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ACCESS TO FAMILY PLANNING SERVICE BY WOMEN IN KIRA SUB-COUNTY, WAKISO DISTRICT.

CHAPTER ONE

INTRODUCTION

1.1 Introduction

The study was all about the accessibility of Family Planning Services by women in Kira Town Council, Wakiso District. This chapter presented the details of Background information to the study, Statement of the problem, Purpose of the study, Research Objectives, Research Questions, Scope of the study, Significance of the study, Limitation and Delimitation to the study.

1.2 Background to the study

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.

According to MoH, (2009), Family Planning activities were started in the 1960’s by NGOs which were integrated into the Maternal and Child Health (MCH) program in 1984. Since then, it has been recognized as one of the priority interventions for the maternal and newborn morbidity and mortality as well as for addressing Adolescent pregnancies. Family Planning services are therefore available in most of the health facilities and are provided free of charge; even NGOs are accessing free contraceptives. Although promotion of Family Planning services in an official government policy is supported by government and donor resources, there is lack of National consensus to practice Family Planning. As a consequence, many contradictory arguments emerge from political and religious leaders and for that reason several Private Not-For-Profit (PNFP) facilities do not provide/promote use of modern Family Planning Services. Therefore, religious background and community health seeking behavior also limit service delivery. This is especially important given that the PNFP facilities owned by religious bodies represent only accessible source of health care for some population in the country.

According to Alcala (1995), 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 (Alcala, 1995). The further suggested that the gap frequently exist between the number of children, women they say they want to have and the number they have.

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 (1995) 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.

According to UBOs (2009), It was reported that there was an alarming increase in population growth rate of about (   %) in Uganda by (        ). In Kira Town Council, there is a big population growth rate. According to the Uganda Bureau of Statistics (UBOS, 2009) the population of Wakiso district was      people and but today, it’s estimated to be about           of people and the population growth rate to make matters worse, the number of children to the total population is very high. Most of the women do not work, but spend most of their time at their homes as housewives. This problem is as a result of the so many children and the few resources are available. Others women carry out small scale activities to earn them a living like Kiosks.

According to Malinga (2000) Uganda is still faced with a high population growth rate. In addition, the fertility rates have consistently remained high, recorded at 6.9 in 1995 and 6.5 in 2006. However, if the current population growth rate of 3.2% continues unabated, it is expected that the population size will double by the year 2032. This makes delivery of services more difficult as there are significantly more people to provide services to and increasing population density makes spread of some condition more favourable.

He further stated High fertility and high population growth rate creates high child dependency ratio placing a heavy burden on the working population and challenging government capacity to provide good quality social services to meet basic needs hence resulting into poverty.

According to the MMR Report of Uganda (2006), this has been as a result of the lack of Family Planning in these developing countries which has brought about health hazards and others. Maternal death means the number of mother dying during pregnancy, labour and 1 month after delivery out of 100,000 births. In Kira Town Council compared with other problems like inadequate medical facilities equipments and personal among others. The lack of Family Planning Services has caused many MMR. Therefore embracing Family Planning is one of the ways of curbing down the ever increasing MMR in developing countries especially Africa.

It is generally acknowledged that rapid population constitutes a definite obstacle to socio-economic development population pressure at the family levels have resulted into poor health low income levels, unemployment or underemployment and inadequate access to social services among others thus leaving majority of the large families in unfavorable environmental conditions and in unplanned settlements. This problem too means that at national level, a large part of output or incomes of the Adult will be consumed hence little is left for savings or investments as capital for development purposes for example, improving their modern infrastructure like good houses generally advancing socio-economic development. This is why some governments like the Zambian adopted the Comprehensive National Policy with the objectives of initiating improving and sustain measures aimed at showing the nations high population growth rate (Zambian Comprehensive National Policy, 2004).

Reproductive Health and Rights perspectives for further development in Africa (July, 2010) emphasized that there is a high gap in access to these services like Family Planning Services between the rich and poor, and rural and urban populations and between the educated and uneducated. Further stated that, of all health educators MMR display the highest inequality between the rich and poor both between and within nations. And this has a devastating impaction individuals, families and communities.

In Kira Town Council, Functional Adult Literacy (FAL) has not been embraced, despite the fact that there are so many illiterate Adults and the fact that the government has tried to promote FAL. It has not been implemented to its fullness in the sub-county. This has affected the day to day functions of the people because they lack knowledge.

The situation in Kira Town Council is left unattended to and may contribute to more problems and it is from the above background that the researcher was compelled to establish the accessibility of Family Planning services in Kira Town Council

1.3 Statement of the Problem

Positive attitude to access Family Planning Services by women is a foundation for the development of the nation and to reduce maternal mortality rate and infant mortality rate (WHO, 2009).

In Wakiso district however, Family Planning are available but the turn up of women is very low as reported by the District Health Report (2008).

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1.4 Purpose of the Study

The purpose of the study was to assess the accessibility of family planning services by women in Kira Town Council, Wakiso District.

1.5 Research Objectives

The study was guided by the following research objectives;

• To identify the awareness about the availability of Family Planning Services in  Kira Town Council.
• To establish factors that hinder women from accessing Family Planning Services in Kira Town Council.
• To find out the strategies to promote the access to Family Planning Services by women in Kira Town Council.

1.6 Research Questions

The study was guided by the following research questions;

• What is the level of awareness about the availability of  Family Planning Services in Kira Town Council, Wakiso district?
• What factors hinder women from accessing Family Planning Services Kira Town Council, Wakiso district?
• What strategies can be used to promote access family planning services by women in Kira Town Council, Wakiso district?

1.7 Scope of the Study

The study was carried out in Kira Town Council, Wakiso district in the three parishes of Kireka, Bweyogerere and Kira. It focused on accessibility of family planning services by women and  lasted for six months.

1.8 Significance of the Study

The study is expected to provide information to stakeholders and service providers to identify the achievements and weakness of the programme in accessing Family Planning Services by women in Kira Town Council.

The information will be used to guide, sensitize and encourage women to access Family Planning in health centres.

The study will enable the researcher to fulfill the requirements for the award of degree in Bachelor of Arts in Social Work Community Development of Kyambogo University.

The information is also expected to help the readers and researchers in educational health planning and policy makers in monitoring of health centres to come up with strategies of how to assist women.

1.9 Limitations

Power problems which affected the typing and editing of this work. This in most cases delayed the students from submitting on time hence prolonging the period that was stipulated for the study.

High expectations and suspicion by the local people. They expected money and other materials of the kind from the researcher while others were suspicious that the researcher had come to spy on them. And some respondents deliberately refused to give information related to the study.

Time scheduled for data collection was not enough and the  uncertain changes and increase in costs like transport as compared to the expected costs.

1.10 Delimitations

The area covered was familiar to the researcher since the place was near her home of residence. And communication was effective since the researcher knew the language spoken in the area of the study.

Time was budgeted for to ensure the research is done in the stipulated period of time and also used few respondents but met them at their convenient time. And the respondents were assured of  confidentiality of the information they gave at all levels to ensure they provide information.

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 accessibility of Family Planning by women in Kira Town Council, Wakiso district.

The related literature presented under this  topic is based on  the three of objectives hereunder;

• The awareness levels of Family Planning Services by women.
• The factors that hinder women from accessing Family Planning Services by
• The strategies to improve access to Family Planning Services by women.

2.1.1 The Concept of Family Planning

According to Bertrand (1995), Family Planning is strategy of working out plans with your partner on how you want to deal with procreation within the context of sexual relationship.

He further defines Family Planning as means of planning when and how many children you are going to have and how to prevent unwanted pregnancy. However, Family Planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their birth. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her death and well being as well as on the out come of each pregnancy.

According to the Uganda National Planning Advocacy Strategy (2005), Family Planning is the consensus effort of individual or couple to decide for themselves when to start having children, how many children to have, how to space them and when to stop having them their artificial and natural method of contraception. Family Planning connotes contraception control to avoid pregnant but it also includes efforts of couples to induce pregnancy.

According to World Health Organization (Department of Reproductive Health and Research, 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. Over 120 million women world wide want to prevent pregnancy but they, and their partners are not using contraceptives.

According to the speech by the Prime Minister of Uganda, Professor, Apollo Nsibambi, he said that the promoters of Family Planning Services are aware that adopting Family Planning to keep size of the Family small world allow families to invest more in each child’s nutrition and health care and could reduce poverty and hunger for all members of the household. Besides saving children lives, it can also prevent MMR.

Another importance of Family Planning is reducing the population growth rate of an economy in particular and the overall population of the world in general and with its related problems for example, the 512m in malnourished people, 215million households without access to safe water, and 293 million children not attending primary school. All these problems aroused due to the ever increasing population with the lack of Family Planning program being one of main causes. Most of these problems are also experienced in Kira Town Council where many of children lack food nutrition and others.

So many women in Kira Town Council no longer cut children but end up having unintended pregnancy due to the inaccessibility of Family Planning services. It should also be made accessible in order to sensitize the adolescents who do not have easy access to Family Planning information should include in counseling and follow-up services like provision of contraceptives.

2.2 Awareness about Family Planning services by women

Today every 17% of women of reproductive age in sub-Sahara Africa use a modern contraceptive. But about 60% of women in the growth who want to avoid pregnant are not using Family Planning or are using a tradition almost 80% of women who need care each for complications of pregnant and delivering do not receive it. If reproductive unhealthy services were provided to all women in need, maternal deaths would be reduced by 70%, newborn deaths would be cut by heavily half and 750,000 lives would be saved each year.

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

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

2.2 Factors  that Hinder Women from Accessing  Family Planning  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 in accessing it, hence some reasons for low turn up of women for services like they have worries of the side effects. For example injecta-plan method, many women 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 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, future research that covers that determinates of 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 from bearing children which is interference to the plan of God as seen in some Kiganda expression, like “Muzaale mwale” meaning you can produce as many as possible.

Wakiso 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 have stereo types which have been constructed by the society in which they live. For example, the need for 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 Kira Town Council whereby women 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 Kira Town Council.

According to International Conference on Family Planning (2009), an estimated 41% of Ugandan Women 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 and men say that they want to space children or limit children bearing (71% of women 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 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 Kira Sub-county where so many women 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 and non-working women 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. 55.9% of the working women participated in Family Planning decision making with their spouses as compared to 23.5% of the non working women. 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 Kira 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 in Kira Town Council. 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 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 to access Family Planning Services, therefore you find out that women 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 Kira Town Council where women 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.

2.3 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 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 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 Kira Town Council 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 on the advantages of smaller families. The same has also taken route in Kira Town Council 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 Kira Town Council.

CHAPTER THREE

METHODOLOGY

3.1 Introduction

This chapter of the study focused on research design, research population, the sample, sampling procedure, methods of data collection, procedure of data collection and data analysis.

3.2 Research Design

According to Robinson (1989) Research design refers to the process of turning the main research objectives into the project in order to examine social interaction between the main subjects of the research. Investigator used both qualitative and quantitative approaches but the qualitative approach dominated because it focused on perceptions, facts, feelings, values and emotions that can not be measured quantitatively. The responses and presentations from the respondents were weighed in terms of authenticity and originality and this formed the back bone of the data. Quantitatively simple tables were used to summarize the data into meaningful themes.

3.3 Target Population

Population as defined by Mbabazi (2005) refers to the systematic collection of human beings at a given time in a specific area. The investigator used doctors, antenatal mothers, breast feeding mothers and those from Mothers Union who were expected to be having information relevant to the study that is accessibility of family planning services by women in Kira town council.

3.4 Sample

The sample constituted of twenty five (25) respondents, of which two (2)  where male doctors, three (3) midwives, two (2) women with disabilities, two (2) women from mothers Union, ten (10) Breast feeding mothers, six (6) expectant and Post- natal mothers. This number of participants was taken because it was believed by the student that it would be manageable during data collection more especially during interview and in fact it saved time during data collection by the student.

3.5  Methods of Data Collection

The investigator used the Interview method to collect data. An interview is a conservation between two or more people (Robinson, 1993). While Cohen, (1976) adds that interviewing is an activity requiring careful preparation, much patience and considerable practice if the eventful reword is to be worth while taken. This is because the method helped in obtaining fast hand information from the respondents and also to measure the feelings of the respondents.

3.6 Procedure of Data Collection

The student designed the interview guide and discussed it with the supervisor and before leaving the University for the field for data collection, the student received an introductory letter from the Dean of Faculty of Special Needs and Rehabilitation. Sought permission to carry out research in the area of study.

The investigator wrote to the respondents explaining the purpose of the study and requesting them to participate. She visited the selected health centres and made appointments with the head of departments, after presenting the letter from Kyambogo University. The head of department introduced the student to the nurses and midwives of each respective centre. Then made appointments with the selected midwives. However, the student requested the midwives to guide and prepare the mothers for interview.

The student briefed the respondents and there was free interactions between the researcher and the respondents. And interviews through the questioning techniques were conducted in the language that was understood by each respondent that is to say English for Doctors, Midwives and Luganda  for respondents who could not speak English.

      3.7 Data Analysis

The study was analyzed qualitatively. The data analysis involved sorting raw data as well as coding them, identification of emerging issues and finally the responses were categorized. Presentation of data was done through tables as shown in the next chapter.

CHAPTER FOUR

PRESENTATION AND DATA ANALYSIS

4.1 Introduction

The purpose of the study was to establish the accessibility of Family Planning Services by women of Kira Town Council, Wakiso 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. There were 25 respondents in total, two of them were doctors, three were midwives and 20 were mothers, 10 of them were mothers with 4 children and also 4 having 5 children, 4 having 7 children and 2 others without children.

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 marital status, the majority of the respondents were single, some of them were married and a few of them had divorced their marriages.

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 Awareness about availability of family planning services in health centers

Research objective one aimed at finding out whether women were aware of family planning by women and the responses are reflected in the table below.

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

Table 3 above, shows that  all the respondents (25) knew about family planning. The respondents had different ways of understanding family planning; 10 respondents understood it as  ways taken to space children, others (5) respondents looked at as ways used not to have unwanted pregnancies while 10 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; 20 respondents said yes, while 5 said that the know of it but have never used any method. In fact one lady said that, “Tuwulira era twayagala nnyo famire naye tetugitegera ate olumu tebakunyonyola abasawo bulungi,” 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, 6 respondents got information from friends or peer groups, 4 said that they got the knowledge through mass media that is radios, televisions, news papers among others. 3 respondents said that Straight talk programmes and 4 agreed that skits and drama  was their source of information. One respondent was quoted saying; “Mukwano gwange ye yambulira ku bya famile, anti ng’alaba nzaalira kumukumu era yeyatwala ne mu ddwaliro omulundi ogw’asooka” 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.

4.4 Factors that Hinder Women from Accessing Family Planning Services in Kira Town Council

Research objective two aimed at finding out the factors that hinder women from accessing family planning services  and the responses are reflected in the table below.

Table 4: Factors that hinder women from assessing family planning services

From table 5, about the factors that hinder the women from assessing family planning services, negative attitude about western methods and  lack of sensitization  about the services were supported by 5 respondents respectively. Illiteracy levels were supported by 6 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 “Tombulira ebyo, ebyamwe mbu Famire pulaningi, mugendayo ku nonya ngambo,” meaning that he didn’t want to know anything about Family Planning Services and  lack of skilled personnel were supported by 4 respondents respectively. Inadequate  facilities (methods) was supported by 3 respondents, 3 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 2 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 promote access to family planning services by women in Kira Town Council

Research objective three aimed at finding out the strategies to promote the participation of women in accessing  family planning services  and the responses are reflected in the table below.

Table 6: Strategies to improve family planning services

Findings reveal that, majority of respondents (10)  suggest distribution of contraceptives freely, followed by  health education talks and public sensitization with 5 respondents, provision of adequate health facilities with 3 respondents, 3 respondents  agreed with guidance and counseling, effective follow up and monitoring was supported by 2 respondents, conducive environment for women with disabilities  and involvement of women in leadership scored 1 respectively. Majority of respondents agreed that the contraceptives should be given out freely because most of these rural women don’t have financial power to buy thus hindering their use. One respondent said that; “ Famire nnungi naye bagisera ante nga tetulina sente” 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 to get informed and get rid of the myths they have about family planning services. As one respondent said that; “Bagamba nti famire bwogikozesa ozala abaana abalema, kyenva sizikozesa”. 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

The purpose of the study was to investigate the accessibility of Family Planning Services by women in Kira Town Council, Wakiso District. The study was carried out basing on the following objectives;

• To identify the awareness about the availability of Family Planning Services in  Kira Town Council.
• To establish factors that hinder women from accessing Family Planning Services in Kira Town Council.
• To find out the strategies to promote the access to Family Planning Services by women in Kira Town Council.

5.2.1 Discussion of Results

5.1.1 Awareness  about the Availability of  Family Planning Services Objective one sought to identify the awareness about the availability of Family Planning Services in Kira Town Council 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 are using family planning services. However, almost twice that number or about two in every five women would like to space their nest birth or stop having children altogether but are not using any method of family planning. These women 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 would like to space their next birth or stop having children altogether but are not using any method of family planning. These women are considered to have unmet need for family planning stated by Uganda on the move.

5.2.2 Factors Hindering Women from Accessing Family Planning Services

As indicated in table 4of chapter 4, most of the women in Kira Town Council respondents highlighted the factors that hinder women 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 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 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, its 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 have negative attitudes derived from limited knowledge misconception, and myth surrounding the methods. Hence it has prevented men and women 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 in Kira Town Council

Objective three sought to find out the strategies that are used to promote access to family planning services by women  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  and involvement of women 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 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 Kira Town Council 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 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 Kira Town Council, that is to say it has benefited the people who have used its services;

However, some people in Kira Town Council 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?

References

Family Planning Association of Uganda (2007), Golden Jubilee, 50 Years Moving Generations to Reproductive Health Rights.

Ministry of Health (March, 2005); National Family Planning Advocacy Strategy 2005 – 2010.

Tonny (2007); The Need for Training in FPAU, in a Family Planning Association of Uganda (FPAU) Annual Newsletter.

Family Planning (2007); A Global Handbook for Providers, A World Health Organization Family Planning Cornerstone.

http/www.pupline@orgacasrestrievedon

(WHO, 2007),

MoH, (2009),

Alcala (1995),

Uganda Service Provision Assessment – UPSA, 2007).

United Nations (1995)

UBOs (2009),

Malinga (2000)

MMR Report of Uganda (2006),

(Zambian Comprehensive National Policy, 2004).

Reproductive Health and Rights perspectives for further development in Africa (July, 2010)

District Health Report (2008).

Bertrand (1995),

Uganda National Planning Advocacy Strategy (2005),

World Health Organization (Department of Reproductive Health and Research, 2007)

School of Public Health (2010)

Byarugaba (2009),

Wakiso district health service report (2010),

International Conference on Family Planning (2009),

Uganda National Family Planning strategy (2005 – 2010)

MoH, (2009),

Family Planning Global Handbook for providers (2008),

African Union Commission (2009),

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),

African Union Minister of Health (7^th May, 2009)

Charves and German Rodnguez (2005),

Mbonye (2008)

APPENDIX I

 INTERVIEW GUIDE FROM MOTHERS

I am a student of Kyambogo University carrying out a research. This questionnaire is intended to seek for information regarding the accessibility of Family Planning Services in Kira Town Council. Please attempt to answer all questions honesty. All the information you give will be kept with utmost confidentiality.

Section A: Background Information

Age: ……………………………………

Village:………………………………………………………………………

Occupation:………………………………………………………………….

Level of Education:…………………………………………………………..

Religion:……………………………………………………………………….

Section: B

1. What do you know about Family Planning?
2. Have you ever used Family Planning Services?
3. If yes, what method did you use exactly?
4. Was it effective to you?
5. If yes, how has it been effective?
6. What are some of the side effects/barriers to use of Family Planning Services in your community?
7. What are the reactions of your spouse on the use of Family Planning Services.
8. Any other information that you wish to add concerning Family Planning Services.
9. What are the factors that hinder women from accessing family planning services?
10. what are the strategies to improve family planning services?