Calls for Katine men to take more interest in family planning
'Serious campaign' needed to counter the idea that more children means greater wealth and status
Women in Katine are are asking government and other development partners to join hands to find ways to ensure that men take more of an interest in family planning if issues of maternal and infant mortality are to be addressed.
Efforts by development partners to encourage communities in Katine sub-county to have fewer children or to allow for a longer period of time between giving birth have hit a snag after reports indicate that men continue to spurn family planning programmes.
The difficulty of reaching men was acknowledged in Amref's annual report, published last month. "At present there is low participation of men in reproductive health activities The project is encouraging male participation through IEC [information education communication] messages on behavioural change," the report stated.
The NGO implementing the Katine project, funded by Guardian readers and Barclays, has trained village health teams (VHTs) to help mobilise and inform the community about contraception.
Some 85 VHTs have been trained on the advantages of family planning as a way of cutting infant and maternal mortality rates, and on the different contraceptive methods available. They are now able to advise the community and also distribute condoms.
According to Amref, the number of women accessing contraceptives increased from 1% in 2008 to 4.3% in 2009. In the first year of the project only 63 women of child bearing age accessed family planning services out of 5,909 of women. In the second year the number rose to 251.
While women have accepted the message, men are yet to fully come on board.
"It is very difficult to get men to accept family planning because for them, family planning means stopping producing [babies]. The situation is complex for the Iteso culture, where the more children mean more pride," said Santina Awio Abongi, a teacher of Katine primary school. "To get them to accept the message needs a serious campaign."
Awio, a mother of five, is aware of family planning methods, but doesn't believe she will use any herself. For her, breastfeeding has helped a lot because it gives her a guarantee that she won't conceive another child for around two years.
Awio says VHTs have not done as much as they could to inform the community on family planning issues.
"Most of these VHTs fear to speak to people. Now, how do you expect the community to get informed? I'm not saying that all of them are cowards, but a big number of them are. Yes, Amref has trained them, but are they delivering?" she said. She advised Amref to conduct routine follow-up meetings with the VHTs to ensure that they do deliver.
George Obiro, a resident of Atirir trading centre, concurs with Awio on the issue of information. He said the biggest challenge is with the illiterate men who see children as a source of wealth. Some women also take this view.
"It is not true that all men do not want family planning. To me, the problem mostly is with these illiterate men who see children as wealth," he said.
Obiro said government should pass family planning policies that restrict couples to only having the number of children they can afford to feed, cloth and educate.
Controversial issue
Family planning is a very controversial issue in Uganda. Quite apart from the cultural issues, it would be unlikely for Obiro's idea to win support from religious and political leaders. The Ugandan president, Yoweri Museveni, has previously welcomed the country's increasing population as a way of ensuring economic growth and prosperity. The Catholic church has also spoken out against the use of artificial contraception.
However, in November last year, Uganda's first lady, Janet Museveni, did acknowledge at an international conference on family planning that men needed to support their wives in using contraception, as well as supporting their wives during pregnancy and after the birth.
The conference, held in Kampala and supported by the Bill and Melinda Gates Foundation, was told that while global contraceptive use had risen from 20% in the 1960s to more than 60% today, around 200 million women around the world still lack access to family planning services.
Uganda has the highest unmet need for contraceptives in east Africa, with 41% of women not having access to contraceptives, according to the Ministry of Health.
On average, women in Uganda give birth to between six and seven children. In Katine, the average number is eight. But when community members want to investigate using family planning methods, there is limited information about the side effects and, moreover, access to contraceptives are hard to come by.
The in charge antenatal officer at Tiriri health centre in Katine, Teddy Akello, said that on several occasions when community members have been ready to receive information and contraceptives, officials from other organisations, such as the reproductive health NGO Marie Stopes, do not appear. In the past, Marie Stopes officials have spoken to Katine residents about female sterilisation, which has proved popular.
Akello also stresses the need for development partners to involve local leaders and VHTs to target men – encouraging them to adopt family planning methods and to take more of a role in supporting their wives during pregnancy and childbirth, such as through attending antenatal classes.
Amref does not have particular programme aimed at getting men more involved in family planning, but hopes this can be achieved through strengthening the VHTs to promote behavioural change.
"We are trying to fight myths that having many children proves someone's manhood. That is wrong; instead manhood should reflect a small, manageable family," Oscar Okech, Amref's project manager, said. "But this will be realised over time since behavioural change is a gradual process," he added.
Through the empowerment component of the project, Amref is hoping to encourage women to take more control over family planning decisions.
Joseph Malinga and Liz Ford, The Guardian 22-02-2010