education needs to be delivered and repeated, if necessary, through all stages of women‘s lives. Women with disability need to be involved in the development of these resources (Burgen, 2010).

Primary carers and health care providers who do not see beyond the woman‘s disability, who fail to recognise her holistic health needs, or who do not adjust their care and services to meet those needs, exclude women from mainstream health services. Many people with disabilities rely on carers – family members and service providers – for intimate physical care as well as access to services. Women with these needs are in a particularly vulnerable position [Noonan and Heller, 2002]. De-institutionalization has meant that people with disability now have a physical presence in the community, however, access to externally provided support and opportunities is essential and the low expectations of others, including health service providers, can act as significant barriers.

Attitudinal barriers arise from negative societal beliefs about the worth of women with disabilities. These barriers may include the disrespect and/or discomfort of medical professionals; unwillingness to communicate with women whose speech or hearing is impaired; professionals’ lack of knowledge about particular disabling conditions; and focus upon the disability, to the exclusion of other health needs. Some practitioners wrongly believe that disability inevitably diminishes a disabled woman’s value or quality of life. They may therefore fail to explore or offer all treatment options, assuming instead that death is preferable to living with a significant disability. Doctors, nurses, and other clinic and hospital staff people may benefit from training and education in these areas. In addition, women with disabilities should be fully informed about their rights as patients (de Kretser, 2010).

Gender based violence is experienced by women with disabilities up to two to three times more often than women without disabilities, with lower rates of access to justice and health systems. High levels of dependency, cognitive and communication disabilities place women at higher risk of violence. Perpetrators are often known to women, they can be carers, residents or other providers of assistance. They may also be partners or family members [Murray and Powell, 2008]. In addition, Healey (2008) women with high degrees of physical impairment are more likely to perceive themselves as sexually inadequate and unattractive than women with mild impairment‘.

Access to health promotion initiatives, including screening is as important for women with disabilities as for women in general. However these programs, including those for mammography and Pap screening, are not currently meeting their service obligations for this group of women. This places women with disabilities at higher risk of delayed diagnoses of breast or cervical cancer [Carlson, 2002].

International, national and state policies enshrine the rights to health, freedom, respect, equality and dignity. However, discrimination on the basis of disability was the most common cause of complaint. These principles need to be translated into equitable and accessible services. Significant practical, attitudinal and organisational barriers to inclusive services for women with disabilities remain. Women with disabilities experience higher levels of disadvantage and discrimination, much of which is based in a lack of knowledge and sensitivity about disability among health care providers; the physical layout and paucity of appropriate equipment in health services; and a lack of appropriate policies, guidelines and information resources [Barr, 2008].

2.4 Strategies being used to Improve Access to Family Planning Services in Uganda

The main objective of strategy is to campaign is to accelerate the availability and use of university accessible quality health services including those related to sexual and reproductive health which are critical for reduction of maternal mortality. According to African Union Commissioner for Social Affairs AdrBience .P. Gawanas for the 4^th session of the conference of African Union Minister of Health (7^th May, 2009) said that the focus is not to develop more strategies and plans but rather to ensure co-ordination and the effective implementation of existing plans and strategies. He further stated that all efforts should be done to save the lives of women with disabilities who should not die while giving life. And also it is essential to establish accountability, of maternal, infant and child mortality and it’s the same happening Mukongoro sub county where the health sector strategic plan is trying all its best to promote people’s health.

According to Charves and German Rodnguez (2005), there is a strong understanding interest within population policy and Family Planning proof   circle in the potential impact on contraceptive behavior and reproductive preferences of mass media messages that try to inform and motivate people on the methods and advantages of regulating fertility these messages have taken many forms ranging from radio program and television designed to persuade women with disabilities on the advantages of smaller families. The same has also taken route in Mukongoro Sub County where mass media like the local radio stations have been used to hold talk shows in order to sensitize the people on the advantages of smaller families.

Mbonye (2008) stated that repeated dissemination of information will have more of an impact than random images and massages such repeated massages on public transport billboard, television, radios may act to reinforce such behavior change. Whereby reinforcement is the key element of behavior change and maintenance. He further gives solutions to that, to avoid unwanted pregnancy if you are sexually active, seek Family Planning Services and counseling, comprehensive reproductive health services and also increased awareness about unwanted pregnancy and Family Planning Services.

In conclusion, the literature reviewed above shows both the modern and traditional understanding of Family Planning. It also reviewed literature related to the importance of Family Planning, challenges facing the use of Family Planning and the strategies being used to promote the knowledge of Family Planning. This reviewed literature therefore has been compared with the situation on ground in Mukongoro Sub County.

CHAPTER THREE

METHODOLOGY

Introduction

This chapter presents about the research design, sampling procedures, sample size, data collection instruments used, procedure and data analysis.

Research Design

The study will use a cross-section research design. Qualitative approach of data collection will be used to acquire information on the study under investigation. This will enable the researcher to gather a wide range of information required by the objectives of the study.

Area of Study

The study will be carried out in Mukongoro Sub County, Kumi District. This is due to the easy access to the area. The study will be carried out in four parishes out of 16parishes in Mukongoro sub county and these will include; Agaria, Akadot, Kachaboi and Mukongoro.

Target Population

According to Baron, (2011), population constitutes people-individuals, organizations, groups, communities or other units that provide information for the study. The population will include: women with disabilities, men, health workers and the local council chairperson.

Sample size

A sample size is a part of a population methodologically selected for purposes of drawing a conclusion about a population and its characteristics (Allan, 1962). In this case therefore, the sample size will be made of 19 respondents.

Sample size

Women with disabilities will be involved in the study because they will be the main culprits; LC1 Chairperson will be selected because he/she has concern in affairs in the community. Men will be selected because they are involved in family affairs such as deciding on whether to use family planning. Health workers will be selected because they are aware of the health issues affecting women with disabilities.

Sampling Procedure or Technique

A sample technique is a way of gathering statistical information where few elements or individuals will be chosen out of the population to present the whole population. The study will use purposive sampling which is the deliberate selection of respondents. In this study, WWD and men will be selected purposively because the researcher will choose the sample based on who she thinks will be appropriate for the study. Health workers will be selected using convenient sampling because it will involve selecting them by virtue of their positions.

Data collection and instruments

Interviews

Cohon and Manioh (1989) qualify interview to be a conservation initiated by the interviewer for specific purpose of obtaining research relevant information and focuses on content specified by research objectives of specific description. Semi-structured interviews will be used to generate additional information from the respondents. This method is chosen becauseit helps in the collection of more data as it allows the interaction of both the researcher and the respondents. It is cheap and does not waste much time.

An interview guide will be used for the in-depth interviews with health workers. The interview guide will be developed based on the objectives. They will be designed in English language.  It will be used because it promotes greater depth of response which is not possible through other means and it allows the researcher to get information concerning feelings, attitudes in relation to research questions. It is also cheap and easy to administer.

Informal observation

Informal observation is usually done when the researcher has little knowledge of a population and its behaviour. The main purpose of informal observation is to create hypotheses to be tested later, in a survey or using for a survey. This method involves watching and listening to people.

Focus group discussions

Focus group discussions will be used due to the capacity of the short period of time. Focus group discussions will be used on WWDs.  This will enable the WWDs to debate and discuss on the study directed by the few questions set and followed. The instrument to be used is the focus group discussion guide where questions will be set and followed. The study will involve 3 focus group discussions (in groups of 5 WWDs) and will take about 30 minutes each.

Data Collection Procedure

An introduction letter will be obtained by the researcher from the university at the Department where it will be used to introduce the researcher to the heads of the community where the study will take place. The introductory letter will be used to seek for permission for the researcher to carry out research in the area. The researcher will collect data upon seeking respondents’ consent after revealing the type of information needed and the purpose to avoid potential concealment of vital information. The researcher also will maintain confidentiality of respondents’ information; and will report the true findings of the study without any bias.

Data analysis

Data will be qualitatively analyzed using quick impression which will be done by summarizing the key findings, content analysis will include recording and reviewing of the recorded information in order to understand data better and on a broader context, thematic analysis will also be used. Here the researcher will identify relevant information and classify it into relevant topics.  These techniques will be exploratory in nature since they will be highlighted, sorted, scrutinized and reviewed data better to ensure accuracy in the data collected.

CHAPTER FOUR

PRESENTATION AND DATA ANALYSIS

4.1 Introduction

The purpose of the study was to investigate the access to Family Planning Services by women with disabilities in Mukongoro Sub County, Kumi district. This chapter therefore presents the findings of the study which are organized and analyzed according to the objectives of the study. The information in each table is described at the end of the table.

4.2 Background Information of the Respondents

This section presents the background on the studied characteristics of respondents used for the study. A total of 18 respondents participated in the study.

Table 1: Background information of the respondents

Respondents were asked information relating to their age and the majority revealed that they were between the age of 18-25 years, others claimed that they were between 25-30 years of age and a few claimed that they were above 30 years of age.

Relating to the education background, the majority of the respondents were “O” leavers, very few had made it to degree level, A” level certificate level and primary level, regarding the religious affiliation, most of the respondents were Muslims, some of them were Catholics and a few were protestants, regarding sex, most of the respondents were females and only few were men. Finally, respondents were asked to give information about their occupation and the majority were not working while a few were working.

4.3 Factors influencing access to family planning among women with disabilities

Research objective one aimed at finding out factors that influence access to family planning services by women with disabilities and the responses are reflected below.

Table 2: People who had Knowledge and used Family Planning Services.

Table 2 above, shows that all the respondents (18) knew about family planning. The respondents had different ways of understanding family planning; 7 respondents understood it as ways taken to space children, others (4) respondents looked at as ways used not to have unwanted pregnancies while 7 respondents understand it as  the agreement between spouses on the number of children they want to have and stick by that through the use of family planning.

When the respondents were asked whether they have ever used family planning; 13 respondents said yes, while 5 said that they know of it but have never used any method. In fact one lady said that, “ipupi iso nu ikamanara kede famile planning, id ikoto aitoswam konye isio idumunit nu ikamunitosi famile pulaning otoma aidulesi”, meaning that they know about it and they would like to use it only that they lack proper explanation from the health workers.

When the student asked the respondents about how they acquired the knowledge about family planning services they had this to say as seen in table 4 below;

Table 3: Ways in which people acquire knowledge on Family Planning Services.

Majority of respondents (8) agreed that they acquired knowledge on family planning services through workshops, 5 respondents got information from friends or peer groups, 2 said that they got the knowledge through mass media that is radios, televisions, news papers among others. 1 respondent said that Straight talk programmes and 2 agreed that skits and drama was their source of information.

One respondent was quoted saying; “abu apaperika olimoki eong nu ikamanara kede famile pulaningi ewanyu ngesi ebe awurieri eong atipet atipet, ido obu ngesi inyamaki eong adekis” meaning that; she was not spacing her children and her friend  got concerned and told her about family planning and in fact she escorted me to my first visit the health center.

The researcher further asked the respondents the factors that hinder women with disabilities from accessing family planning services and the responses are reflected in the table below.

Table 4: Factors that influence women with disabilities from assessing family planning services

From table 4 above, majority of respondents said sensitization and effects, followed by attitude about western methods, illiteracy, availability of facilities (methods) and skilled personnel each was supported by 3 respondents respectively. Respondents stated that some women tend to forget the returning date back for another dose because they do not know how to read and write, Factors like fear of long term effects like condoms they think it will rupture into a woman’s vargina, and end up being taken to theatre for operation.

Others like Pillplan, there is a fear of deformed children after birth, intra-uterine device (coil) will tear the cervix which will result into removal of uterus and among others. After its use one lady said that he was told by her husband that

“mam eong akoto ijene nu ikamunitos famile pulaningi” meaning that he didn’t want to know anything about Family Planning Services and distance from home to health centers and supported by 2 respondents, religion and infrastructure available were supported by 1 respondent each.

Reaction of spouses was the least supported factor as it was supported by 1 respondent, the researcher found out that most of the people had knowledge about Family Planning Services and they cannot use them because of the reaction of spouses (husbands) towards it, husbands do not appreciate very much the family planning services by the government, but they have different perception.

One respondent made a comment stating what a husband said when she raised an issue of Family Planning Services said that, “If you know that you’re wife make sure never to go for Family Planning Services and not to take my children for immunization.”

4.5 Challenges encountered by women with disabilities in accessing family planning services

Research objective two aimed at determining challenges encountered by women with disabilities in accessing family planning services and the responses are reflected below.

Table 5: Challenges encountered by women with disabilities in accessing family planning services

From table 4, about the factors that hinder the women with disabilities from assessing family planning services, negative attitude about western methods and lack of sensitization about the services were supported by 3 respondents respectively. Illiteracy levels were supported by 3 respondents; they tend to forget the returning date back for another dose because they do not know how to read and write, Factors like fear of long term effects like condoms they think it will rupture into a woman’s vargina, and end up being taken to theatre for operation.

Others like Pillplan, there is a fear of deformed children after birth, intra-uterine device (coil) will tear the cervix which will result into removal of uterus and among others. After its use one lady said that he was told by her husband that

“mam eong akoto ijene nu ikamunitos famile pulaningi” meaning that he didn’t want to know anything about Family Planning Services and lack of skilled personnel were supported by 1 respondent. Inadequate  facilities (methods) was supported by 2 respondents, 1 respondents  supported religion as a factor, poor infrastructure for disabled and  long distance from home to health center to assess family planning services were supported by 1 and 2 respondents respectively.

Reaction of spouses was the least supported factor as it was supported by 1 respondent, the researcher found out that most of the people had knowledge about Family Planning Services and they cannot use them because of the reaction of spouses (husbands) towards it, husbands do not appreciate very much the family planning services by the government, but they have different perception.

One respondent made a comment stating what a husband said when she raised an issue of Family Planning Services said that, “If you know that you’re wife make sure never to go for Family Planning Services and not to take my children for immunization.”

4.5 Strategies to improve access to family planning services by women with disabilities

The study aimed at finding out the strategies to improve the accessibility of family planning services by women with disabilities and the responses are reflected in the table below.

Table 6: Strategies to improve family planning services

Findings reveal that, majority of respondents (5)  suggest distribution of contraceptives freely, followed by  health education talks and public sensitization with 4 respondents, provision of adequate health facilities with 3 respondents, 3 respondents  agreed with guidance and counseling, effective follow up and monitoring was supported by 1 respondents, conducive environment for women with disabilities with disabilities  and involvement of women with disabilities in leadership scored 1 respectively.

Majority of respondents agreed that the contraceptives should be given out freely because most of these rural women with disabilities don’t have financial power to buy thus hindering their use.

One respondent said that; “ejok famile pulaningi konye ebeyi ededenge” meaning that; family planning is good but expensive yet we don’t have money.

Other respondents suggested that health education talks and public sensitization should be improved to help women with disabilities to get informed and get rid of the myths they have about family planning services.

As one respondent said that; “elimokiten eong ebe etoswam eong famile pulaningi awuniei eong iduwe lu erasi ingwasikii nesi mam eong etwasiama famile pulaningi”. Meaning that; I was told that if you use family planning you give birth the lame children, that is why I don’t use them.

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 Introduction

This chapter therefore presents the discussion of the study in sub-sections on the basis of the specific objectives set to achieve as analyzed in chapter four, the conclusion, and recommendations.

5.2.1 Discussion of Results

5.1.1 Factors influence access to family planning services by women with disabilities

Objective one sought to find out factors influence access to family planning services by women with disabilities in Mukongoro Sub County and the responses reflected in table 2 shows that; all respondents involved were Adults of Child bearing age. Thus was because of the assumption that they knew about family Planning. For this above reason, a few male respondents were used and majority were Female. This choice was made to ensure that the information got equal basis. Furthermore, these respondents were selected from 3 parishes and the reason was to get balanced information from the area. When it can the level of awareness it was discovered that all the respondents were aware of family planning services  although they differed that is to say they viewed it in three ways; spacing of children, not to have unwanted pregnancies and  agree on the number of children they would like to have.

In line with the above, the most recent national survey, only 18% of Ugandan women with disabilities are using family planning services. However, almost twice that number or about two in every five women with disabilities would like to space their nest birth or stop having children altogether but are not using any method of family planning. These women with disabilities are considered to have unmet need for family planning stated by Uganda on the move. (September, 2010)

In agreement with the above School of Public Health (2010) stated that almost twice that number or about two in every five women with disabilities would like to space their next birth or stop having children altogether but are not using any method of family planning. These women with disabilities are considered to have unmet need for family planning stated by Uganda on the move.

As indicated in table 4 of chapter 4, most of the women with disabilities in Mukongoro Sub County respondents highlighted the factors that hinder women with disabilities from accessing Family Planning Services. Factors like Negative attitude about western Methods, Long distance from home to Health centers to access it, Inadequate facilities (methods), Lack of skilled personnel, many fear of long term effects, Lack of sensitization about the Services, Religion, it is viewed as a sin, Poor infrastructure for disabled, Illiteracy and Reaction of spouses were highlighted by respondents as seen in table 5 of chapter four.

The above is supported by Byaruhanga (2009) said that Family Planning Services are available both in Private Clinics and Government Health Centres, but there is a poor low turn up of women with disabilities for services. He further stated that majority have a fear of the side effects of Family Planning methods which are along term and short term effects all these comes as a result of lack sensitization about the services. This also goes in line with what some mother say if they could be taught first and understand what is all about Family Planning Services

Further still, some Health workers are not skilled in most Family Planning methods and in addition to that they are also not available in Health Centres which others respondents prefer to the use for example Coper T-coil, Norplant, Creams and among others. Another big challenge is the unfriendly environment for women with disabilities with disabilities especially those with morbidity and visual impairment. For example, for wheel chair users no ramps to most health centres and visual impairment no guide in Health Centre hence hinders disabled mothers to access Family Planning Services. And also in cases of hearing impairment, it’s very difficult to find a Health worker who is skilled in sign language, with positive attitude. There is a belief in community that disabled people do not bear children.

According to District Health Services (DHS, 1995), states that fertility may indicate a need for Family Planning methods to be used but most women with disabilities have negative attitudes derived from limited knowledge misconception, and myth surrounding the methods. Hence it has prevented men and women with disabilities from making decision to adopt the services others include social norms for fertility, child bearing and gender images also affects the attitude towards the Family Planning Services.

5.1.3 Strategies to Promote Access to  Family Planning Services by Women with disabilities in Mukongoro Sub County

Objective three sought to find out the strategies that are used to promote access to family planning services by women with disabilities  and the results in table 5 of chapter four showed that; distribution of contraceptives freely, health education talks and public sensitization, provision of adequate health facilities, guidance and counseling, effective follow up and monitoring, conducive environment for women with disabilities with disabilities  and involvement of women with disabilities in leadership as the suggested strategies.

The above is in line with, African Union Commissioner for Social Affairs Adr Bience .P. Gawanas for the 4^th session of the conference of African Union Minister of Health (7^th May, 2009) said that the focus is not to develop more strategies and plans but rather to ensure co-ordination and the effective implementation of existing plans and strategies. He further stated that all efforts should be done to save the lives of women with disabilities who should not die while giving life. And also it is essential to establish accountability, of maternal, infant and child mortality and it’s the same happening Mukongoro Sub County where the health sector strategic plan is trying all its best to promote people’s health.

According to Charves F. Westoff and German Rodnguez (2005), there is a strong understanding interest within population policy and Family Planning proof   circle in the potential impact on contraceptive behavior and reproductive preferences of mass media messages that try to inform and motivate people on the methods and advantages of regulating fertility these messages have taken many forms ranging from radio program and television designed to persuade women with disabilities on the advantages of smaller families.

In agreement with the above, Mbonye A. (2008) stated that repeated dissemination of information will have more of an impact than random images and massages such repeated massages on public transport billboard, television, radios may act to reinforce such behavior change. Whereby reinforcement is the key element of behavior change and maintenance. He further gives solutions to that, to avoid unwanted pregnancy if you are sexually active, seek Family Planning Services and counseling, comprehensive reproductive health services and also increased awareness about unwanted pregnancy and Family Planning Services.

5.3 Conclusion

Accessibility of Family Planning Services has played a big role in improving the livelihoods of the people in Mukongoro Sub County, that is to say it has benefited the people who have used its services;

However, some people in Mukongoro Sub County are aware of family planning services although there is still negative towards these Services. They are not fully embraced because of people’s cultural beliefs and religious affiliation, it was considered foreign and that it had along term side effect. There is great need for more awareness raising about Family Planning Services in all areas in the district and Strengthening Family Planning Services would also help Uganda achieve millennium Development Goal (MDG) to improving maternal health and infant health.

5.4 Recommendations

The Ministry of Education and Sports should ensure the recruitment and training of Special Needs teachers about Family Planning Services to be distributed to all districts in different Health Centers to deal with People with Disabilities and also help enable them gain the required skills.

Some local people at the grassroots should be trained to volunteer as promoters to enhance the services and regularly issue public statements supportive of Family Planning to mobilize both political and people’s support. Hold meetings to harmonize and rationalize implementation of policies with stakeholders involved in Public Health services.

Ensure that Family Planning is a key component of all National strategies, including the National Development Plan. Thus by increasing allocations for contraceptive in National and district health budgets.

Increase involvement of the private sector in the provision of Public Health Services. They should be invited to Ministry of Health/District training and workshops benefits from supportive supervision and have feed on their activities the existence of illegal/non immersed private sector service providers must also be addressed. It is difficult at this time to control the price charged by private sector by Public Health service providers.

Improve use of existing policies and guidelines by increasing number of copies, improving on distribution methods and implementing a system of resupply that ensures availability support supervision should be used to check compliance to guide lines as well as drawing attention to use existing guidelines.

Ensure that Family Planning is a key component of all national strategies, including the National Development Plan thus by increasing allocation for contraceptive in National and District Health Budgets.

The government through the Ministry of Health should increase funding and investment in the population control through family planning provision. Between 2011 – 20015, if the government increases investment in Family Planning Services to US$ 10 million meeting the need for Family Planning substantial savings could be realized.

Guidance and counseling services should be conducted regularly to both mothers and community. And intensify advocacy and awareness raising at all levels for Public Health services.

5.4 Areas of Further Research

The role of training, sensitization and awareness in changing people’s attitudes towards the use of Family Planning services.

What factors lead men to be  against the use of Family Planning?

LETTER OF INFORMED CONSENT

Dear respondent,

I am Asire Sarah, a student of Kyambogo University pursuing a bachelor degree in Community Based Rehabilitation and as part of the requirement for the fulfillment of the award, I am carrying out a study on the extent that poverty has affected PWDs in Nakisunga Sub-County, Mukono District.

For the completion of this study, you have been identified as one of the key respondents for this study. Therefore, I request for your cooperation. You will not be forced to answer any question that is against your will, you may not also need to mention your name incase you don’t need to be recognized. The information you will provide will be treated with utmost confidentiality and will only be used for academic purposes.

Therefore, I request you to answer the questions that follow.

Thank you for your time.

Yours sincerely,

Luyinda David

Student, Kyambogo University