Articles by Uganda
Integration of DMPA‑SC into the method mix contributes to increased uptake of all methods of family planning
Injectable contraceptives are an increasingly popular method of family planning. They are safe, discrete, highly effective, and generally last for several months. Sayana® Press, also known as subcutaneous depot medroxyprogesterone (DMPA‑SC), is a lower‑dose formula version of the already popular injectable Depo‑Provera. DMPA‑SC combines the drug and needle in a single‑use unit, which makes it easy to transport and simple to use with little training. DMPA‑SC can be administered by community health workers (CHWs) and women themselves – potentially making injectable contraceptives available to women who can’t easily travel to clinics.
Sayana Press: empowering women with the ability to administer their contraceptive of choice
Every year, hundreds of millions of women in Sub-Sahara Africa travel to their local health clinics to receive regular contraceptive injections. Injectables are popular because they are safe, discrete, highly effective at preventing unintended pregnancy, and last for several months. However, for many women, travelling to a clinic to receive a contraceptive injection is not feasible. The costs of travel are too great; the distance too far; and the time spent away from family or work too great a challenge to overcome. Sayana Press has the potential to address these problems, and in doing so, bring injectable contraception within reach of women millions of poor women who might not otherwise be able to prevent unintended pregnancies. Unlike traditional injectables, Sayana Press can be administered by any (non-medical) person who has received minimal training - including community health workers, pharmacists, and crucially, by women themselves. This is because, unlike traditional traditional injectables, Sayana Press has a user-friendly design that makes it safe and easy to use. It is injected just below the skin (subcutaneously) rather than deep into the muscle, and comes in an ‘all in one’ injection system - rather than in a vial with a separate syringe like traditional injectables. IPPF along with other global service delivery partners, such as Marie Stopes International (MSI), Population Services International (PSI), and PATH are playing an important role in introducing Sayana Press to under-served communities. By using their systems, technical capability, and community-level presence, these partners are galvanising on Sayana Press’s potential role help reduce unmet contraceptive need and reach new users. Specifically, with support from USAID through SIFPO-2, IPPF's Ugandan Member Association, Reproductive Health Uganda, is leading the introduction of Sayana Press, as part of a comprehensive mix of methods, in four rural districts within Uganda. Public health providers and community workers are trained to counsel women in a full range of family planning methods, and their side-effects, so that they can make a full, informed and voluntary choice. As regulatory approval for injectables is being granted in more and more countries, there is an opportunity to apply lessons from early-adopter regions where Sayana Press is already being provided. Recently, with support from USAID, IPPF convened a technical workshop with PSI and MSI to collaboratively prioritise the expansion of quality access to Sayana Press, so that more marginalized women with the greatest unmet need for family planning can also benefit from this option. Attendees came from Kenya, Uganda, Burkina Faso, Zambia, Ghana, Niger, Nigeria, Madagascar and the Democratic Republic of Congo. They developed plans and strategies for to increase access to Sayana Press and other methods in their countries. Together, the efforts of these partners will reduce the unmet need of the 225 million under-served women and girls around the world, who want to use contraception but can’t get it. Sayana Press is part of this puzzle which will improve the lives of these women and girls.
Safe Abortion Action Fund in Uganda
Safe abortion is heavily restricted in Uganda, yet gender inequality and sexual violence are widespread. Hosted by IPPF, the Safe Abortion Action Fund is helping vulnerable women to turn their lives around. People are learning about safe abortion and fewer girls are dying. Community attitudes have been transformed and social stigma has started to give way to human rights and understanding. Read the success stories and meet the people behind the scenes
Sex workers in Uganda: fighting violence and inequality
In Uganda, 42% of all pregnancies each year are unintended. The country's weak economy is exacerbated by high levels of gender inequality and poor access to jobs for women. Many women who turn to sex work are at risk of abuse and often rape. Abortion is heavily restricted in Uganda and clandestine safe services are very costly. This results in further poverty for many sex workers and sometimes unplanned pregnancies or even death from unsafe abortion. View the project and meet the women who are turning their lives around
Ugandan communities against unsafe abortions
Rural communities in Uganda have a high prevalence rate of gender inequality, sexual abuse and incest. There is little provision of sexual and reproductive health services and abortion is highly restricted. The Safe Abortion Action Fund, hosted by IPPF, is financing the grassroots organization, VODA, to empower young people as changemakers in their schools and communities. With training and support, peer educators have been educating friends about sexual and reproductive health, and local health providers are serving women in need. Death from unsafe abortion was once a widespread problem but through the power of peer education, these have almost disappeared and community attitudes towards safe abortion has been transformed. View the project and meet the school communities making change
A graduate in need turns to sex work
The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Lady Mermaid's Bureau. I am Pretty Lynn, aged 25. I am a sex worker but I went to university. I graduated with a Bachelor's Degree in Tourism in 2013. But now, during the day I’m sleeping and during the night I’m working. That is how my day goes every day. I got into sex work through friends. Okay it is not good but I am earning. I tried to get a job when I graduated. I have been applying since I graduated in 2013. I’m still applying but I’m not getting anywhere. You know to get jobs in Uganda; you have to know someone there and no one knows me there. To be a sex worker is like a curse. People look at you like, I don’t know, as someone that has no use in society. People look at you in a bad way. They even don’t consider why you are selling. They just see you as the worst thing that can happen in the society. So it is not comfortable, it is really hard but we try and survive. The fact sex working is illegal means you have to hide yourself when you are selling so that police cannot take you. And then you get diseases, men don’t want to pay. When the police come and take us, sometimes they even use us and don’t pay. So it is really hard. They want a free service. Like if they come and take you and pay that would be fair. But they say it is illegal to sell yourself. But they still use you yet they are saying it is illegal. You can’t report the police because there is no evidence. Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. Though at times we get female condoms from Lady Marmaid’s Bureau (LMB) because there are so many of us they can’t keep on giving you them all the time. At times when we get pregnant we use local methods. You can go and use local herbs but it is not safe. One time I used local herbs and I was successful. Then the other time I used Omo washing powder and tea leaves but it was really hard for me. I almost died. I had a friend who died last year from this. But the good thing is that LMB taught us about safe abortion. I have had a safe abortion too. There are some tabs they are called Miso (misoprostol). It costs about fifty thousand shillings (£10 pounds or $20.) It is a lot of money. But if I’m working and I know I’m pregnant, I can say, "this week I’m working for my safe abortion". So if I’m working for twenty thousand, by the end of the week I will have the money. It is expensive compared to Omo at five hundred shillings but that is risky. So if I say I will work this whole week for Miso (misoprostol) it is better. But I'm working and I'm not eating. A project like this one from Lady Mermaid's can help young girls and women. But to take us from sex work, it would really be hard. They would not have enough money to cater for all of us. So what they have to do is to teach us how to protect ourselves, how to defend ourselves. Safe abortion yes. They will just have to sensitise us more about our lives, protection, female condoms and all that. I don't have a boyfriend but maybe when I get money and leave this job I will. But for now, no man would like a woman who sells. No man will bear the wife selling herself. And that will happen only if I get funds, settle somewhere else and become responsible woman. I don’t want this job. I don’t want to be in this business of sex work all the time. I want be married, with my children happily, not selling myself. Stories Read more stories about the amazing success of SAAF in Uganda
Working to stop unsafe abortion for school girls
The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA). Unsafe abortion is a huge problem in Uganda with an estimated 400,000 women having an unsafe abortion per year. The law is confusing and unclear, with abortion permitted only under certain circumstances. Post-abortion care is permitted to treat women who have undergone an unsafe abortion, however lack of awareness of the law and stigma surrounding abortion mean that service providers are not always willing to treat patients who arrive seeking care. The VODA project aims to ensure that young women in Uganda are able to lead healthier lives free from unsafe abortion related deaths or complications through reducing abortion stigma in the community, increasing access to abortion-related services and ensuring the providers are trained to provide quality post-abortion care services. I am Helen. I have been a midwife at this small clinic for seven years and I have worked with VODA for four years. Unsafe abortion continues and some schoolgirls are raped. They then go to local herbalists and some of them tell me that they are given emilandira [roots] which they insert inside themselves to rupture the membranes. Some of them even try to induce an abortion by using Omo [douching with detergent or bleach]. At the end of the day they get complications then they land here, so we help them. Unsafe abortion is very common. In one month you can get more than five cases. It is a big problem. We help them, they need to go back to school, and we counsel them. If it is less than 12 weeks, we handle them from here. If they are more than 12 weeks along we refer them to the hospital. Most referrals from VODA are related to unwanted pregnancies, HIV testing, family planning, and youth friendly services. A few parents come for services for their children who are at school. So we counsel them that contraception, other than condoms, will only prevent pregnancy, but you can still get HIV and STIs, so take care. I am Josephine and I work as a midwife at a rural health centre. I deal with pregnant mothers, postnatal mothers, and there are girls who come with problems like unwanted pregnancy. I used to have a negative attitude towards abortion. But then VODA helped us understand the importance of helping someone with the problem because many people were dying in the villages because of unsafe abortion. According to my religion, helping someone to have an abortion was not allowed. But again when you look into it, it’s not good to leave someone to die. So I decided to change my attitude to help people. Post-abortion care has helped many people because these days we don’t have many people in the villages dying because of unsafe abortion. These days I’m proud of what we are doing because before I didn’t know the importance of helping someone with a problem. But these days, since people no longer die, people no longer get problems and I’m proud and happy because we help so many people. My name is Jonathan. I am married with three children. I have a Bachelor of Social Work and Social Administration. I have worked with VODA as a project officer since 2008. Due to the training that we have done about abortion many people have changed their attitudes and we have helped people to talk about the issue. Most people were against abortion before but they are now realising that if it’s done safely it is important because otherwise many people die from unsafe abortion. I have talked to religious leaders, I have talked to local leaders; I have talked to people of different categories. At first when you approach them, they have a different perception. The health workers were difficult to work with at first. However they knew people were approaching them with the problems of unsafe abortion. Due to religion, communities can be hard against this issue. But after some time we have seen that they have changed their perception toward the issue of safe and unsafe abortion. And now many of them know that in some instances, abortion is inevitable but it should be done in a safe way. I’m Stevens and I am nurse. We have some clients who come when they have already attempted an unsafe abortion. You find that it is often inevitable. The only solution you have to help those clients is to provide treatment of incomplete abortion as part of post-abortion care. Because of the VODA project there is a very remarkable change in the community. Now, those people who used to have unsafe abortions locally, know where to go for post-abortion care - unlike in the past. I remember a schoolgirl, she was in a very sorry state because she had tried some local remedies to abort. I attended to her and things went well. She went back to school. I feel so proud because that was a big life rescue. A girl like that could have died but now she is alive and I see her carrying on with her studies, I feel so proud. I praise VODA for that encouragement. This service should be legalised because whether they restrict it or not, there is abortion and it is going on. And if it’s not out in the open, so that our people know where to go for such services, it leads to more deaths. Stories Read more stories about the amazing success of SAAF in Uganda
A mother's heart break after losing teen daughter to unsafe abortion
The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA). Margaret's daughter, Gladys, was raped by a relative as a teenager and became pregnant. She did not tell her mother what had happened and not wanting to have a child at such a young age conceived through incest, Gladys tried to terminate the pregnancy herself using local herbs but got an infection and died. "My name is Margaret and I am a widow." "I lost my daughter in 2011. She was called Gladys and she was 16. I didn’t know that she was pregnant. She tried to use local herbs to abort. I only found out about it three days later when she was bleeding very heavily. I tried to take her to the hospital but unfortunately she died on the way." Despite being the cause of many deaths in the region, the stigma surrounding abortion means that most people do not mention the cause of death publically. However at Gladys' funeral one of her school friends spoke out and said that she had died due to unsafe abortion. This prompted VODA to start working on the issue and when the project started they included Margaret in their training on how to prevent unsafe abortion. "The training made me stronger to talk about it. Now, I continue to tell my remaining two girls about the dangers of unsafe abortion, sexually transmitted infections and unwanted pregnancies. VODA has really helped us. I think my girl wouldn’t have died if VODA was active then like it is now." "I have used VODA's information to carry on with my parental work. That information has been helpful because we are noticing change. I keep on reminding them, 'didn’t you see what happened to your friend here?'. So they have really changed especially with the ongoing help of the people from VODA." "Unsafe abortion was rampant in the past. We had tried to speak to the students, as parents, but it seemed that our information was not enough. But now we have another helping hand from VODA, especially with those seminars targeting the girls." Stories Read more stories about the amazing success of SAAF in Uganda
Educating their peers about unsafe abortion
The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grassroots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA). Peer educators in schools provide counselling and advice to other students, who otherwise would have no one to turn to in times of crisis. Today, we have the largest generation of young people ever, each one with their own unique needs. Peer educators are critical in gaining the trust and confidence of hundreds of young girls each term, and together they help each other gain more knowledge about their sexual and reproductive health. Peer educators themselves also gain a great deal from the training and experience and VODA has been successful in empowering many of these young girls to feel confident and be able to talk out in public, something that they were not able to do before. Poverty, gender inequality, lack of knowledge about sex and relationships and lack of access to sanitary protection mean that girls in rural Uganda are at high risk of sexual exploitation and abuse. All of this coupled with very little access to contraception means that Uganda has high rates of unintended pregnancies among young girls. Despite abortion being legal in Uganda in cases of rape and incest, most girls are not aware of the law and resort to unsafe abortion often using local herbs or washing liquid. The peer educators trained by VODA are able to listen to other young people's issues and provide support and information a range of issues including safe abortion as well as how to access contraception. My name is Mabel. I am in my final year of O'Levels and I am a peer counsellor at a Secondary School in Namuganga. I was selected with two others by VODA and my head teacher, and then trained to be a peer counsellor. We were trained to help our colleagues at school to handle various problems. Girls used to get pregnant and some were dropping out of school. So we counselled many of our colleagues about unwanted pregnancies. We have seen a change because we get free condoms from VODA. We could preach abstinence from sex. For those that could not manage abstinence, we could give them male condoms. Unsafe abortion has been a big problem. Girls were using local herbs and sharp instruments like metallic hangers for abortion. Many would get injured and some would die. I remember last year there was a girl who aborted using those local methods but she died and was buried in Seeta. If VODA wasn't here I think things would be very bad because as students, we did not have access to most of the information that we needed. We would have seen a big number of girls out of school because of unwanted pregnancies or unsafe abortion. I have benefited a lot. I have acquired information which I have used to keep myself safe in terms of unwanted pregnancies. I don’t think I could ever be lured to perform unsafe abortion because I know the risks. In the past, I wasn't able to speak in public but now I can stand and talk freely. I’m Sharon and I’m a student counsellor at a Secondary School in Namuganga. I counsel fellow students, young people in communities and even adults. Before I was selected for VODA training I thought it was just an organisation to promote abortion. But then I realised they were addressing a big problem that was happening at our school and our villages. I have learnt that when someone gets pregnant I don’t have to force her to abort and I don’t encourage her to go for unsafe abortion. If we hear that a certain girl has a boyfriend, we approach her and counsel her on issues like unwanted pregnancy. Many young girls have been lured into early sex because they need money, which is why we end up with unwanted pregnancies. In a bid to fulfil those needs, they get boyfriends or other guys who use them for money, impregnate them and then leave. The girls know about contraceptives like the pill and we have given some of them referral cards for them to access the contraceptives from the health centres. But there has been debate against giving young girls contraceptives. There are restrictions that the government puts in place but that does not mean that girls are not getting pregnant. I remember the girls who died after aborting through unsafe abortion methods and I think about the lives that would have been saved if they had knowledge about contraceptives. I’m Rita and I’m 15-years-old. I was twelve when I was selected to be a VODA counsellor in my primary school. I was lucky because many people wanted to be counsellors but I was chosen. My parents were very happy and they got interested. When I joined this school, I introduced myself to other students because I wanted to continue with my work as a counsellor. I told my colleagues to feel free to share with me their issues. We are lucky here because there are many counsellors. Girls are having unwanted pregnancies because they are lured by men who give them presents and things such as money for sanitary pads that they cannot get from their parents. Before I joined this school, there were many cases of girls terminating pregnancies with unsafe abortions. It was common to hear of or see someone who had aborted. Many would abort so that they would return to school. When I joined this school last year and we intensified the counselling sessions, many came and shared their problems with us. We have learnt that two girls at school gave birth and have since returned to school but we have not had cases of unsafe abortions here since I joined. I wasn’t as serious with studies before I became a counsellor but because I want to maintain my status, I have improved in my studies because I don’t want to feel ashamed in front of my fellow students. VODA gave us T-shirts for identification purposes which has made people in the community respect me as well. In terms of preventing unwanted pregnancies in schools, most of what we see here originates from the girls' homes. Many parents don’t provide for the girls’ necessities (like sanitary towels) so that makes them vulnerable to be lured by men. Stories Read more stories about the amazing success of SAAF in Uganda
Post-abortion care for straight-A student
The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was a fund set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such project which received funding is called Volunteers for Development Association Uganda (VODA). My name is Anne*, I am 14-years-old, I am a student at one of the local schools near my (rural) village. I recently went to the health centre for post-abortion care. I was referred there by VODA and I was helped by the mid-wife, her name was Grace. The VODA community volunteers, they found me at my grandmother's house. They brought me to the health centre. I was on my way to visit my grandmother. A man just caught me. After he finished with me he told me to go back home and never to tell anyone about it. I went back home to my parents, in Luwero District. There is no VODA there. I realised I was pregnant because I found out I had missed my periods. Then I told my mother. My mother said we should try to do something about the pregnancy, but not in our home district, otherwise my father would not longer pay my school fees. I had just finished my Primary Leaving Examinations and I was looking forward to joining secondary. So then I had to go back to my grandmother's house. She said we were going to the hospital but it wasn't like the one where Grace works, where I finally got my post-abortion treatment. She took me to a place where a woman gave me some herbs. Then we went home and the thing came out. I was bleeding. Then the VODA counsellor came to my home and suggested to my grandmother that I should be taken for treatment. I had learnt about how girls can get pregnant but I didn't know anything about safe abortion. In Luwero, where I come from, many girls I hear they use herbs to abort but I had not tried it because I had not had any sex until that man forced me. I am telling my friends about safe abortion and contraceptive services but I also need to be given more information about it because I was not taught about most of what Grace the midwife was telling me. I know that women can take precautions for family planning like pills but my mum told me it's only for married people. I am very thankful to VODA, I maybe could have died if the counsellors from VODA hadn't asked to rush me to the health centre for post-abortion care. *Not her real name Stories Read more stories about the amazing success of SAAF in Uganda