Uganda has just released the result of Demographic Health Survey (UDHS 2016) highlighting the success in family planning and reproductive health.
Uganda’s population is the second youngest in the world, with half of the country younger than 15.7 years old (just older than Niger’s median age of 15.5 years). As of January 2017, the population of Uganda was estimated to be 40 million, the age structure defines 49.9% in the below 15 years, 48.1% in 15-64 year of age group and the rest 2.1% are 64+ .n the past 10 years, showing increasing growth rate (3.24 in 2016 est.), the country has added more than 10 million, from 24 to 35 million.
Uganda’s Achievement in Family Planning and Reproductive Health is the success of Advocacy and hard work of many. Among them, the role of Dr. Jotham Musinguzi, the previous Regional Director of PPD Africa Regional Office and his colleagues in achieving these progresses in Uganda is commendable, said Dr. Joe Thomas Executive Director of PPD. From the late 1990s Musinguzi headed the Population Secretariat of Uganda, a government agency within the Ministry of Finance; a position from which he was able to influence policy and, crucially, win the trust of Uganda’s President Yoweri Museveni “despite the latter’s disagreement about the importance of family planning”.
Dr. Jotham Musinguzi is the recipient of the 2013 UN Population Award and the current Director General of the National Population Council of Uganda. The autonomous government body l oversees the country’s population, reproductive health, and family planning policies.
Dr. Thomas also mentioned that this success demonstrate the success of South to South cooperation as Uganda is always a vibrant actor in South to South cooperation, through since the inception of PPD, the Inert-Governmental Organizaton of 26 countries promoting South to South cooperation in the area of population and reproductive health.
In the near past, Uganda struggled with the increasing population growth. The UN’s most optimistic projections even assumed that the greatest drop in current growth rates will place the country on track to still more than double in size by 2050, growing to 83.5 million people. But the UDHS 2016 depicted a positive shift of the indicators (presented in Table 1)
DHS 2016 showed noteworthy success in maternal health care. Nearly three-quarters (74%) of live births were delivered by a skilled provider and almost the same proportion (73%) were delivered in a health facility which was almost half in 15 years back (Fig 1). It will definitely reduce the risk of serious illness for the mother, baby, or both. But the urban rural difference is exasperating the overall success.
Throughout the course of their lifetimes, Ugandan women have a 1-in-35 chance of dying due to pregnancy-related causes; every day, 16 women die in childbirth. However, overall trend indicates a decline of pregnancy-related mortality over the time. MMR indicated 336, still high to reach SDG target. Gradual decline identified over the period of time in pregnancy related deaths (Fig2) but the disparity between urban rural in terms of maternal services that demand utmost priority.
Infant and Child Mortality:
Infant and child mortality rates are basic indicators of a country’s socioeconomic situation and quality of life. The country’s infant mortality rate was one of the highest in the world, but 2016 DHS showed steep declining trend. At 43 infant deaths per 1,000 live births, Uganda showed success over the period but still effort required to reach SDGs (Fig 3). Here IMR is the probability of dying before the first birthday; CMR is the probability of dying between the first and the fifth birthday per 1,000 live births. Child Mortality indicates the probability of dying between birth and the fifth birthday per 1,000 children surviving to age 12 months. Critical challenge is still exist in the universal success of immunization, Malaria control and to ensure nutritional attainment.
Fertility and Family planning:
Unmet need of family planning was indicated as barrier towards reducing total fertility rate in Uganda. The previous DHS indicated that if as a minimum 10% of the unmet need could be satisfied TFR will fall for below 3. However, the increased demand for family planning and use of contraception affected fertility rates, Fig 4 shows that the fertility is dropping very quickly in Uganda from 6.2 to 5.4 from 2011 to 2016, the falls in TFR have been steady but quite modest, a disappointment remark upon and must be address with extreme effort. A high disparity exists across urban and rural and the difference of TFR is almost 2 in those settings (indicated in Table 2)
The term Contraceptive Prevalence Rate (CPR) refers to use of modern contraceptive methods among married women of reproductive age, as defined by the DHS.CPR has risen steadily from a low starting point and moved upward sharply in most years in Uganda, on the other hand the unmet need of contraceptive is showing gradual decreasing trend. In five years, from 2011 to 2016, there have been major accomplishments as a result of the Uganda’s National Family Planning Program is CPR increased 9%
Demand and Unmet Need of FP
A major theme depicted in the DHS reports involves demand and unmet need. The overall demand for family planning has increased in recent years, and even with this increase, unmet need has declined steadily (Fig 5). Unmet need for family planning (counting all methods) is 28% in still sizable percentages. The decline in unmet need has been remarkably sharp according to the DHS, from 34% to 28% in Uganda (2011 to 2016).
The increase in demand of contraceptive suggests that family planning has essentially become a cultural norm in Uganda. The remaining unmet need, while still sizeable, can be seen not only as an indicator of ‘challenge’ to a family planning program but also as an indicator of ‘success’ because so much demand for family planning has been generated.
Urban Rural disparity:
As the country’s population continues to grow, no doubt, the majority of that growth is taking place in rural areas, where access to health services is extremely limited. Uganda has recently unfolded its 6th demographic health survey which indicated clear disparity across rural and urban setting. Table 2 shows the disparity across rural and urban in major indicators
The call for universal access to reproductive health, including family planning pronounced from ICPD to SDG, the country is moving rapidly towards this goal. Such progress will help the country move closer to the targeted demographic that are linked with the larger development goals. Significant effort still required to mitigate rural-urban disparity. Political commitment beyond the health sector, partner collaboration, community provision to increase community engagement is the behind story of Uganda that has been reflected in 6th DHS key indicators report.
However the challenges still remain in teen age pregnancy is high; to address the high rates significant focused effort is required. The difference of TFR between rural and urban is noticeably high (urban 4, rural 5.9) that require special attention. 55% of children age 12-23 months received all basic vaccination, and 37% receives all age-appropriate vaccinations where gaps remain for the implementers. On the other hand more than half of children age 6-59 months (53% percent) suffered from some degree of anemia which is not a healthy picture of child health that demand more investment and effort. More than 1 in 5 women age 15-49 (22%) reported that they have experienced sexual violence at some point in time where Uganda needs to pay further attention. Overall achievement of Uganda needs to be targeted towards the benchmark of SDGs, political commitment; continued investment and finally development efforts designed through community participation could draw the positive result for the wider population irrespective to the age, sex, residence and economic attainment. PPD wishes all the success for Uganda and looking forward to contribute more through South-south cooperation.
Uganda Bureau of Statistics (UBOS) and ICF (2017). Uganda Demographic and Health Survey 2016: Key Indicators Report. Kampala, Uganda: UBOS, and Rockville, Maryland, USA: UBOS and ICF. https://dhsprogram.com/pubs/pdf/PR80/PR80.pdf
Guttmacher Institute (2017). Contraception and Unintended Pregnancy in Ugand, https://www.guttmacher.org/fact-sheet/contraception-and-unintended-pregnancy-uganda
FHI 360 (2012). Three Successful Sub-Saharan Africa Family Planning Programs:Lessons for Meeting the MDGs, http://www.fhi360.org/sites/default/files/media/documents/africa-bureau-case-study-report.pdf
White Ribbon Alliance Uganda (2016). White Ribbon Alliance for Safe Motherhood, Uganda, http://whiteribbonalliance.org/national-alliances/uganda/
Byaruhanga J (2013). Comparative Analysis of Uganda’s 1999 and 2009 Health Policies, http://www.academia.edu/3727879/Comparative_Analysis_of_Ugandas_1999_and_2009_Health_Policies
Nankinga O., Misinde C., Kwagala B., (2015). Gender Relations, Sexual Behaviour, and Risk of Contracting Sexually Transmitted Infections among Women in Union in Uganda, https://dhsprogram.com/pubs/pdf/WP117/WP117.pdf