Ms Nagudi (not her real name), a mother of six, looks frail and exhausted. Poverty and sadness are etched on her face.
The 29-year-old resident of Kiwata Village, Bugobero Sub-county, Manafwa District, can barely provide for her six children. She says her husband abandoned them and now spend his days drinking alcohol and philandering. ‘My elder children no longer go to school because they must work to earn a living,’ Ms Nagudi says, breaking down in tears.
‘It’s a sad situation. ‘ Ms Nagudi lives in a rural part of the Bugisu Sub-region where a man’s wealth is often measured by the number of children he has. In such communities, it is taboo for women to engage in family planning.
She says her husband blocked her attempts to access contraceptives, arguing that he was an only child. However, Ms Nagudi confided in her mother and mother-in-law that she planned to seek family planning services secretly. But her mother-in-law betrayed her trust, revealing the plan to her husband. He gave her an ultimatum: Choose family planning and leave the marriage, or keep having children and stay. Out of fear and dependence, she chose to stay. Ms Nagudi’s story is far from unique.
Across the rural areas of Uganda, many women are denied access to family planning. Some are left to raise children alone while their husbands spend their earnings on alcohol while demanding more children. Despite widespread poverty, many continue bearing children in silence, held back by ignorance, harmful cultural beliefs, or lack of access to reproductive health services.
Access to family planning methods
Ms Agnes Magagwayi, the senior district educator in Mbale, says there is no justification today for anyone being denied access to contraceptives.
‘It is the duty of medical workers to ensure that every woman is empowered to plan her family and her life,’ she says.
‘There should be no debate about whether to use family planning, it’s essential for the wellbeing of women and girls,’ she adds.
Ms Magagwayi says men, especially in rural areas, must understand that family planning is a woman’s reproductive health right that must be respected.
Dr Dennis Kutoosi of Bulamu Health Care agrees, noting that access to reproductive health services, including family planning, reduces maternal and child deaths, the burden of post-abortion care, and new HIV and STI infections. ‘It is a fundamental right for individuals to decide freely when, whether, and how many children to have,’ he says. Dr Kutoosi adds that educating people about manageable family sizes can prevent poverty and promote sustainable development.
Globally, research has shown strong links between contraception and improved maternal and child survival, household welfare, and women’s empowerment. Dr Julie Asiimwe, who works at a private hospital in Mbale City, urges the government to remove barriers to women’s empowerment and education in rural communities like Ms Nagudi’s. ‘Family planning not only prevents unwanted pregnancies but also protects the lives of mothers and children,’ she says.
Government’s plan
According to the Ministry of Health, the government plans to scale up access to family planning services to at least 50 percent, as part of efforts to improve the quality of Uganda’s population and reduce unplanned pregnancies. Family planning allows individuals or couples to control the number and spacing of their children through contraception or voluntary sterilisation. Common methods include condoms, contraceptive pills, implants, IUDs, sterilisation, and emergency contraception.
Health experts say contraception empowers couples to make informed decisions about childbearing, while also benefiting men by improving household wellbeing and fostering more stable relationships. A 2018 United Nations Population Fund (UNFPA) report, ‘The Power of Choice: Reproductive Rights and the Demographic Transition,’ found that family size is closely tied to reproductive rights, which in turn are linked to other human rights such as access to education, health, and employment.
The report revealed that 28 percent of Ugandan women have an unmet need for family planning, leading many to have more children than they want. The 2011 Uganda Demographic and Health Survey similarly found that more than four in 10 births are unplanned, with Ugandan women having nearly two more children than they desire (5.4 versus 4.2). For women like Ms Nagudi, these statistics are more than numbers, they represent lives lived in quiet struggle, caught between poverty, patriarchy, and limited choices.