CHAPTER TWO
REVIEW OF RELATED LITERATURE
2.0 Introduction
This chapter presents review of related literature by other researchers and educationalists on topic about “the accessibility of Family Planning by women in Kira Town Council, Wakiso district.
The related literature presented under this topic is based on the three of objectives hereunder;
- The awareness levels of Family Planning Services by women.
- The factors that hinder women from accessing Family Planning Services by
- The strategies to improve access to Family Planning Services by women.
2.1.1 The Concept of Family Planning
According to Bertrand (1995), Family Planning is strategy of working out plans with your partner on how you want to deal with procreation within the context of sexual relationship.
He further defines Family Planning as means of planning when and how many children you are going to have and how to prevent unwanted pregnancy. However, Family Planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their birth. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her death and well being as well as on the out come of each pregnancy.
According to the Uganda National Planning Advocacy Strategy (2005), Family Planning is the consensus effort of individual or couple to decide for themselves when to start having children, how many children to have, how to space them and when to stop having them their artificial and natural method of contraception. Family Planning connotes contraception control to avoid pregnant but it also includes efforts of couples to induce pregnancy.
According to World Health Organization (Department of Reproductive Health and Research, 2007), there is a global concern about reproductive health programmes/care (Family Planning Services) for all women irrespective of their reproductive age and disability. It further suggests that family Planning remains unfinished. Over 120 million women world wide want to prevent pregnancy but they, and their partners are not using contraceptives.
According to the speech by the Prime Minister of Uganda, Professor, Apollo Nsibambi, he said that the promoters of Family Planning Services are aware that adopting Family Planning to keep size of the Family small world allow families to invest more in each child’s nutrition and health care and could reduce poverty and hunger for all members of the household. Besides saving children lives, it can also prevent MMR.
Another importance of Family Planning is reducing the population growth rate of an economy in particular and the overall population of the world in general and with its related problems for example, the 512m in malnourished people, 215million households without access to safe water, and 293 million children not attending primary school. All these problems aroused due to the ever increasing population with the lack of Family Planning program being one of main causes. Most of these problems are also experienced in Kira Town Council where many of children lack food nutrition and others.
So many women in Kira Town Council no longer cut children but end up having unintended pregnancy due to the inaccessibility of Family Planning services. It should also be made accessible in order to sensitize the adolescents who do not have easy access to Family Planning information should include in counseling and follow-up services like provision of contraceptives.
2.2 Awareness about Family Planning services by women
Today every 17% of women of reproductive age in sub-Sahara Africa use a modern contraceptive. But about 60% of women in the growth who want to avoid pregnant are not using Family Planning or are using a tradition almost 80% of women who need care each for complications of pregnant and delivering do not receive it. If reproductive unhealthy services were provided to all women in need, maternal deaths would be reduced by 70%, newborn deaths would be cut by heavily half and 750,000 lives would be saved each year.
According to the most recent national survey, only 18% of Ugandan women are using family planning services. However, almost twice that number or about two in every five women would like to space their nest birth or stop having children altogether but are not using any method of family planning. These women are considered to have unmet need for family planning stated by Uganda on the move. (September, 2010)
In line with the above School of Public Health (2010) stated that almost twice that number or about two in every five women would like to space their next birth or stop having children altogether but are not using any method of family planning. These women are considered to have unmet need for family planning stated by Uganda on the move
2.2 Factors that Hinder Women from Accessing Family Planning services in Uganda
According to Byarugaba (2009), Family Planning services are available both in private clinics and government health centres but there are some challenges faced by women in accessing it, hence some reasons for low turn up of women for services like they have worries of the side effects. For example injecta-plan method, many women suffer the consequences of chronic bleeding without ceasing or at times it cause obesity. Other beliefs such as religious affiliation for example Catholic have a negative attitude about Family Planning methods, they don’t use it but prefer bearing children till it is no more. The duration of the methods such Norplant method which after insertion, lasts for 5 years to expire and another one like Copper T-coil some expire after 10 years. Hence hinders the turn up of women for services. Ignorance of both spouses is a challenge to access the service in the area.
Byarugaba further noted that some health centres have the services but they do lack skilled personnel for example, he once missed clients in his private clinic (Kireka Medical Centre), who had come for Norplant method and was away and all the nurses were unskilled to take on the procedure. However, future research that covers that determinates of perceptions of both community level and individual level quality could provide key insights for developing effective and efficient Family Planning programs.
World Health Organization (WHO, 2009) further stated that, reasons for unmet need are many and they are attributed to limited services and supplies, fear for social disapproval of partner’s opposition pose formidable barriers, worries of side effects and health concerns hold some people back, others lack knowledge about contraceptive options and their use.
In the traditional understanding, Family Planning was not an issue to be considered because a large number of children were seen as a blessing, security for the future and guarantee for continuity of lineage and clan. The more children a man had, the more he was respected and the more children a woman had, the more she was valued in the clan. If she is married to therefore the introduction of the new Family Planning practices was concerned as a plan to stop women from bearing children which is interference to the plan of God as seen in some Kiganda expression, like “Muzaale mwale” meaning you can produce as many as possible.
Wakiso district health service report (2010), pointed out that, in Uganda, though there is an effort to provide this Reproductive Health Programme, it is very weak because of the challenges it is still facing for example, the stereo type thinking and ignorance among the local people. Most women have stereo types which have been constructed by the society in which they live. For example, the need for so many challenges and most often men, they are also ignorant of the importance of reducing Family sizes through Family Planning. This problem is worse when it comes to Kira Town Council whereby women are always in great fear to take up the services because they feel that they will get serious complication in the future. This problem leads to under development and the low socio-economic development of Kira Town Council.
According to International Conference on Family Planning (2009), an estimated 41% of Ugandan Women who would like to stop having children have no access to Family Planning Services. However, this has resulted into unintended pregnancies and bigger families. It further stated that in Uganda a woman will give birth to an average of 6 – 7 children in her life time. Such large families in developing countries are linked to poverty, poor nutrition, low education levels and even health dangers, for example a woman is at risk of maternal mortality increase with each birth.
According to the Uganda National Family Planning strategy (2005 – 2010), March, 2005, Development by the Ministry of Health over two thirds of Ugandan women and men say that they want to space children or limit children bearing (71% of women and 67% of men). However, they face many challenges which include the social, cultural, religious values which have strong influence on reproductive choices for women in Uganda. Early frequent child bearing and large Family size reflect long standing societal norms among most segments of population.
According to the 1980’s law, further controversy emerge when social and religious conservatives began alleging that the very availability of Family Planning services promoted promiscuity and abortion, and that the provision of confidential services to teenagers encouraged the disrespect of parental authority (The Development Office of the Kenya Catholic Secretariat). The Catholic Church and some societies have always preached against use of Family Planning Services saying that it’s a sin and against Gods command that is to say “Go, subdue and fill the world”. These controversies initiated a big challenge to the delivery of Family Planning Services in most societies for example Kira Sub-county where so many women have bared children as commended by the churches, their spouses, among others.
According to the MoH, (2009), The levels of understanding and acceptance of Family Planning Services is also a big challenge. According to the study of working women and non-working women in Bargladesh 59% of the working group who had acquired some education were employing contraceptives compared to 41.4% of non working group who had acquired less or no education at all. 45.1% of the non working group had never used contraceptives compared to 23.9% of working women. 55.9% of the working women participated in Family Planning decision making with their spouses as compared to 23.5% of the non working women. The level of understanding here influences acceptance that is to say the more people understanding the importance of Family Planning, the more they will be lured to adopt. In Kira Sub-county, the level of understanding of Family Planning services is still very low and therefore acceptance to embrace it is still low.
The rising costs of some contraceptives and of state of the art medical technology complicated the delivery of Family Planning Services to the existing and at the same time, Family Planning Services (methods are inadequate). Also contributed to inaccessibility of Family Planning services by women in Kira Town Council. They’re just few (2 – 3) methods only in per Health centre out of different methods available in hospitals.
According to the Family Planning Global Handbook for providers (2008), some women find it very hard to discuss their desires to use condoms or any other method of Family Planning. (To access the Family Planning Services). Men give different reasons why they stop their women to access Family Planning Services, therefore you find out that women with low bargaining power end up being oppressed and exploited by their partners through convincing them to access Family Planning methods. This situation can be clearly seen in Kira Town Council where women often have inferiority complex with in them and always feel ashamed to talk about it hence leaving the decision to be made by men.
African Union Commission (2009), states that high fertility is directly related to child and early marriages. other factors related to this are unmet needs for contraceptive services, lack of sexuality information and lack of Family Planning Services for the prevention of pregnancy. All these conditions make birth spacing difficult to manage and increase incidents of unwanted pregnancies. Hence may lead to MMR is IMR.
According to Ministry of Health, (Dr. Stephen O. Malinga), in the second National Health Policy of promoting people’s health to enhance socio-economic development Speech (July, 2010), he said health resources such infrastructure has grown from 1979 in 2004 to 2301 in 2010. However, inequity exists in the distribution of health facilities and most facilities are in a state of despair, inadequate transport is a major limitation especially newly created districts. He further said that rehabilitation of buildings and maintenance of medical equipment is not regularly done. Other challenges are shortage of basic medical equipment accommodation of staff, and transportation remains major challenges. He further stated that inadequate financial and human resources, only 30% of the essential medicines and health supplies required for the basic packages are provided for in the framework for medium expenditure.
This has increased dependency on the private sector and therefore most patients often find that medicines are not affordable. For that reasons, many mothers mentioned that the few Family Planning methods which are cheap have bad side effects and other best alternatives are two expensive for them to use.
2.3 Strategies being used to Improve Access to Family Planning Services in Uganda
The main objective of strategy is to campaign is to accelerate the availability and use of university accessible quality health services including those related to sexual and reproductive health which are critical for reduction of maternal mortality. According to African Union Commissioner for Social Affairs Adr Bience .P. Gawanas for the 4th session of the conference of African Union Minister of Health (7th May, 2009) said that the focus is not to develop more strategies and plans but rather to ensure co-ordination and the effective implementation of existing plans and strategies. He further stated that all efforts should be done to save the lives of women who should not die while giving life. And also it is essential to establish accountability, of maternal, infant and child mortality and it’s the same happening Kira Town Council where the health sector strategic plan is trying all its best to promote people’s health.
According to Charves and German Rodnguez (2005), there is a strong understanding interest within population policy and Family Planning proof circle in the potential impact on contraceptive behavior and reproductive preferences of mass media messages that try to inform and motivate people on the methods and advantages of regulating fertility these messages have taken many forms ranging from radio program and television designed to persuade women on the advantages of smaller families. The same has also taken route in Kira Town Council where mass media like the local radio stations have been used to hold talk shows in order to sensitize the people on the advantages of smaller families.
Mbonye (2008) stated that repeated dissemination of information will have more of an impact than random images and massages such repeated massages on public transport billboard, television, radios may act to reinforce such behavior change. Whereby reinforcement is the key element of behavior change and maintenance. He further gives solutions to that, to avoid unwanted pregnancy if you are sexually active, seek Family Planning Services and counseling, comprehensive reproductive health services and also increased awareness about unwanted pregnancy and Family Planning Services.
In conclusion, the literature reviewed above shows both the modern and traditional understanding of Family Planning. It also reviewed literature related to the importance of Family Planning, challenges facing the use of Family Planning and the strategies being used to promote the knowledge of Family Planning. This reviewed literature therefore has been compared with the situation on ground in Kira Town Council.