For the last four years, I have designed and implemented community based family planning programs in rural communities in mid-western Uganda. These programs have enabled utilization of contraception to over 30,000 women including adolescents mothers in and out of school. I participated in initiatives geared at building capacity of Village Health Teams (VHTs) to deliver sayana press, EC, condoms, and pills to women particularly young women in communities. Designed a performance based models for VHTs to deliver FP services. Customizing the "Positive Deviant" approach we have identified and engaged men (positive deviants) to lessen the burned of FP on heir spouses by encouraging fellow men to adopt FP especially condom use, and vasectomy. Engaged religious, & cultural persons.
Earlier in my public health carrier, I encountered many young girls with pregnancies at tender ages of 12-15. Often these pregnancies would end with dare consequences include death to some. However, most would testify that had they been given tools and power to decide on when to have these pregnancies they would never have become pregnant. And of course the economic, health and education burden of large families to the poor households convinced me that FP is the cheapest option available to us.
The biggest challenge I have faced is to have men appreciate their role in FP and also the overwhelming FP burden women shoulder everyday and yet it takes two to make a pregnancy. This negative masculinity is exacerbated by culture and religion especially in rural Uganda which favors misogyny. This encouraged me to engage men using the positive deviant model. Where positive men/cultural/religious leaders within the communities have been at the center of driving change with their fellow men.
The biggest challenge to FP delivery in my region is the inability to provide the most suitable method preferred by each and every woman/man. Often FP programs provide to the communities what they imagine works or economically suitable using the push-system. Compounded by contraceptive insecurity, this limits choice for the individual. The answer to this challenge is sustained political will, increased investment in FP services while ensuring the appropriate method mix & integrated SBCC.