Paying ultimate price of family planning

Women face double-edged sword for choosing to prioritise their own health and well-being and receive contraceptive services

COMMENT | Joy Asasira | The media was awash earlier this month with reports of the murder of 25-year-old Twikirize Ronious. Her husband, Innocent Kibwetere, killed her because she had dared to take control of when she would want to have another baby.

Ronious’ death comes just over a year after Beatrice Amito, a mother of seven, was beaten to death by her husband for taking family planning pills. As Ronious lay dead in her home in Kyegegwa, delegates from across the globe and national players advocating for the closing of the gap of the unmet need for contraception were packing their bags to converge in Thailand for the International Conference on Family Planning (ICFP) that took place between the 14th and the 17th of November 2022.

An even bigger irony is that Uganda hosted the inaugural Family Planning conference in 2009, and over the years has been heralded as one of the exemplary countries that have taken heed of the value and the possible return on investment that well planned and sustainable family planning programs can yield at national, household, and individual level.

Indeed, Uganda has truly been a leader in the fight for access to universal, voluntary, and quality contraceptive information, services, and supplies. It comes as no surprise that it has yielded results with the modern contraceptive rate increasing from 22.8% in 2011 to 39% in 2016 according to the Uganda Demographic Health Survey.

For a country that has one of the highest maternal mortality ratios at 336 per 100,000 live births, this progress is laudable. However, these programs may not address all the unique socio-cultural issues that women like Ronious and Beatrice deal with while seeking to take charge of their reproductive lives.

It was not uncommon for men in some communities like among that Karamajong to take a knife and extract an implant that their wife or even family member had inserted. In some cases, as was the sad fate for Ranious, men resort to violence that costs women their lives.

Apart from legitimate cultural reasons where children are seen as wealth and a source of labour, there are some insidious persons and groups that have gone out of their way to spread disinformation about the side effects of contraceptives. These groups often talk about “the population control agenda” intended to slow down the growth of the African population to ensure that their population does not exceed that of other countries in the west pausing a security and economic threat.

Others argue that contraceptives, when used by women, cause infertility leading to difficulty in conception thereafter. The most outrageous and perhaps most dangerous narrative is that contraceptives are used by women seeking to cover up their promiscuous ways.

In a country where many people are religious, this narrative has fast been weaponised leading to discord among couples and within families. Dare I add to this list the misguided pre-contraception counseling that seeks to give the man (husbands and partners) veto rights on the decision as to whether their wives can use contraception?

Multiple studies have shown that contraceptives have the potential to improve the life and well-being of women, especially for a country where the fertility rate (the number of children that women may have within their lifetime) is still high at 6, compared to other countries in the region and globally.

And yet contraceptives remain a double-edged sword. If they fail to take them, women risk death or injury from too many or too close together pregnancies. On the other hand, as was the case for Ronious and Beatrice, they still risk death and/or injury at the hands of their partners for choosing to prioritise their own health and well-being and receive contraceptive services.

The role of men in promoting and ensuring the success of family planning is undeniable. However, their role and input should complement rather than supersede the rights of the women who own the bodies that will, directly and indirectly, benefit from these services.

To promote family planning services, the interventions and narratives employed should center the woman and her agency. Further, law enforcement agencies should severely deal with any individuals or organisations seeking to harm women by causing moral panic and fear among citizens by relying on pseudoscientific dangers related to the use of contraceptives.

Indeed, it is commendable to focus on the big picture of progress made in improving contraceptive access in Uganda. But it is better and more urgent to also look at the every day lived realities of every woman seeking these services and ensure that their own experience is enjoyable, of good quality, and leads to a better quality of life.

    Joy Asasira is a Reproductive and Gender justice Advocate