I first became interested in the low uptake of family planning in Uganda, when I visited an educational project in the south west corner of Uganda, near the border with both the Congo and Rwanda.
I had been wondering how a UK GP could make contribution to the desperate shortage of trained health workers, and the evidence of schools bursting at the seams, was my first realisation of the demographic time bomb threatening sub- Saharan Africa.
Low contraception use
The average Ugandan woman in this rural part of Uganda has six children. Many have more than ten. I assumed that they must feel exhausted and be desperate to limit their family size. Yet in sub-Saharan Africa only a quarter of women of child bearing age use contraception. This compares with the rest of the world where between two thirds and three quarters of women use it.
Why? Is it because large families are needed? Yes, partly. If you are scratching a living on a hillside where the soil is poor, you need child labour. In some parts of the world, children will have earned their keep by the time they are 12 years old.
Is it because they are fearful their children won’t survive to be able to look after them in their old age? Yes, although infant mortality is now rapidly dropping. By far the most common reason women give for not using family planning, is fear of side effects. Most people have had little contact with health workers, and the idea of doing anything that affects the natural function of their bodies feels very alien.
Yet Ugandan women admit to have nearly two more children than they actually want. Thousands of women die each year in their attempts to rid themselves of unwanted pregnancies. The maternal mortality rate remains stubbornly high, with 25% of these tragic deaths being due to unsafe abortions.
What is U-SHAPE?
Since 2013, we have been developing training in family planning for health workers, and in sex education for teachers. The project U-SHAPE (Ugandan Sexual Health and Pastoral Education) uses the skills of volunteer doctors and teachers to facilitate a training cascade aiming to disseminate positive messages about modern contraception in an attempt to dispel fears and misconceptions and address high rate of unmet need for family planning.
We are supported by the Tropical Health & Education Trust (THET) as part of the Health Partnership Scheme, which is funded by the UK Department for International Development (DFID). We are also featured as a ‘success story’ on the WHO family planning website.
To date, we have trained more that 180 health workers to a basic level and equipped nearly 130 with the skills and knowledge to work as family planning providers.
Our ‘whole institution’ approach to training has led to service developments including screening for unmet need for contraception with the target to reduce this from 40% to 20%. In addition to health workers giving talks in churches and villages, 60 primary school teachers meet quarterly for training to help reduce teenage pregnancies and HIV transmission.
Volunteering for U-SHAPE
Dr Emily Clark was acutely aware of the need for family planning while volunteering at the neighbouring Kisiizi Hospital. Unmet need was measured at 51%, but she found beliefs around family planning encompassed not only religious and cultural ideals, but also factors in gender roles, family values and health beliefs.
‘My enthusiasm was sparked by hearing of the work of U-SHAPE, and with their support, we were able to learn from their experience to carry the U-SHAPE initiative forward with great momentum to Kisiizi hospital,’ she says.
We are working with the RCGP to give UK family doctors the opportunity to train Ugandan U-SHAPE trainers. So far, 11 RCGP members have been working with us, and several more are planning to take the ideas beyond Uganda. Most volunteers work for a year, but there will be opportunities for shorter terms, particularly if you have had some prior experience in Africa.
If you are interested in volunteering for U-SHAPE you can find out more on the RCGP website here. The closing date for volunteers starting this summer is Friday 29 January. You can also visit the U-SHAPE website.
- Dr Clare Goodheart is a GP in Cambridge and RCGP clinical lead for the U-Shape Project.
Previous volunteers Dr Claire Marie Thomas and Dr Ceri Gullivan have produced the video below about working with U-SHAPE.