Let’s Intensify Behavioral Change Campaigns Amongst Adolescents to curb HIV/ Aids.

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Uganda is one of the countries pursuing the ambitious UNAIDS 90-90-90 global target: Ensuring that 90 per cent of all people living with HIV know their HIV status, 90 per cent of all people diagnosed with HIV infection receive sustained anti-retroviral therapy and 90 per cent of all people receiving anti-retroviral therapy have viral suppression by 2020. To achieve this ambitious target, we need concerted effort of all stakeholders, right from the donor community, through the private sector to the general public.

The considerable number of HIV/Aids infections occurring among adolescents is partly attributed to early onset of unprotected sex and multiple concurrent sexual partnerships coupled with substance abuse. Statistics from UNAIDS reveal that about 65,000 female adolescents (aged 10-19) live with HIV in Uganda compared to about 49,000 male adolescents. This trend must change if Uganda is to develop a quality population.

Understanding factors related to HIV transmission, behaviour and practices is invaluable in designing appropriate behaviour change communication . BCC is an interactive process to develop tailored messages and approaches using a variety of communication channels to develop positive behaviours; promote and sustain individual, community, and societal behaviour change; and maintain appropriate behaviours.

The 2014 HIV/Aids Uganda Country Progress Report decried the limited funding for comprehensive social and behavioral change communication despite low HIV/Aids comprehensive knowledge. The percentage of women aged 15-24 who correctly identified ways of preventing the sexual transmission of HIV and who rejected major misconceptions about HIV transmission stood at only 35.7per cent.

Behavioral change is a gradual process that occurs over a long period of time. In order to sustain the observed changes or effects in adolescents behavior and attitudes towards HIV/AIDS, information flow  greatly shapes the behaviors of adolescents.

A 2015 behavior change campaign survey by Uganda Health Marketing the multimedia  condom campaign dubbed ‘If it is not on, it is not safe’ scaled out in 8 districts among adolescents observed that (80.3%),of youth reformed their sexual behaviors after  listening to radios, (23.8%) televisions and billboards (23.1%). Only 6.8% of the respondents had been exposed to the campaign via Interpersonal communication channels.

Based on participatory formative research with adolescents, the OBULAMU adolescent sub campaign named What’s Up developed a series of print, audio and visual messages to address the unique sexual and reproductive health needs of this audience. The campaign messages so far  trigger self-reflection, dialogue and action towards desired adolescent behaviors such as skills to navigate relationships;  pregnancy and HIV prevention; partner reduction;  safe male circumcision; HIV testing, care and treatment; and early TB detection  and treatment.

 In order to intensify the campaigns, we need to scale-up age- and audience-appropriate social and behavioral change interventions including targeting, adolescents (both in and out of school) and young people we need to avail adolescents with necessary information through different fora such as radio programmes with role models, community outreaches as well as Information, Education and Communication (IEC) materials which will enable them make more informed decisions. This will also allay the misconceptions about HIV among them.

Campaign efforts should be continuous in order to ensure constant exposure to campaign messages, which is crucial in sustaining behavior change among adolescents.

Government partnerships and buy-in is very important in rolling out behavior change campaigns in order to maximize success and sustainability of planned activities, district ownership of the campaign activities greatly contributes to the success of the campaign. The advent of web 2.0 technologies has also posed a threat to our youthful population  but with clear plans can help to beef up the behavioral change campaigns.

The National HIV and AIDS Strategic Plan 2015/2020 indicates a missed opportunity in schools where a fair proportion of young boys and girls spend majority of their time and could be reached with HIV and AIDS messages through civic education. Schools have very organized systems for information flow and shape the behavior of young people, notably making  Information Education and Communication programmes part of the school curriculum or community initiatives aimed at fighting HIV will go a long way in reducing HIV/AIDS prevalence among this vulnerable group.

Joyce Tamale Namirimo

The writer is a managing director Uganda Health Marketing Group.(UHMG)

The article was published in the New Vision of 1 December 2017

Hot Culture Week: Celebrating Our Diversity

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In today’s multicultural world, it would be weird if all your fellow coworkers were from the same ethnic background as you. People move around Uganda a lot, and workplaces have now become a lot more like airport terminals where you get to be with all sorts of people. If your workplace doesn’t have people from different cultural backgrounds you’re missing out on all the fun.

Cultural diversity makes us excited because it means we get to taste food from all around the world – why would you ever go to fusion restaurants when your workplace is the biggest fusion kitchen in town? Plus, we get to learn how to say various terms in all sort of languages and who doesn’t love that?

A recent study found that in the ‘colorblind’ workplace, where racial and ethnic differences are downplayed, employees may feel less engaged. But workplaces that promote multiculturalism may have better retention rates and employee investment. This week, we are showcasing culture. Dubbed “Hot Cultural Week”, staff will take up the mantle to showcase respective cultures assigned and in it enable others appreciate and understand more of what that specific culture represents. Friday will be a Hot Culture Galore where all cultures will be celebrated as e end a week of intense excitement and learning.

So, please don’t be in awe when you visit our offices to find people dressed in local attire – or holding spears. It’s Hot Culture Week and we are celebrating it with a bang!

Jonathan Ssekitondo
Social Media Officer (USAID – Uganda Social Marketing Activity)

Delivering health services in Caroline’s community ensured she received her Jadelle

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Apac Pic

A health worker administers Jadelle to Caroline during a health camp at Ayago Health Center II.

Angom Caroline, 37, is a mother of six, five living and one still birth. Since giving birth to latest baby girl three years ago, she has been worried about getting pregnant again. She desired to look after her family, nurse her baby as she cultivates her land in Agali Village, Ayago Parish, Akokoro sub-county, Apac district. She longed for a peace of mind knowing she can look after her family with no worries.

“I didn’t want to get pregnant after I delivered my baby, for now this baby is keeping me busy, adding on another one on top of the four I have already will make it hard for me,” says Caroline.

Caroline would not afford transport to go to the nearest facility at the district health facility to get Family Planning services. She had heard about Family Planning through her peers and the village health team member of her cell. The health education session and testimonies from her peers motivated her to seek for the Family Planning services.

“I only needed to go to the health facility to get my family planning method, but the place was so far and my baby was still young. I also had no one to take care of other siblings if I decided to leave,” says Caroline.

With the support of her husband, Caroline decided to visit Ayago Health Center II, a facility at her sub county, after she had heard on radio that there would be a health fair organized by Uganda Health Marketing Group, and Family Planning services were going to be provided. She had discussed this with her husband and opted to go for the permanent tubal-ligation because the family had grown big, and supporting their children was becoming hard. However, when she met the health provider at the health camp, she was taken through the other options for Family planning and decided to go for Jadelle as her choice, ditching tubal-ligation.

‘I opted for Jadelle because it’s inexpensive, natural and will give me peace of mind. I can remove it anytime and have another baby, if my husband and I choose to. I don’t have to worry about taking tablets,’ says Caroline.

Caroline, feels happy now that she received her Jadelle. This gives her hope that she can go on with her life with no worry. She is determined to raise a happy family, till her land to raise money to facilitate her children’s education, and having this Jadelle will deliver her dreams of a happy and healthy family

The USAID/Social Marketing Activity project aims at contributing to a reduction in new HIV infections, total fertility rate, maternal and child mortality due to malaria by increasing utilization of socially marketed products and services in the country. Bringing services closer to people like Caroline contributes to that overall aim.

What is Jadelle?

Jadelle is a contraceptive implant, used to prevent pregnancy. Contraceptive implants such as Jadelle are for long term (up to five years) use. The implants contain a synthetic hormone, levonorgestrel, which is also one of the active ingredients used in many oral contraceptives.

Expand malaria fight beyond nets

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(Mother and son receive a LLIN during the 2014 distribution exercise)

The government of Uganda launched an effort to distribute 24 million long lasting insecticide treated nets (LLINs) to households across the country. The launch represented the highest number of mosquito nets ever to be distributed in Uganda; up from 12 million in 2013/2014 and the 7.2 million distributed in 2010.

However, having mosquito nets ‘in place’ and having them ‘used’ are two different indicators of success. A major weakness of past public health programming has been providing people with technologically sound and useful interventions without taking into full account the social, cultural and behavioral factors that influence acceptance and use of the interventions. The proportion of households owning one or more insecticide-treated net (ITNs) in Uganda did surely increase from 60% in the 2011 Demographics and Health Survey (DHS) to 78% in 2016, and the proportion of children under five years reported to have slept under an ITN the night before the survey also increased from 43% in the 2008 DHS to 62% in the 2016 DHS, which is huge progress but certainly not enough.

According to the Uganda Malaria Indicator Survey 2014/2015, the most common reason why people shunned sleeping under a mosquito net was that it was too hot. A smaller percentage of households said the nets were too difficult to hang, the nets were not needed or there were no mosquitoes.

However, despite issues dragging ITNs efficacy, demand appears to be on the upswing. Ministry of Health completed the first wave of the distribution that took place in the 22 districts such as Adjumani, Agago, Alebtong, Amuru, and Apac, the ministry of health has so far distributed a total of 4,439,639 long lasting insecticide nets protecting over 8 million Ugandans in just two months since the nationwide launch in Apac.

So how do we engage more effectively with communities to increase net usage to rhyme with numbers coming from the demand curve? Community participation and knowledge remain main drivers to increase demand and use of ITNs. The culture of malaria prevention must become part of the fabric of life in every community. Provision of nets alone will not bring about high coverage in Uganda. There must be need to create the demand for insecticide treated nets and for malaria control services. This has to be done by raising awareness of malaria and community knowledge about the most effective means of preventing and treating it. Communities must be engaged in activities centered on information, education and communication.

There is need for more effectively mobilize communities and organizations to advance the welfare of children and mothers. In Uganda, political and traditional leaders are often on the front lines of changing behavior. Local area political leaders too have a huge role to play here. Sunk by statistics from the Arua district health office which indicated that 386 people of all ages die from malaria annually, district vice chairperson, Mr Genesis Acema asked Ministry of Health to enact a law that punishes citizens who misuse treated mosquito nets distributed by government. “People who use these nets for raising chicken should be punished incase such a law is enacted. People are more scared about HIV/Aids and are giving less attention to malaria which kills many especially children and is responsible for some of the miscarriages,” he said. ITNs have for a long while been used as bedsheets, and for caging chicks and coffee seedlings against pests. Addressing such attitudes and behavior that water-down the value ITNs offer communities must be addressed.

According to the National Malaria Control Programme (NMCP), Uganda is expected to achieve close to 100% success in parasitological confirmation of all suspected malaria cases before prompt and accurate treatment of positive cases with ACTs, at all levels of care. For community based health care, the Ministry of Health, in 2010, adopted a strategy for integrated community case management (iCCM) to facilitate access to and reduce the treatment gap for malaria, pneumonia and diarrhea. The iCCM program includes using ACTs to treat malaria after confirmation with malaria RDTs, amoxicillin for prompt treatment of pneumonia and oral rehydration solution and zinc for the management of diarrhea at the community level.

Joyce Namirimo Tamale (FCCA)
Managing Director Uganda Health Marketing Group (UHMG)

Using non-traditional outlets to increase access to condoms

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(A stall selling Protector condoms in Kishanga A, Kasese)
Promoting condom use to prevent HIV transmission is futile if condoms are not readily available. 87% of women and 88% of men aged 15-49 (according to the 2016 Uganda Demographics and Health Survey) know that consistent use of condoms  prevents the spread of HIV, however some do not find them readily available.  People will continue to engage in risky behavior that will expose them further to HIV/AIDS and unintended pregnancies because they lack condoms, irrespective of knowledge on the purpose they offer.
Users at the end mile,  in the remotest of villages in Uganda, must have access to condoms if their duo role of preventing HIV transmission and unintended pregnancies is to be actualized. Supplying condoms to rural-based merchandisers, irrespective of how big their shops/stalls are, is vital in ensuring people have ready, continuous access to condoms. We found a small stall in located in one of the red light areas of Kasese, Kishanga A, Kichwamba Division that readily served Protector condoms to the community. Talking to the stall owner, Fura Ibrahim, we found out  that two  Protector condom dispenser of 20 packs of 3’s, an equivalent of 120 condoms are sold in just under a week!
The USAID/Social Marketing Activity aims at contributing to – reduction in new HIV infections, total fertility rate, maternal and child mortality due to malaria by increasing utilization of socially marketed products and services in the country. Providing superior and affordable quality health care products to the community does not only contribute to the project’s overall aim, but also to Uganda Health Marketing Group (implementing partner)’s mission. Reaching the hard-to-reach places of Uganda like Kishanga A divsion will  ensure availability of condoms, which when consistently and correctly used provide protection against  Sexually Transmitted Infections (STIs) including HIV and unintended pregnancies.
Jonathan Ssekitondo
Social Media Officer (USAID – Uganda Social Marketing Activity)

Modern Contraceptives: All you need to know

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maggie(2) (Participant poses for a photo at the SMA Family Planning Workplace Activation Event in Njeru – Jinja)

Enrolling for a suitable family planning option is a process, a process where a woman hears, consults and makes a decision to seek the option. Many, being in relationships, seek guidance and counsel from their husbands – some ask friends before they decide on what option to take on. One of the most frequently asked question by women before getting a modern contraceptive method is “After using contraceptives, will I be able to fall pregnant as soon as I am off it?” It never ends there. The questions keep lingering on. “Will using birth control for a long period of time affect my fertility? “Will it take months (or longer) for my fertility to return?” “What are the contraceptives side effects I should be aware of?”

These questions must be answered with all due honesty if uptake of modern contraceptives is to be improved in Uganda. The 2016 Uganda Demographics Health Survey stats indicate that 39% of currently married women are using a method of family planning – 35% using modern methods while 4% are using a traditional method. That stands at 51%  for the unmarried women, with 47% using a modern method and 4% a traditional method. Answering questions that arise from the use of modern contraceptive, and clearly explaining the benefits they offer, how effective they are, and side-effects each method comes with will go a long way into seeing more women take up family planning options.

“After using contraceptives, will I be able to fall pregnant as soon as I am off it?” and more can be answered in one statement –  it depends on the type of contraceptive a women chooses and the way in which it introduces hormones into her system, that is if it is a hormonal method. Some contraceptive methods have no impact on a woman’s fertility once she decided to come off them, and she can fall pregnant as soon as she stop using the method, while with others, the effects take a slightly longer time to return to fertility, which means that even when she stops using them, it could some time to fall pregnant again.

We’ve taken a look at different modern contraceptive we market to give a better overview of each one and its effect on a woman’s fertility. The choice on what option to take on will solely depend on how long a woman wants to be protected against falling pregnant

Pills (PilplanPlus and SoftSure)

In general, the contraceptive pill is an effective method of contraception that changes the environment in the uterus by introducing hormones that will stop the egg and the sperm from meeting. The discontinuation of pills implies and immediate return to fertility therefore this would be the best method to use if you wanted to delay pregnancy with the hope of falling pregnant immediately after you stop using the method.

Injectable contraceptive (Injectaplan)

The injection, as it’s commonly known, is the most misunderstood method altogether. While it’s relatively convenient to use and discreet (you only need one injection every three months and is injected into your buttocks or upper arm), this method presents the worst side effects of most contraceptive methods. Because this method introduces a larger amount of hormones into your body it may take a longer time as compared to other methods to get out of your body. Return to fertility when using this method can be up to 9 months. If you want a discreet method that is less hormonal and has a faster return to fertility, this may not be your choice.

IUD (The loop’)

Although the intrauterine device (IUD) – more commonly known as ‘the loop’ – provides protection from pregnancy for up to ten years at a time, you might be surprised to know that return to fertility is immediate after you take it out. Also, you can choose to remove it any time that you like – you don’t have to wait the entire ten year period to remove it. Because the loop is a barrier method that works by changing the environment in the uterus and stops the egg from meeting with the sperm and doesn’t introduce any hormones into your system in the process. Return to fertility is quicker than the pill and the injection that are discussed above. Therefore we would suggest the IUD if you want to prevent pregnancy for a long period of time without affecting your return to fertility time frame when you decide to then fall pregnant.

The Implant (Implanon and Jadelle)

The implant, which is inserted under your skin and is effective for up to three years (Implanon) and five years (Jadelle), releases progesterone into the bloodstream at a slow and steady rate. As with other progesterone-based contraceptives, it works by preventing ovulation and thickening the mucous in the cervix to create a mucous plug, which stops sperm getting to the womb to fertilize an egg. It also thins the lining of the womb. The implants’ return to fertility period is immediate once the small rods are removed from your upper arm. We would recommend the Implant for women who are breastfeeding, women who want to prevent falling pregnant for a couple for years to come, woman who want a less invasive insertion method than the IUD and do not want to affect their return to fertility.

Oh, and then this question – “Do they protect me from sexually transmissible infections (STIs)?” No! Modern contraceptives do not protect a women from STIs. You need to use condoms (male and female) correctly and consistently alongside modern contraceptives to protect you and your partner against STIs and unintended pregnancies.

Making your smart choice

Before you choose your contraceptive method, ask yourself:

  1. How long do I want to be protected against unwanted pregnancy for?
  2. When do I want to fall pregnant?
  3. How long am I willing to wait until I can fall pregnant after stopping a contraceptive method?

Once you have answers to these questions, then you’ll be in a good position to make the right choice. Of course, there’s always extra assistance available at our network of GoodLife Clinics. Our doctors and nurses at these facilities are experienced at helping clients figure out exactly what type of contraceptive would be best for them. So if you want to be sure you’re making the right choice, visit your nearest GoodLife Clinic and talk to one of them. They’re super friendly, helpful, and everything you discuss remains totally confidential.

But I do not know the nearest Health Provider/GoodLife Clinic?

Simple! Go to the message option of your mobile handset and type PLAN <leave a space> Your location and send it to 8464. For example, if you are in Namuwongo, type; PLAN NAMUWONGO and send to 8464. A message showing the nearest GoodLife Clinic/Health Provider will be displayed. Visit the provider and you will be helped. Or, you can talk to a counselor FREE on 0800200600, Monday to Saturday 8:00am to 7:00pm.

Jonathan Ssekitondo
Social Media Officer (USAID – Uganda Social Marketing Activity)


UDHS 2016 – Infant And Maternal Motarlity Rates Decline (Full Report)

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The Uganda Bureau of Statistics (UBOS) released the key indicators report for the sixth Uganda Demographic and Health Survey 2016. Among other notable achievement Uganda registered was the significant decline in child and maternal health.

The results show that Infant Mortality Rate has declined from 54 deaths per 1000 live births in 2011 to 43 deaths per 1000 live births in 2016. The report also indicated that child mortality has seen a steady decrease from 38 deaths per 1000 live births in 2011 to 22 deaths per 1000 live births in 2016.

Uganda has, according to the report, also made great strides in maternal health. Maternal mortality has reduced from 438 deaths per 100,000 live births registered in the 2011 UDHS report to the current 336 deaths per 100,000 live births. There is also marked improvement in pregnant women attending four or more antenatal care visits from 48% in 2011 to 60% in 2016 while the number of births in health facilities increased from 57% in 2011 to 73% in 2016.

Read the full UDHS 2016 Report here.

One condom per session: Talking correct condom use

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(Swaibu Luwembo)

It’s almost like condoms are the black sheep of the contraception family, because they are seen as not 100% effective or they diminish sexual spontaneity. However, condoms, male or female, are the most commonly available types of contraception and apart from abstinence, are the best way to avoid getting a sexually transmitted infection during penetrative sex, if used correctly and consistently.

The spread of STIs and unintended pregnancies isn’t usually the result of “product failyre” but rather incorrect use – solely a human error. In spite of changing attitudes towards sex and sexually transmitted diseases and efforts by health services to promote condom usage, there is still a lack of understanding on how to use them properly.

At one of our community dialogue sessions on proper condom use in Malaba town, we met Swaibu Luwembo, 27, a manicurist. He confessed that he has always worn two condoms every time he had sexual intercourse. In his own confession, he said – “Honestly I cannot lie, I have been using two condoms at once. You cannot trust these girls of Malaba. Sometimes I get sex in payment for a manicure. I always feel more protected with two condoms.”

This here is one form of incorrect use of condoms that affects their effectiveness. Wearing two condoms at once is a sexual myth. It does not make a condom twice stronger or the user doubly protected in doing so. On the contrary, the condoms are exposed to higher risks of breaking during sexual intercourse. The friction created between the condoms can get too high that they’ll break each other off. This is why it is a bad idea to wear two condoms at the same time.

Addressing myths like the one here will go a long way into curbing the sky-rocketing new cases of HIV infections and abortions among young people. Swaibu was lucky that he was taught out of his ignorance, and learnt that one condom is enough if correctly and consistently used. He left a happy, satisfied young man equipped with knowledge on correct condom use. We intend to reach out to more Swaibus because we know such myths still exist in society, and expose many young people to unintended pregnancies, HIV and other STIs. It’s important to emphasize correct and consistent use of condoms if we are to make them 99% effective in prevention of unintended pregnancies and STIs including HIV.

Written by Jonathan Ssekitondo and Jeanne Marie Nakato



Maternal Health Voucher: The story of Rachel Namuluuta

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img_4089 (Rachel holds her baby as a GLP displays the maternal health voucher)

When Rachel Namuluuta, 34, eight months pregnant with her fifth child, made the decision to purchase the Maternal Health Voucher, little did she know that it could potentially save her life and that of her unborn baby. The voucher, currently being marketed by USAID Uganda Social Marketing Activity Project under Uganda Health Marketing Group (UHMG), goes for 4,000shs (Four thousand shillings only), and it entitles a mother to a whole MCH comprehensive package covering four antenatal care visits, delivery, post natal care, postpartum family planning and referrals for complicated cases, and immunization.

Rachel lives in one of the blighted area just outside Lugazi town, one that houses poor families who battle to raise money for safe child delivery. While 88% of wealthy women in Uganda have a skilled attendant at delivery, fewer than half of poor pregnant women deliver in the presence of a skilled attendant. According to 2011 Uganda Demographic Health Survey, Uganda’s maternal mortality rate was found to be 438 per 100,000 live births. To achieve the goal of reduced maternal mortality, Millennium Development Goal 5 (MDG 5), there is need to increase the proportion of women who deliver with skilled attendants, and ultimately, we want every woman to deliver with a skilled provider. A critical step toward achieving this goal, we believe, it is through health innovations like this Maternal Health Voucher.

So when Rachel heard about the Maternal Health Voucher from Hadijah, a member of the Village Health Team, also referred to as a Good Life Promoter (GLP), she quickly embraced the idea. In her mind, she was tired of the worry that comes for every poor mother when time for delivery sets in. She was thinking safe delivery, without worries of the insults that are raised at mothers who fail to raise delivery fees at some health centers. All she wanted this time round was to get through the process safe, absent worry. Her first two babies were born at home with the aid of a traditional birth attendant and her mother, after attending three antenatal care visits at a local public facility. While her first two delivery experiences were not bad, the third one almost took her life – but with the grace of God, she managed to pull through.

However, this time she wanted to ensure that, “in case of any complications, I can give birth in a hospital.” She made the decision, and talked to her first born son, 14, who because she cannot raise tuition fees, has dropped out of school and taken over the job of bread winner for the family. Working at a local water point, the young man has been able to look after his mother, who due to pregnancy-related diabetes has been bed-ridden for a while. He subscribed to her mother’s request, gave her the money and she purchased the voucher because it was affordable.

17 days after her purchase, we went back to Lugazi to check on Rachel Namuluuta, the first recipient of our Maternal Health Voucher. This was just 4 days after she had welcomed her baby boy, Joram. The smile that greeted us as we took the cracked stairs leading to her house lifted our spirits! She let out a cry, “You saved me! I could have died. The voucher saved me!” Rachel, had on Sunday 5th February gone with her voucher to Lugazi Muslim Health Center after feeling “uncomfortable.” There, she was told her time was due, and should get ready for delivery. Being a poor woman, and the reason she qualified for the voucher, she did not have money on her. Her mother who later made it to the health center had in her possession only UGX60,000. Will all know this is very little money to get a mother through delivery. Fast forward, the pains kicked in and after assessments, the health center realized it was taking long and the baby was not moving – they recommended she is immediately transferred to Kawolo Referral Hospital, a few kilometers from the health center where she was.

By this time, if it were not for the voucher, the UGX60,000 her mother had with her would have been of no use. A referral, which at this moment meant she had to undergo cesarean section, would have cost her over UGX700,000. Many mothers like Rachel cannot afford this money, and sadly, they pass on while giving life! Such a sad and unfortunate happening! But because of the Maternal Health Voucher, Rachel was referred to Kawolo, at no fee, got the best obstetric care, and underwent successful C-section, the surgical delivery of an infant through an incision in the mother’s abdomen and uterus. She attests to us, this saved her life and that of her precious little baby boy.

That is the satisfaction we derive from this service! The fulfillness we get when as we leave Rachel’s home, she calls out to us, saying “Thank you. You saved me, you saved my baby. Please do not stop with me. Look out for more mothers like me. Help them” is the reason for the Maternal Health Voucher. That is why it is here! We know that when a mother dies, her children are less likely to survive. We know that poor women lack access to quality obstetric care, and this the Maternal Health Voucher will seek to address. We envision a Uganda where no mother dies giving life on grounds that she cannot afford to deliver under the watch of a skilled birth attendant. We hope to bring you as many of such stories as we move along with the voucher. Rachel’s is the first of many.

This Maternal Health Voucher program is being implemented by the USAID-funded Social Marketing Activity project under Uganda Health Marketing Group. The Maternal Health Voucher program seeks to reach 20,000 mothers in the next three years. It works in partnership with private GoodLife Clinics to ensure high quality Maternal and Child Health (MCH) service, and with community-based voucher distributors, the GoodLife Promoters, to provide information to recipients, the poor mothers.

The Maternal Healthy Voucher program set out to address the objective of increasing access to comprehensive obstetric care for the poor in well facilitated health centers. It has, in the first two weeks of implementation, achieved remarkable results. More than 300 vouchers have been sold, with, thus far, thirteen babies delivered – among them a set of twins, all under the watch and care of a skilled birth attendant at a health facility. These mothers, and those to come, will use the vouchers for postnatal care, which includes family planning counseling. Now in only Kampala, Wakiso and Buikwe, the Maternal Health Voucher will in the next two weeks be rolled out in districts of Masindi, Kasesse and Kamuli.

Written by Beatrice Kakiiza and supported by Jonathan Ssekitondo.


Debunk myths and misconceptions to raise family planning services uptake

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(Courtesy Photo)

Recently I was having a conversation with a pregnant friend, Claire. She told me something that I found completely outrageous. Eyes locked, Claire said to me that upon delivery, she would make sure that her baby’s umbilical cord does not fall off. And, if it fell off she would have to pick it up with her mouth off the floor to ward off some taboo befalling her baby.

I was aghast, completely shocked that such a well-educated lady would still believe in something like that! But before I could protest, I realized that there are many Claires out there. When it comes to the subject of contraception and birth, the beliefs that our society still holds dear are boundless. And that regardless of how well educated one might be, some of these things are deep seated within our psyche.

Figures from the latest Uganda Demographic Health Survey show that only 3 in 10 women are using some form of contraception – a big number is not. Many desist from using contraception for various reasons that include among many cultural, religious et al. In the ten years of family planning provision, Uganda Health Marketing Group has also noted that some women don’t use contraception out of a sense of duty to their husbands. You see the feeling here is that in some cases if a woman uses contraception then she is up to no good to her husband. Other women feel that they need to show readiness to get pregnant when the husband demands so.

Many misconceptions come from the fact that in many Ugandan societies a woman is objectified. If that woman is not pregnant in perpetuity then their usefulness is quickly waning. So as sure as clockwork, they will be pregnant as soon as they give birth. Family planning is detested, feared by some men because they think it gives women a certain control of their lives.

However, what ranks up there when it comes to the low uptake of family planning methods is the fear of side effects. According to the Uganda Demographic Household Survey (UDHS) 2011, 2 in 10 women have opted not to use modern family planning methods because of fear of perceived side effects. Many think, believe that when they use modern contraceptives like pills, implants etc, they will give birth to children with deformities, get cancer, become infertile … the list is endless. This affrights them from seeking a suitable method to delay birth.

It’s on this background that UHMG has developed the I WAS WRONG campaign.  The mass media and interpersonal communication campaign is being implemented under the Social Marketing Activity project with funding from USAID. The campaign, now in its implementation stage, seeks to debunk contraception misconceptions – fronting facts that family planning methods myths are absolutely that – MYTHS! They just do not exist! The campaign will seek to tackle myth by myth, exposing the various falsehoods that have for years been tagged along each specific family planning method.

I Was Wrong will build on UHMG’s efforts in providing adequate family planning information and services for women in rural and urban areas that remains absolutely important even as we seek to tackle these myths. Since UHMG provides socially marketed products and services through its network of GoodLife Clinics (GLCs), the campaign will also refer couples to centers where they will get readily available and accessible family planning services.

The campaign does not forget the importance of involving men to increase uptake of available modern contraception options as most resistance in communities is attributed to men opposition towards these options. But it also goes without saying that in many instances the low intake of family planning methods is due to lack of knowledge and stifling poverty that women miss out on contraception. However, when those in the villages are told that the use of contraception inhibits libido, they are stuck between a rock and a hard place. You see, many women in this part of the world are taught that sex is for the enjoyment of a man. That they are there to fulfil the sexual desires of a man. Still, biologically, one needs to “want it” at a given time to “give in”. When they are told that the contraception pill inhibits there libido, they know that they will not “want it” and if that is the case, the men are going to wonder about. Other misconceptions center on weight gain and the development of cancer. This is what I Was Wrong will seek to address.

There are enormous life saving benefits family planning offers to mothers and their children. It also contributes to a range of development targets, including poverty reduction, gender equality, and environmental sustainability, as well as maternal and children’s health. Important to note that addressing the myths that promenade along the various modern family planning methods should be in sync with different traditional beliefs and be ready to take on, with sensitivity, the misconceptions therein.

Women should reflect on the myths that have burdened them for ages, shake their heads in disbelief on how wrong and deceived they have been. We hope that after this campaign, the uptake of modern contraceptives will double over the next 10 years from the estimated 30% intake (UBOS and ICF International, 2011), a figure that doubled over a span of sixteen years from 1995 (UBOS and Macro International, 1995). But above all, we yearn to hear and read testimonies from women attesting against myths and misconceptions that have held them hostage against using modern contraception methods for years, saying “I Was Wrong!”

Jonathan Ssekitondo (JSsekitondo) (Additional input from Ritah Mwagale)

Social Media Officer – USAID/Social Marketing Activity (UHMG)