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Socio-economic Determinants of Access to and Ulizaon of Contracepon
among Rural Women in Uganda: The Case of Wakiso District
Deborah Sarah Nakirijja1*, XU Xuili2
and Mark Ivan Kayiso3
1Huazhong University of Science and Technology, Wuhan, P.R. China
2College of Humanities and Development Studies, China Agricultural University, P.R. China
3Uganda Martyrs University, Kampala, Uganda
*Corresponding author: Deborah Sarah Nakirijja, Huazhong University of Science and Technology, Wuhan, P.R. China, Tel: +8615607168142; E-
mail: deborahsn1991@gmail.com; nakirijjadeborah@yahoo.com
Received date: 22 November 2018; Accepted date: 07 December 2018; Published date: 14 December 2018
Copyright: © 2018 Nakirijja DS, et al. This is an open-access arcle distributed under the terms of the creave commons aribuon license,
which permits unrestricted use, distribuon and reproducon in any medium, provided the original author and source are credited.
Citaon: Nakirijja DS, Xuili X, Kayiso MI. (2018) Socio-economic Determinants of Access to and Ulizaon of Contracepon among Rural
Women in Uganda: The Case of Wakiso District. Health Sci J Vol.12.No.6:608.
Abstract
Background: There's dependably an assurance that when
you train a woman, a full country is trained. In maers of
reproducve health, women are generally inuenced
because of their key parts in child birth and nurturing. The
United Naons Sustainable Development Goals states
change of maternal health through decreasing maternal
mortality by seventy ve percent (75%) and accomplish all
inclusive access to reproducve health (Contracepve
prevalence rate) and this demonstrates the high need for
enhancing women's health since they are generally
aected simultaneously. In Uganda, the yearly populaon
rate is 3.2% and it’s one of the most striking in the world
(UDHS, 2016) and this is because of the high ferlity rates
which have handled her in a condion of amazing poverty,
pung the government in high consumpons than
investment funds. High populaon growth rates
accompany a great deal of unfavorable impacts that put
the naon at danger of unemployment and under
development combined with other related components.
Methods: The major aim of the study was to examine the
access and ulizaon of Contracepve use among rural
women in Uganda, with special emphasis on Namasuba
village, Wakiso District. It focused on both key informants
(health care providers) and rural women, combined with a
couple of male respondents incorporated into the study.
The study used a sample of 85 respondents. Rural Women
were 55; key informants were 10 and 20 male
respondents with mostly qualitave techniques, however
quantave strategies were obtained to decide the
prevalence in use of contracepve methods. Data
collecon strategies included personal interviews and key
informant interviews which were unstructured, and
documentaon.
Results: As per the study ndings, a scope of social and
economic components can impact women's access to
Contracepon. This implies that negave circumstances
that block access to informaon accordingly from the
above are not posive for rural women to Contracepve
use. These circumstances may include segregaon or
stereotyping, isolaon and denial of informaon on the
availability of contracepon provided on the market.
These results further revealed that rural women, who
knew about contracepves and their use, used such
learning to care for themselves and living a safe sexual
life. The study was mostly ruled by 20-24 female age
groups.
Conclusion: In terms of possible approaches to enhance
access and ulizaon of Contracepve use, respondents
suggested that modern contracepves ought to be
provided free of charge and extended out to the
household level through community outreaches and
dialogues, changing the undesirable atudes towards
women's access to these contracepves parcularly the
opposing generalizaons labeled to them as promiscuous.
On the basis of ndings and interpretaons made, further
areas of assessment were recommended to cover the
signicance of use of Contracepve use among women,
and how their ulizaon can aect contrasngly on the
development process of the country and women
empowerment health wise.
Keywords: Rural women; Contracepve use; Socio-
Economic; Reproducve health; Development
Introducon
There's a more signicant need to increase the number of
women incorporated in the development discourse, projects
and programs at all levels of organizaon. This should be
possible to guarantee that development programs address
issues which inuence women, related to their mulple roles
in producon and reproducon. The United Naons SDGs
Research Article
iMedPub Journals
www.imedpub.com
DOI: 10.21767/1791-809X.1000608
Health Science Journal
ISSN 1791-809X Vol.12 No.6:608
2018
© Copyright iMedPub | This article is available from: www.hsj.gr 1
(Goal 3) calls for improvement of maternal health by lessening
maternal mortality by seventy ve percent and accomplishing
general access to reproducve health (Contracepve
prevalence rate) and this demonstrates the high requirement
for enhancing women's health since they are for the most part
inuenced all the while. Coupled to the above, SDGs expect to
accomplish widespread access to Sexual and Reproducve
health care services by 2030 and this incorporates the
requirement for family planning data and informaon, and the
joining of reproducve health into naonal programs and
projects.
Uganda is one of the exceponally populated on the planet
and this is for the most part because of the high ferlity rates
which have handled her in a condion of great neediness,
pung the government in high consumpons than funds. High
populaon growth rates accompany a great deal of unfriendly
impacts that put the naon at danger of unemployment and
underdevelopment combined with other related variables. The
real reason for this study is to connect the endeavors and the
reality on ground to address the developing number of
individuals in the naon, yet parcularly taking a look at it
from the reproducve health point of view in maers
concerning contracepve or procurement of family arranging
benets parcularly to the rural women.
Background of the Research
The expanding ulizaon of contracepon has empowered
couples to pick the number and dispersing of their children
and has enormous life sparing advantages since women and
men are given decisions on when, where and how to
characterize their sexual life and labor. Be that as it may
however, the striking addions in making these advances
accessible to the general populaon, contracepve use is sll
low and the requirement for contracepon is high in a poron
of the world's poorest and most populous places.
All around, contracepves keep expected 2.7 million
newborn child mortality and the loss of 60 million of healthy
life in a year [1-3]. A few studies demonstrate that
advancement of family arranging in naons with high birth
rates can diminish destuon and hunger and forestall 32% of
every single maternal demise and about 10% of adolescent
deaths [4,5]. Preventave use in the United States is
praccally widespread among women of reproducve age;
98% of all women who had ever engaged in sexual relaons
had ulized the male condom, 82% had ever ulized the oral
prophylacc pill, and 56% had a partner who ulized pull back
(UN Department of Economics and Social Aairs, 2014). The
2000/2001 World Development Report showed that half of
young females on the planet reported being sexually dynamic
by age 18 years.
Besides, the ulizaon of modern contracepves in most
African naons remains low whereby ferlity, unmet
requirement for contracepon and populaon growth are
high. 30% of all women are assessed to ulize concepon
prevenon, although over half of every single African woman
might want to ulize contracepon in the event that it was
accessible [5,6]. Over the previous years, the calls for including
women in reproducve health issues have stressed the part of
women in enhancing the health of their families and
themselves [7]. Sexual and reproducve health was
emphacally inuenced by sex standards, whereby standards
favored male youngsters and advancing women's monetary
reliance on men, consequently adding to high rates of ripeness
in numerous sengs. Chabikuli et al. [8] recognizes that
women and young ladies overall who neglected to arrange sex,
condom use or monogamy on equivalent terms le them at a
high hazard for undesirable pregnancies, disease and passing
from pregnancy related causes and STIs. Birth control
measures lessen quick populaon growth rates and bring up a
genuine populaon issue. Rapid populaon growth and over
populaon have stayed topical issues of incredible worry to
numerous naonal governments and the universal group [4].
There has been a tendency of connecng specically or by
implicaon high populaon growth rates, parcularly in the
face of low protability, with various types of social issues
extending from destuon, scarcity of land, hunger and
ecological degradaon to polical unsteadiness.
In addion, women and men in Uganda are known to be
poor users of contracepves especially in the rural areas
though it is evident that knowledge about them has increased
steadily [6,7]. The low use could however be accredited to
accessibility and aordability which somemes the women
cannot manage coupled with the lack of knowledge on
contracepve use. While the maternal mortality rate is
esmated at 435 for every 100,000 women giving birth,
Uganda’s total ferlity rate (TFR) of about 6.7 children per
woman remains one of the highest in the world [9], for that
reason, Uganda has populaon growth rates of about 3.2% per
annum, the third highest in the world.
In this case, a wide range of studies have linked the
importance of female educaon in reducing ferlity rates and
the general improvement in labor force parcipaon and
social welfare [8]. Other factors that play a role are urban-rural
residence, women’s work and status, women’s status relave
to men, religion, culture and taboos, age (dierence between
young women and old women), educaon level of the
husband, household standard of living (economic or wealth
status), inuence of the mass media and community
development in form of social networks [3,6,8,10-13].
It is therefore from the above background that the study
lays out the importance of CU in the wellbeing of women and
the country at large. The development process from the global
world should be known to the local populaon and make them
own the development process. Programs directed towards
development should be grass root oriented because most
intervenons are purposed for the hard to reach populaon
and they know what aects them beer.
Feminist perspecve, gender and development
approach (GAD)
The Gender and Development approach to women
empowerment rose in the 1980s from the grassroots
Health Science Journal
ISSN 1791-809X Vol.12 No.6:608
2018
2This article is available from: www.hsj.gr
authoritave encounters and composions of the third world
women's acvists. This methodology addionally acquires/
borrows from the encounters and examinaon of western
feminists’ socialists worries with development issues [14-16].
The methodology further requires a blend of issues of realist
polical economy and the radical-women's acvist issues of
patriarchy and philosophy (patriarchal belief system).
Sketching from the socialist-feminist perspecve on social
stracaon in the public arena, the GAD approach contends
that women's status in the public eye is seriously inuenced by
their material states of life and by their place in the naonal,
local and worldwide economies. Women are signicantly
inuenced by the way of patriarchal force in their social orders
at the naonal, group and family unit levels. Furthermore,
women's material condions and patriarchal power are
exclusively characterized and kept up by the acknowledged
standards and qualies that characterize women's and men's
parts and obligaons in a specic culture [17].
GAD recognizes eects of development strategies and
pracces on women and men and views women as acve
specialists, not just as beneciaries of the development
process. It in this way raises doubt about both sex relaons
and the development process. Within the GAD perspecve, a
disncon is drawn between women’s interests in biology as a
homogeneous enty and gender interests as socially
constructed. From the above, gender orientaon interests can
be either praccal or strategic [15]. Reasonable praccal
gender needs emerge out of exisng condions; these are
prompt essenal needs, for example, the need to give
sustenance, sanctuary, training and health care. Strategic
gender needs emerge out of an examinaon of women's
subordinaon and require changes in the structures of sex,
class, and race that characterize women's posion in any given
society. Vital hobbies (strategic needs) incorporate the
objecve of sex balance.
Development strategies in Uganda ought to consider such
angles that sideline women from seling on healthy choices,
and draw intervenons taking into account the logical
components that limit them from taking fundamental
insurances in birth control measures. This will result in the
reduced populaon size and the burden of extreme
expenditures spent on the over growing populaon in the
country thus resulng in absolute poverty and higher cases of
infant, child and maternal mortality rates. In this context, the
thesis contributes to a highly relevant, broader discussion on
how development should be achieved, and who are the
winners and losers of dominant development strategies
targeted at societal and human transformaon and wellbeing.
The study thereby calls upon mainstream perspecves and
invites a crical reecon on alternave ways of approaching
and rethinking the development of third world countries.
Signicance of the research
The study examined the socio-economic factors that
inuence or determine contracepve use among rural women
in Uganda and especially from Namasuba, Wakiso district. The
study also aimed at building on the already exisng knowledge
on the whole concept of contracepve use and female
reproducve choices, and also the ndings would help in
developing new approaches for increasing use of
contracepve methods among rural women in Uganda. This
may help in the reducon of the ever growing populaon in
the country. This study might also help to ll that exisng
evidence gap and contribute to literature on the same.
Findings from this research may also inform policy makers in
rural development on the eecve ways of supporng women
and men in their daily reproducve life in order to live a safe
sexual life.
Apart from providing recommendaons on how to improve
access and ulizaon of contracepon among the populaon
which is one of the leading causes of poverty in the country,
the study also idened the other technologies used by
women and why they prefer certain methods of birth control
compared to the others. The most beneted category will
mostly be government, rural populaon, women and men,
Civil Society Organizaons (CSOs), including Non-Government
Organizaons (NGOs).
Statement of the problem
In Uganda, rural women face a problem of lack of enough
support, informaon, resources and training on how to make
healthy reproducve choices, coupled with the negave
stereotyping of women as mothers, which leads to quesoning
of their parenng abilies in terms of family planning and child
spacing. The high ferlity rate results in high birthrates,
bringing about large family sizes with negave impact on the
family, the community and naon at large as a result of
economic overload in covering the addional demand of the
persistent populaon growth. Access to modern
contracepves encompasses the most important intervenon
to populaon management, and thus boosng the naon’s
development process.
Limited research has been put in place to address the socio-
economic factors or barriers to contracepve use among rural
women in Uganda. These factors may vary from one society to
another due to the gender norms that exist in the dierent
sociees as far as use of contracepon is concerned. This
research helped to bridge the eorts and reality of
contracepve use among rural women in Uganda through
idenfying the possible factors negang or enabling women’s
adopon of contracepve use. The study also went ahead to
nd out why rural women don’t access and ulize
contracepves, despite making them available by relevant
stake holders and this was done through idenfying the major
challenges to CU. Hence, the study aimed to understand the
access and ulizaon of contracepve use among rural
women in Uganda, Namasuba village, Wakiso District.
Research objecve
The major purpose of this study was to examine the factors
inuencing access and ulizaon of contracepve use among
rural women so as to understand the prevalence in use
Health Science Journal
ISSN 1791-809X Vol.12 No.6:608
2018
© Copyright iMedPub 3
(methods) and constraints experienced by rural women in
Namasuba village Wakiso District.
Specic objecve
The specic objecves of the study were to:
•Idenfy the contracepves accessed and ulized by rural
women in Namasuba Village.
• To determine the current use of contracepve methods
among rural women in Namasuba Village.
• To analyze the factors inuencing access to and ulizaon
of contracepve use by rural women.
• To understand the challenges experienced by rural women
in accessing and ulizing contracepves and related coping
strategies.
Research queson
• What is the prevalence and availability of contracepves
among rural women in Namasuba Village?
• What are the under-lying socio-economic factors
inuencing the access and ulizaon of Contracepve use
among rural women in Uganda?
• What other factors inuence access and ulizaon of
contracepve use among rural women?
• What are the challenges faced by rural women in accessing
and ulizing of Contracepve use and how do they cope
with the challenges?
• What can be done to enhance access and ulizaon of
Contracepves by rural women?
Conceptual framework
The major factors idened in the study inuence how
women respond to birth control methods in the social, cultural
and economic context. It should be noted that there are other
mediang and enabling factors to contracepve use that also
facilitate its ulizaon. Respondents are movated by the
reduced costs on some contracepves like condoms which are
provided in some health centers for free which shows how
costs of certain contracepves inuence contracepve uptake
and usage (Figure 1).
Research Methodology
The study used a qualitave research design and it mainly
used personal interviews which entailed face to face
interviews, semi structured quesonnaires for rural women,
key informant interviews (from the health service providers
especially those dealing with reproducve health issues) and
informal discussions (for example the use of case stories).
However quantave design was also applied to ensure a
larger understanding and interpretaon of results obtained
from the demographic characteriscs of respondents on the
factors inuencing access and ulizaon of contracepve use
in Namasuba village.
Research design
The study used a qualitave research design and it mainly
used personal interviews which entailed face to face
interviews, semi structured quesonnaires for rural women,
key informant interviews (from the health service providers
especially those dealing with reproducve health issues) and
informal discussions (for example the use of case stories).
However quantave design was also applied to ensure a
larger understanding and interpretaon of results obtained
from the demographic characteriscs of respondents on the
factors inuencing access and ulizaon of contracepve use
in Namasuba village.
Figure 1 Conceptual framework on access and ulizaon of
contracepves among rural women.
Area of study
The study was carried out in Namasuba village, Wakiso
District. The village is composed of ve zones namely, Lufuka,
Kalina, Kikajjo, Masajja and Namasuba B. The village is a big
area and it’s going through urbanizaon due to its strategic
locaon close to the main capital city of Kampala. Majority of
the people in Namasuba village are traders and business
people but a few people pracce farming acvies mostly for
subsistence plus poultry keeping. They mostly deal in
agricultural products and the area is known to have one of the
biggest periodic markets where people come from far to buy
products at a cheaper price. The study couldn’t obtain a clear
sample, but Namasuba village has a lot of congeson in
selement, showing the rise in populaon among the local
people. In this case, local services like health centers are put
under pressure by the ever growing populaon and this leaves
most of the people unaended to, and provision of basic
health services not fullled. Other services like educaon
facilies are also in poor shape living people with no educaon
or limited educaon thus enlarging the illiteracy levels among
the local populaon. This also limits their chances of acquiring
knowledge on certain health issues which are partly imparted
in Schools. There’s also a problem of early marriages especially
among girls because most of them are not in school or any
form of employment and are le with no choice but geng
Health Science Journal
ISSN 1791-809X Vol.12 No.6:608
2018
4This article is available from: www.hsj.gr
married. Therefore, this village was ideal for the study
phenomenon because it helped to answer some of the
quesons under discussion, and limited research is available
on rural women and contracepve use in this area (Figure 2).
Figure 2 Map of Wakiso district.
Study Populaon
The study populaon characterized mainly rural women
falling under the age of 15-49 years; this was because it is the
widely accepted reproducve age of women. The study mainly
focused on women in Namasuba village, Wakiso District as the
major category, men included as the sole decision makers in a
patriarchal society and health workers as key informants.
Namasuba village was chosen as a study area because of its
ever growing number of rural dwellers and reported cases of
teenage pregnancies.
Sample Size and Selecon
In order to idenfy respondents for this study, the
researcher used both purposive and snowball sampling
techniques for interviews and informal group discussions.
Purposive sampling is a type of non-probability sampling which
is characterized by the use of judgment and deliberate eort
to obtain representave samples by including typical areas or
groups in the sample [18]. This sampling technique was used
by the researcher to get the hard to reach women and
specialized categories, because of the sensivity of the topic.
For this reason, individual respondents were idened
through snowball sampling, a sampling method where one
respondent idenes another unl a sample size is reached or
saturated [18]. Snowball sampling was ideal in this research
because there was no sample frame from where the
researcher could draw a sample of the women using
contracepves in this area to be involved in the study. Data of
85 respondents was analyzed. Rural Women were 55, 10 key
informants and 20 male respondents. Key informants were the
healthcare providers especially mid-wives and doctors who
provide health services to rural women (Table 1).
Table 1 Summary of sampling frame.
Category Sample size Sampling technique Data type Research instrument
Rural Women 55 Snowball Sampling Primary Questionnaire and in depth interviews
Men 20 Snowball Sampling Primary Questionnaire and in depth interviews
Health Workers 10 Purposive Sampling Secondary/Primary In depth interviews
Data Collecon
Data collecon took place over a period of a month
between 10th July and 10th September, 2017. Before
informaon gathering process, the researcher looked for
authorizaon from the area Local council chairperson (LC.1) to
complete the study in the area. The researcher addionally
sought for authorizaon from health workers to take an
interest in the study. The informaon was gathered through
narrave invesgaon or record audit (document review),
direct percepon and casual talks; researcher administered
unstructured polls, key informants meengs and group
discussions. Unstructured surveys were used as informaon
gathering instruments during the meengs.
Key informant interviews were likewise used as a wellspring
of data for this study. These are subjecve top to boom
meengs with individuals who know exceponally well the
community of the study. Key informants were picked
purposively in connecon to the examinaon subject. These
primarily included health service providers, especially the
individuals who gave reproducve health services. Personal
interviewing as another data collecon strategy included up
close and personal collaboraon with the respondents and the
interview guides were used to gather informaon from rural
women. Report audit/document review was used to gather
secondary informaon from newspapers, diaries, distributed
books and exposions. These were used prior and then
aerward the eld works with a specic end goal to exhibit an
adjusted study.
Procedure of Data Collecon
In order to recruit primary respondents for interviewing,
appointments were made with the relevant respondents. For
key informants appointments were made and interviews were
carried out immediately because of the ght schedules at the
health centers. In-home interviews were conducted and these
were also in-depth unstructured interviews to keep the
discussions open to parcipants to gain insights in the target
respondent’s culture, preferences and behaviors.
Health Science Journal
ISSN 1791-809X Vol.12 No.6:608
2018
© Copyright iMedPub 5
Data Processing and Analysis
The study was purely qualitave and it involved use of case
stories, verbam quotaons, narraves and exploraon.
Qualitave data was analyzed through eding the
respondent’s informaon and this was organized through
themes and sub-themes as organized in the objecves of the
study. Furthermore Qualitave data was analyzed using
content/themac analysis method. Audio recordings were
transcribed verbam and analyzed using content analysis.
Content invesgaon is an exploraon tool used to decide the
nearness of specic words or ideas inside of wrings or sets of
wrings. Specialists measure and break down the nearness,
implicaons and connecons of such words and ideas, then
make inducons about the messages inside of the wrings, the
writer(s), the group of onlookers, and even the way of life and
me of which these are a secon [18].
Data was also analyzed using constant comparave method,
to synthesize the data. A comparave method was also used
to establish between current use and no-use at all among rural
women in this village. This was done to get meaningful data of
actual use of contracepon in this village. Also the researcher
ulized data from other interviews like that obtained from the
male respondents to corroborate with the ndings with other
sources.
Research Limitaon
The main problem to the study included parts of expenses
and subsidizing (Financial Constraints) back to Uganda to
gather the relevant informaon. Subsidizing was an issue to
the study because it obliges one to be completely equipped
with nancial resources, like transport costs keeping in mind
the end goal to nd rural women. Staonery, for example, a
large poron of a ream-of-papers and dierent materials to
use for recording the respondents reacons was addionally
an issue. There were parts of some social or cultural silence
parcularly with the women respondents.
Ethical consideraon
The researcher aempted all levels conceivable to maintain
the strict moral standards all through the study. All members
in the study were legimately educated about the movaon
behind the exploraon and armaon of privacy of their
personality and reacons was given. Respondents were not
compelled to take an interest in the study and those not
willing to take part in the meengs were excluded. Likewise,
the respondents were further prompted that they were
allowed to stop interest of the study at whatever me they
were allowed to. This informaon was perused out to the
respondents from the introductory leer going with the
interview guides.
Results and Findings
This chapter presents the data analysis and discussion of the
ndings from the eld study on the socio-economic factors
inuencing access and ulizaon of contracepve use among
rural women in Namasuba village, Wakiso district, Uganda. The
chapter is organized according to the following themes and
sub themes; socio-demographic characteriscs of
respondents, socio-cultural factors, economic factors and
mediang factors inuencing contracepve use,
contracepves accessed and ulized by rural women, factors
inuencing access and ulizaon of contracepves among
rural women, challenges experienced, reasons for
contracepve use and coping strategies.
Background informaon and socio-economic
characteriscs of the rural women: The demographic and
socio-economic characteriscs of rural women as primary
respondents who were interviewed in the study are discussed
in this secon. In addion, men were also interviewed as
secondary respondents because of their major role in
household decision making. This includes age, gender, marital
status, educaon levels, household size and the main sources
of livelihood.
Age and gender of respondents
All primary respondents were women in Namasuba village
in the three zones of Kalina, Kikajjo and Lufuka because of the
nature of the study targeng rural women and contracepve
use. Men were integrated in the study to provide a balanced
study and since they are the sole decision makers in the house,
their input seemed viable. Figure 3 gives a summary of the age
distribuon of the respondents (rural women) who
parcipated in the study. Majority of the rural women (34%)
interviewed in the study were within the age group of 20-24.
This was followed by age groups 25-26 and 30-39 years
respecvely with 25.5%, the rest 15-19 and 40+ years
comprised a 14% in total. Age was a major variable in the
study because reproducve maers start from age 15-49 years
as the reproducve ages. According to the health workers age
is a major criterion followed in determining a suitable
contracepon or birth control method in maers concerning
RH. Therefore respondents below the age of 15 years were not
included in the study. The gure below shows the age
distribuon of respondents (Figure 3).
Figure 3 Age of respondents.
Health Science Journal
ISSN 1791-809X Vol.12 No.6:608
2018
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Distribuon of respondents by marital status
Marital status was also an important variable in determining
the factors that inuence access and ulizaon of
contracepve use among rural women in Namasuba Village.
Figure 4 above shows the distribuon of women in Namasuba
village by their marital status who parcipated in the study.
Figure 4 Distribuon of respondents by marital status.
Majority (29) represenng 52.73% of the respondents
reported that they were married. This was followed by 25.45%
of rural women (14) who reported that they were single and
not in any relaonship. 9 women (16.36%) reported to be
divorced from their husbands and were running female
headed households, the rest 5.45% of the women were either
cohabing or in other trial marriages. As indicated by
Nalwadda et al. [19], marital status is one of the real
determinants of contracepve use; unmarried women ulizing
contracepves are defamed and thought to be either
prostutes or unfaithful. Dierent studies have set up
challenges to guarantee contracepve needs are met in groups
where contracepves are acknowledged to be for married
individuals [20].
Educaon levels of rural women respondents
Results revealed that most women (41.82%) of those leaving
in Namasuba village in the three zones had an educaon level
of up to secondary level. The other 20 (36.36%) of the total
women interviewed had completed their primary level. The 9
respondents represenng 16.36% of the total had no formal
schooling background. The last 3 of the respondents
represenng (5.45%) completed the Uganda Advanced
Cercate of Educaon (UACE). It can be seen that most of the
women interviewed did not go further with schooling (Figure
5). Women always face challenges more than the men in
educaon accomplishment. Educaon among women acts as
an empowerment tool to help women demand their rights in
maers concerning reproducve health. At the household
level there’s sll a very big gap in the educaon of the girl child
where most parents prefer to send the boys to school and the
girls labeled t for marriage. This infringes on women/girls
right to access to basic educaon services and which in the
end will lead to early marriages with many unwanted and
unplanned pregnancies. This situaon directly causes a gender
disparity in the acquision of resources and opportunies, as
well as gender inequality in household expectaons for
children’s educaon; parents have higher expectaons for
boys’ educaon than for girls’ [21]. Women with lower
educaon levels are at high dangers of being unable to make
sound choice (decisions) both at the community and the family
unit level, and this is because of the absence of all defensive
riggings provided with fulllment of Educaon. During the
interviews, a 19 year old married adolescent with two children
in Namasuba-Kalina zone agreed to this noon by saying the
following in her own words:
I quit school when I was in primary three (3) since my
parents could not aord to pay school fees for all of us at
home. I come from a family of 14 children where 8 of us are
girls and the rest are boys. My brothers connued with school
because my father believed that they can work and bring
money to the home. I was le with the opon of marriage
since my mother had already seen a man for me. In this way
my parents would get bride wealth from me…now I have two
children but I can’t even take care of them. I hope and wish
that I could go back to school or get skills in tailoring and
hairdressing because my dream of learning and speaking
English is sll alive.
Amid the study interviews with the vast majority of the
male respondents (61.03%) had at any rate achieved a training
level higher than that of the female respondents. This
generally claries the discoveries talked about above in
proporon of men and women access to formal instrucon
which for the most part supports the men.
Figure 5 Educaonal aainment of the respondents.
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Demographic characteriscs of male
respondents
This part includes features like age, marital status,
educaonal levels, Religion, prior knowledge to contracepon
and the types of contracepon ever used by the male
respondents. The summary of these ndings are presented in
Table 2 below. According to the study ndings, majority of the
male respondents (7) were in the age group of 20-24
represenng a percentage of (34.67%). This category was
seconded by 5 respondents under the age group of 25-29
(24.10%) of the total male respondents. The other
respondents in the male category (3) in the age groups 30-39
and 40+ respecvely represenng 14% of the total populaon,
the rest of the respondents, 2 were under the age group of
15-19. All these respondents were from Namasuba village.
In terms of prior knowledge about contracepve use,
majority (11) of the male respondents aributed to lack of
informaon concerning contracepve use. This is either
because of lack of enough sensizaon on use of
contracepve methods or they are actually not yet well
embraced in the community. It should be noted that according
to the African home seng, men are the sole bread winners
and decision makers in many cases. This implies that lack of
enough knowledge on important aspects in family sengs may
hinder women’s access to and ulizaon of contracepve
because they lack the support of their spouses. Coupled to the
above, the lack of knowledge is also linked to the fact that
most men have low levels of educaon background. It should
be taken into consideraon that the higher the educaon
aainment of an individual, the higher the chances of
contracepve uptake.
With regard to the use of contracepve methods, a
signicant number of male respondents (11) reported not
using any contracepve methods. This was due to reasons
ranging religious beliefs, cultural norms and customs and also
the lack of awareness on contracepve availability and
accessibility [22]. However, quite a good number of male
respondents aributed to use of contracepves and this can
be linked to the cultural and generaon shi where men are
becoming aware of the value of contracepves. Men have no
readily available contracepve between the condom, with its
high typical-use pregnancy rate and sterilizaon, with its
permanence. Sll, using just these two methods, men already
account for a third of total contracepve use in the United
States [22].
It is always important to include both men and women in
contracepve use informaon and knowledge sharing. Men
should be put at the forefront because, a woman can, of
course control her ferlity without her husband’s cooperaon,
yet when men and women are aware of and responsive to
each other ’s health needs, they are more likely to obtain
necessary services. Data also showed that male respondents
who had received some form of educaon had higher chances
of contracepve use and smaller family sizes as compared to
their counterparts who had less educaon and bigger family
sizes.
According to the study ndings, it is evident sll that religion
shapes people’s percepon and behavior in most of life
decisions. Some male respondents aributed to not using
contracepon as a result of their religious beliefs and customs
that don’t permit them to ulize contracepon. In addion,
respondents also reported the fear of contracng STDs and
above all HIV/AIDS and other STIs and that’s the major reason
for use of contracepon. In addion, they strongly
acknowledged the major reason for CU and uptake so as to be
able to give birth to children at the righul age. This was
mostly emphasized by young adolescents who are in their
early age and want to delay child birth.
Table 2 Summary of socio-demographic characteriscs of male
respondents.
Variable Class Frequency
Age (Years)
15-19 2
20-24 7
25-29 5
30-39 3
40+ 3
Marital status
Single 5
Married 12
Divorced 2
Others 1
Education level
None 4
Primary 6
Secondary 8
Tertiary/University 2
Religion
Catholic 8
Pentecost 4
Islam 5
Anglican 3
Knowledge about CU
Yes 9
No 11
Types of contraceptives ever
used
Condoms 7
Natural Methods 2
None 11
Components of contracepves used by rural
women
Findings in Figure 6 below indicate that most women prefer
condoms (35%) and Pills (20%) as a method of birth control
during the study. This is mainly due to the fact that condoms
and pills are relavely cheaper as compared to the other types
of modern contracepve methods. Condoms and pills are
mostly used by the unmarried women and girls who are
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8This article is available from: www.hsj.gr
seeking to control child birth mostly for a short period.
Tradional methods (11%) of birth control are also ulized by
most women and couples because of their accessibility and
availability for most women. Women who use tradional
methods acknowledged that tradional herbs of birth control
are easy to administer and there’s less stereotyping aached
to their access as compared to the other types especially IUDs
and Injecons (Injecta-Plan).
Figure 6 Contracepves used or ever used by rural women.
Socio-demographic factors inuencing access
and ulizaon of contracepon
The researcher was interested in nding out the socio-
demographic variables that serve as major factors in
inuencing the access and ulizaon of contracepve use
among rural women in Namasuba village, in the three zones of
Kalina, Kikajjo and Lufuka. The study discovered factors ranging
from the age of the respondents as related to contracepve
uptake, the marital status, and the educaon levels.
Age and contracepve use
Age is a major factor idened contribung to women
uptake of a contracepve method. Majority of women (9)
interviewed who use a contracepve method fall in the age
group 20-24 with a percentage (16.4%) out of the overall
34.5%, the rest of the women in the same age group (18.2%)
aributed to not using any contracepve. Uganda is comprised
mainly of young people of 15-24 years of age, 11% of
adolescents in Uganda have iniated sex and, 64% of young
people have had their rst sexual encounter (UDHS, 2006).
Young women are thus exposed to the risk of unplanned and
unwanted pregnancies for a longer period and as a result in
high rates of maternal mortality, unsafe induced aborons
leading to death. This therefore calls for an increased need for
contracepve use in terms of birth and ferlity control. This
was followed by women 25-29 and 30-39 (25.5%). There’s a e
in the contracepve prevalence rate and uptake in ages 25-39
years because this is where majority of women are able to
make responsive decisions of CU and uptake or not to. Young
women or adolescents in the age group 15-19 years, aributed
to no use of contracepon (9.1%) due to reasons varying from
age, side eects and cultural norms. The rest 3.6% of women
above the age of 40 acknowledged that they are not of child
bearing age and are not using any contracepon due to their
age, not engaging in any sexual behavior and mostly because a
desired family size has been achieved. Contracepve use is
lowest among young women, reaches a peak among women in
their thires and declines among older women [23]. This is
indicave of a high desire for child bearing among young
women and a high growing interest of spacing children among
women in their thires (Table 3).
Table 3 Contracepve use among rural women by age.
Age
(Years)
Are you using any CU method? Total
Yes No
15-19 1 5 6
20-24 9 10 19
25-29 7 7 14
30-39 6 8 14
40+ 0 2 2
Men were also included in the study as secondary
respondents because of their major role in household decision
making sand contracepve use. 20 male respondents were
included in the study and 58.6% of the total number of men
(12) reported not to use any kind of birth control or CU, falling
mainly in the ages 25-29 years. Men’s decision to use a
contracepve method depended mainly on their religious
beliefs, cultural norms, educaonal levels and the gender
power relaons which put them at an advantage over the
women.
Marital status and contracepve use
Results in Table 4 below show that contracepve prevalence
and ulizaon is mostly among the married women (15) with a
percentage of 27.3% out of all 52.7%. This is mainly due to the
fact that contracepve use is perceived to be used only in the
marriage context for issues to do with child spacing and family
planning. In any case, it ought to be noced that, it is in the
same establishment (marriage) that most women (14) with a
25.5% not ulizing contracepves because of elements ranging
from social standards, and gender power relaons at the
family level. In addion some women interviewed aributed
to not using modern contracepves but only tradional
methods but these were few. This was also followed by 23.6%
of unmarried women (single, 13) who don’t use any form of
birth control; unmarried women using contracepves are
sgmazed and perceived to be unfaithful in marriage. Most
single young women admied not using contracepves due to
the societal norms that do not support use of contracepves
at an early age and parent’s disapproval. Parents reject CU
because they do not want their unmarried daughters engaging
in sexual acvity at an early age. Sex before marriage in a
tradional context is considered inappropriate and may incur
many disciplinary responses from the elders. During one of the
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© Copyright iMedPub 9
informal discussions with a group of young adolescents, one
member said the following in her own words:
My elder sister got pregnant when she was 15 years old. My
parents forced her to marry the man but the man was not yet
ready for marriage or any commitment. It really taught me a
lesson to use all the protecve measures to avoid geng
pregnant even if I and my boyfriend were engaging in sexual
behavior. We decided to use condoms as our birth control
method. I could get them from the youth centre for free and
take to him. My mother discovered that I have condoms in my
possession, she lost condence in me. Parents should be made
to accept that things are changing and we young people need
to protect ourselves not only from pregnancy but also STDs
and HIV/AIDS. Many people believe that contracepves are for
the grown up people especially the married.
These ndings agree with many studies on factors
inuencing contracepve use among women including,
Nalwadda et al. [19] and Asiimwe et al. [12] who found out
that contracepves were perceived to be for married couples
who have had a number of children. It is noted that young
people are sgmazed if they use contracepves.
Finding in the study also revealed that men have a dierent
percepon of contracepve use, where most of the male
counterparts interviewed said they don’t use any
contracepve method. One male respondent (married) said
the following during the interviews when asked of his
percepon on contracepve use in his own words:
My name is Muwanguzi David (gave permission to be
menoned) am a gate keeper at a secondary school in
Namasuba-Kikajjo zone. I spend most of the me sing here
at the gate and not going anywhere to look for women. I have
my wife who is always waing for me at home and I trust her
not to cheat on me. I don’t see any reason why a person can
use those things you call contracepves, because I trust my
wife and she trusts me too. I have to enjoy my sex life with my
wife without any obstacles like condoms, and I also want to
produce more children unl Jesus comes back.
Table 4 Contracepve use of women by marital status.
Marital
Status
Are you using any CU method? Total
Yes No
Single 1 13 14
Married 15 14 29
Divorced 5 4 9
Others 2 1 3
Educaon levels and contracepve use
Female educaon appears to be an important determinant
of modern contracepve use, the more a woman is educated
the more likely to make choices on child birth and mostly the
use of all reproducve health technologies including
contracepon. Cohen reported that small amounts of
educaon have been found to somemes rise rather than
lower ferlity because it breaks down tradional birth spacing
pracces such as prolonged breaseeding or postpartum
absnence without lowering ferlity desires or increasing age
at marriage. Table 5 below illustrates the eld ndings which
are related to others study ndings.
Findings in Table 5 reveal that use of contracepve methods
among those in Primary (18.2%) and Secondary (18.2%)
educaon was higher than those who had no educaon
background (3.6%). The last category (1.8%) indicates a less
desire to use contracepon due to the age variable. There is a
signicant associaon between contracepve methods and
level of educaon. It should be noted however that the
number of non-contracepve users exceeds the ones using
contracepves by levels of educaon. Majority (23.6%) of the
female respondents reported not to be using any modern
contracepve method per the overall total of 41.8%. These
had an educaon level of up to secondary, choices at this level
depend mostly on the household level of autonomy where by
most women at this level have to consult their husbands on
maers concerning child birth and use of contracepon. Most
women in this category are married or in a dened
relaonship as those women who dropped from primary level
(18.2%).
The study also revealed that a husband’s educaon is likely
to increase the likelihood of a woman using contracepve
method as divergent to lowering it. A few men included in the
study with some educaon acknowledged the use of
contracepon and in fact helping their wives in accessing them
in order to plan and space their children. During an informal
discussion with male respondents, one respondent 29 years,
married in his words said:
Table 5 Contracepve ulizaon by levels of educaon.
Education Levels
Are you using any CU
method? Total
Yes No
None 2 7 9
Primary 10 10 20
Secondary 10 13 23
Tertiary/Vocational 1 2 3
It’s not always that men don’t want to use contracepves.
Somemes I ask my wife to use the IUD for longer child
spacing so that we avoid frequent births like a rabbit…in this
era of absolute poverty we may not manage a large family size
so the only way to do so is limit on the number of children we
give birth to. But this is most common in men who have
aained a certain level of educaon; other men will tell you
they don’t want like most of my friends here in the village.
Socio-cultural factors inuencing access and
ulizaon of contracepon
The researcher was interested in nding out the socio-
cultural factors inuencing the access and ulizaon of
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10 This article is available from: www.hsj.gr
contracepve use among rural women in Namasuba village, in
the three zones of Kalina, Kikajjo and Lufuka. The study
discovered factors ranging from religion and gender norms,
(beliefs and pracces and community networks and atudes).
Religion
The study revealed that majority of rural women (18) was
from the catholic and Islamic faith with the same
representaon of 32.7%. Of all the women in the catholic and
Islamic faith, 20.0% and 9.1% acknowledged no use of
contracepon due to their religious beliefs. The rest of the
respondents were from the Anglican (18.2%) and Pentecost
(16.4%) or born again faiths. Religion in Uganda plays a very
vital role in the decision of the people since the country is built
on a religious background. People perceive religious teachings
of great importance, and in most cases these teachings are
against CU (Table 6).
Table 6 Contracepve use by rural women by religion.
Religious
Affiliation
Are you using any CU method? Total
Yes No
Catholic 7 11 18
Anglican 5 5 10
Islam 8 10 18
Pentecost 3 6 9
Many women in Namasuba village acknowledged there use
of contracepon as based on the doctrines of their respecve
faiths. During the interview one male respondent argued in his
words:
Usually it’s not safe to go beyond the words of Allah; the
Quran emphasizes giving birth to children because they are
considered to be gis from Allah. The Imam at the mosque is
totally against these family planning methods and this is a big
sin which awaits punishment. That is why Islam permits the
provision of extra wives in order to give birth. Children are
even a source of labor in the old age. If you give birth to only
one child or two and they unfortunately die what would you
do? It is always good to have backup when the others die. As
for me I think the people should be le to produce as it was
long me ago during our great grandfathers and see whether
they will starve (Married man 38 years).
This shows a clear picture of how religious beliefs shape
people’s behavior and knowledge of certain aspects of life
including maers pertaining reproducve health and
especially contracepve use. Some women respondents
especially from the catholic faith quoted the book of Genesis
in the bible saying that “go mulply and ll the world…” as
commandment to mankind by God which has to be respected
unl when Jesus comes back. In addion to the above, the
catholic women who use contracepves in most cases
received some awareness either with educaonal aainment
or through sensizaons and health talks.
Gender norms
Gender is also another detriment of contracepve uptake
among women in Namasuba village. This is because society in
Uganda is organized in a set of norms and beliefs that shape
the way women and men perceive certain aspects in life.
These norms are normally socially or culturally constructed
during the process of socializaon, and mostly put females at a
posion of passiveness as compared to their male
counterparts. The study found out many power relaons in
terms of decision making in choices concerning contracepve
usage. Women are socialized to be submissive to their
husbands in maers concerning sexuality and they reported so
many hindrances from the men in maers concerning child
birth. This is because a woman’s role in marriage is shaped in
child birth without any birth controls. Most women
interviewed recalled spousal disapproval on maers
concerning contracepve use to an extent of being divorced or
abandoned and labeled promiscuous because of refusing to
give so many children as society wants to. During the informal
discussions one female respondent lamented her case in her
own words:
My name is Cecilia Nassiwa (agreed to menon name) am
28 years old. I am married with 4 children, I have been married
with my husband and everything was going on well unl not
long ago when we had this last born that things became worse
to the extent of divorcing me. I have been secretly using
contracepves (pills) in order to avoid unwanted pregnancies
and child spacing as educated by the doctors, but me came
when I had to stop doing it in secret and tell my husband
about it because he is the head of the house and makes all the
decisions. When he came back home I told him about the
need to start using contracepves to space children because
we sll had the desire to connue giving birth to children. He
was so furious, he bit me up like a child, blamed me of wanng
to sleep with other men for fear of becoming pregnant and
other things. He said he will divorce me if I ever talked about
using contracepves. I have no problem in using pills because
they reduce on my burden as a woman on connued
pregnancy and to take care of myself to but I have to listen to
my husband for fear of divorce and living my children in the
hands of other women he might get (married woman, 28
years).
The above noon corresponds with Laurie and Alex [24]
using data from the UDHS, 2006 discovered that women in
areas or sociees where females more commonly have control
over household decisions were 29% more likely to adapt or use
modern contracepves. This is because communicaon on
maers concerning when and how to give birth to children is
communicated freely between the couples without fear of the
unnecessary outcomes. These are mainly in the urban areas
were services are readily available to the people and educaon
aainment has been achieved to a certain minimum level for
safe RH choices. In general, individual’s decisions and choices
are shaped by the perceived beliefs and norms of the
community on maers concerning CU.
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Economic factors inuencing access and
ulizaon of contracepon
The study aimed to assess the economic factors that
inuence women’s access to contracepon in Namasuba
Village. This was done to inform the study whether economic
condions have an eect on women’s contracepve choices
and uptake. Economic factors are arranged varying from
sources of livelihood (to determine the income levels),
employment status and the costs of contracepon.
Source of livelihood for women in Namasuba
village
The researcher was interested to nd out from the women
and men in the study the other sources of livelihood they
engage in, in order to make health choices and take care of
their families. This was mainly because aspects of a large
family size among couples whether married or unmarried but
with children require a decent and earning job or career to be
able to provide the necessary basic necessies of life to the
beneciaries of the household especially children with gears
and safety nets like basic health and educaon and also a
mother’s wellbeing. Table 7 above shows the frequency
distribuon of rural women in Namasuba village according to
the sources of livelihoods engaged in both formal and informal
to raise incomes.
This informaon (as shown in the table above) shows that
majority of the respondents have no sources of livelihood to
help them earn a certain income for the basic necessies of
life. Those who have a means of livelihood are conned in the
informal sector which provides fewer alternaves to
development in terms of providing health choices to RH and
CU. Most families interviewed in the study had a large number
of living dependents with an average number of 5-10 children
per woman. This indicates that most of the lile resources
obtained from the pey jobs done by women and their
spouses are diverted to take care of the family and less is
shied to the health of the mothers themselves. This seems to
be a household level problem but it puts more strain on the
naonal health system and retards the development process.
In addion, the study was also interested in nding out the
status of employment for rural women in Namasuba village.
Findings from the study indicate that most women are
unemployed (49.09%) with no form of formal or informal
employment. Employability status is an important factor in
inuencing maternal and child care service ulizaon in
collaboraon with contracepve ulizaon and uptake.
Findings from the study shows that majority of women (27)
out of the total sample interviewed were unemployed making
it dicult for them to access the market for contracepon and
demand for them is limited. The employment status of women
has also been linked to knowledge and use of contracepon.
Women (25.45%) who work in the public sphere have a higher
rate of use of contracepon compared to women who are
conned in the domesc sphere (mostly the unemployed).
Health workers also add that paid work or self-employment
provides an alternave to self-development for women,
through provision of sasfacon in child bearing and rearing.
Women can be in posion to take care of them and their
children from the incomes obtained from their work. There’s
limited number of farmers in Namasuba village because the
place if semi-urban heading to urbanizaon through
populaon increase but limited healthcare services.
Table 7 Sources of livelihood for respondents.
Source of livelihood Number of rural women
Cashier 1
Cleaner 1
Commercial sex worker 1
Farming 7
Hairdressing and saloon 3
Laundry services 1
Charcoal selling 1
None 18
Sells soft drinks 1
Operates a restaurant 1
Shop attendant 1
Selling clothes 1
Selling airtime 1
Selling vegetables 4
Housemaid 4
Student 1
Community worker 1
Office attendant 1
Costs of contracepves
The study assessed the costs of various contracepves
available to the women and men in Namasuba village. The
costs involved in the buying and ulizaon of these
contracepves is an aspect that can be overseen but
contributes primarily to women inability to ulize the available
contracepves. According to the health workers condoms and
pills are ulized more because they cost less between
500-1000 and 1000-5000 Uganda shilling a packet respecvely.
They are mostly ulized by the unmarried, who haven’t started
child birth. Married women use the long term methods of
birth control which are extremely expensive to the low income
earners or women who have no income at all. Injector plan (or
the injecon) costs 3000-10,000 shs (Uganda shillings) for 3
months, whereas the Intra-Uterine Device (IUD) costs between
50,000-80,000 shs (Uganda shillings). These costs are too
expensive for most women, as one woman narrates during the
interview in her own words:
Some women agree on use of contracepves with their
partners but the problem is these contracepves come with a
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cost. It is always too expensive to get most of them especially
the injecon which is short term for a period of only three
months and the money to buy it some women can’t aord in
the same period due to so many being unemployed and
depending on husband’s money which is not enough. Women
would have been able to access these contracepves if they
had like good paying jobs to raise some money to be able to
pay for them depending on what they use…you have to also
consider the transport to go to town, you may end up not
using these contracepves and geng pregnant(Unmarried
woman, 26 years).
Mediang factors to contracepve use by rural
women
As a precursor to understanding the contracepve choices
and factors driving their uptake among rural women in
Namasuba village, the study invesgated the mediang factors
that serve as a linkage between women’s choices in CU and
Reproducve Health. In this part, mediang factors include;
knowledge of contracepon, role of the media, spousal
support, access to the health services and support from the
health service providers.
Knowledge of contracepon
Most women aributed to the fact that they have ever
heard about contracepve use through dierent plaorms like
radios, hospitals, billboards, through community health
dialogues and health surveys from the health centers.
However a group of young adolescent girls said the lack of
enough family planning and contracepve choices was
associated to their not using contracepon. During the
interviews, most women and girls rst heard informaon
during their rst visits to the hospitals and also over the media
(radios), so this informaon is missed to the women who can’t
aord health care systems. Women with disabilies face major
challenges in access health centers because of their physical
limitaons and lack crucial informaon on maers concerning
reproducve health and especially CU.
Views from personal interviews revealed that radios helped
in the acquision of knowledge and informaon on
contracepon, through adverts and open discussions on
health issues in addion to providing a forum for sharing
personal experiences thus helping to reduce on ignorance
about reproducve health issues among rural women. Rural
women who do not have access to radios and or televisions
could lack access to vital informaon such as the use of
condoms and pills that would help guarantee them safely
against unwanted or unintended pregnancies, and to live a
safe sex life. It is through radios and televisions that people are
easily and mostly informed in this era. Health workers also
emphasized that due to the fact that most health centers are
located far from the residents and the most convenient means
to access this informaon is over the radios.
It should be noted, though women had posive informaon
and knowledge about contracepve use, quite a good
proporon of women reported not using contracepon
because of the negave informaon got from their friends
about their experience in contracepve use. During one of the
interviews a female respondent aged 23 years narrates her
knowledge on contracepon:
When I was sll in school, I had friends who were already
sexually acve. They used to sneak out of school and go to
clubs and play sex with men but they used to use condoms.
They used to say aer using the condoms; they could itch
down in their genitals or vagina. So whenever I could
remember their stories I could be puzzled on which method to
use. The doctor advised me to use the female condom but it’s
too big for me. I want to avoid unwanted pregnancies and
sexually transmied diseases but problem is when you hear
about people’s stories, I get scared.
The story above indicates that some women have the desire
to use contracepon but negave myths or misconcepons
exist on CU. Health workers say that most women are reluctant
to go to the hospital for this kind of informaon and that’s why
health centers have developed a strategy to extend the
community outreaches to the people. Women’s health is also
subjecve both by biology and by cultural instuons which
dene power relaons within households and between men
and women, and inuence women’s access to knowledge and
resources.
Therefore, access to informaon and ownership of
knowledge and informaon are major key issues in women’s
access to health care services. Unmet needs for CU are mostly
inuenced by these issues in the long run.
Spousal support
Support from spouses has been idened from the study as
a major pre determinant of contracepve uptake especially
among women. This is because women require certain form of
approval from their husbands on whether or not to use
contracepves in a marital relaonship. It has also been
idened in most young female adolescents interviewed that
it’s always a boy/man who brings a condom when going for
sexual intercourse. In this case the support of the spouse
enables a woman to use a certain method of birth control and
the reverse is true for those couples where the man is not in
agreement.
Most women who come to access these contracepves rst
seek permission from their husbands. As you see our society is
rooted in patriarchal values that put man in a decision making
posion than a woman, so it is always hard for her to make any
move without approval of the husband. In cases where women
don’t ask or talk to their husbands on contracepve use,
situaons of family break ups and domesc violence prevails
Midwife, St. Apollo Kivebulaya Namasuba Health Centre.
The ndings above indicate that men’s control over
women’s reproducve health and sexuality is likely a result of
upstream factors related to the masculinity and gender role
norms prevailing in most patriarchal sociees. In addion,
issues to do with sexuality, ferlity and a large family size are
strongly linked to the denion of man-hood in many rural
areas in Uganda.
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Access to health service systems
Accessibility to health services including hospitals and clinics
involves aspects of geographical locaon and costs involved to
reach the service systems. Majority (47.69%) of women
respondents reported in access to health care systems as a
major hindrance to contracepve use. This is because the
village is so over populated and there’s only one government
aided hospital to handle the growing number of people in the
area. Most private clinics reached to in the study oer services
related to contracepve use at a much higher price compared
to the governments’ hospitals. There’s also a problem of
shortage of drugs and contracepves in these hospitals, since
health workers get them at a cost. During the interview with a
doctor, he said in his words:
In most cases we also buy these contracepves at an
expensive price, so there’s no way we can give them out to all
the women in the village. We x the price of the contracepve
according to the price bought and also following the Ministry
of Health (MOH) regulaons. This is where I call upon the
government to help the grass root clinics and pharmacies that
provide these services through equipping them with more
contracepves. This will in the end improve the livelihood of
the general populaon and reduce on the cases of maternal
mortality, infant and child mortality and so many unhealthy
aborons leading to death and so many adverse eects.
In addion, Mathole et al. [25] found poor quality of care
services and the negave atudes of the health service
providers as barriers to ulizaon of contracepves and
Antenatal Care (ANC) in Zimbabwe. They study highlighted
that poor relaonships between the doctor and the paents,
and the unfriendly environment were the major reasons some
women preferred not to go to hospitals and to adopt to
tradional methods of birth control. Youth friendly or
adolescent friendly services are encouraged in this case to
aract more girls to adapt to ulizaon and to avoid
unintended or unwanted pregnancies.
Reasons for and against contracepve use
The study examined the reasons why some women and men
use contracepves while others don’t. During the study
interviews, women and men combined gave reasons as to why
they decide to use a certain contracepve method and
actually not to, and these reasons are explained below.
According to the study ndings, it is evident sll that religion
shapes people’s percepon and behavior in most of life
decisions. Majority male and female respondents aributed to
not using contracepon as a result of their religious beliefs and
customs that don’t permit them to ulize contracepon. In
addion, respondents also reported the fear of contracng
STDs and above all HIV/AIDS and other STIs and that’s the
major reason for use of contracepon. Women strongly
acknowledged the major reason for CU and uptake so as to be
able to give birth to children at the righul age. This was
mostly emphasized by young adolescents who are in their
early age and want to delay child birth.
Unintended/unwanted pregnancies are one of the leading
causes of maternal mortality among most women in Uganda.
Respondents pointed out that the use of condoms and pills
help them most in the prevenon of unwanted pregnancies
and other STDs/STIs. This is because they are easily used and
readily available in the hospitals and shops as compared to
other methods. Unsafe aborons occur on a daily basis among
women, and these lead to death because they are not done in
the right way. This is because aboron is illegal in Uganda and
highly punished if carried out.
According to the ndings in Figure 7 above, the major
reasons against contracepve uptake among rural women in
Uganda are related to the so many side eects (8) associated
with the birth control technologies. Some women (6) also
pointed out the fact that their religious beliefs and background
doesn’t permit them to ulize contracepon. This is mainly
according to the catholic and Islamic faiths. Non-use of
contracepon varies from individual to individual as there are
some women who reported not interested in the use of birth
control methods. It should be noted that 4 women reported
using tradional methods of birth control and these include
but not limited to use of local herbs and others.
Figure 7 Reasons for and against ulizaon of contracepon
by rural women.
Challenges faced by women in access and
ulizaon of contracepon
User perspecve: Some contracepves come with negave
eects on women's health which discourages them from using
them for example missing their monthly periods, and other
diseases like cancer of the reproducve system. It should be
noted that this was the major challenge listed by women as a
major challenge to contracepve use. Some women gain a lot
of weight (over weight), headache, bleeding, loss of sexual
appete, making them dry. During interview with a midwife
she added to these ndings as below in her own words:
Among other side eects, most women say they become
fat, others thin. Some become black and others brown, some
women experience over bleeding, and or missing their
monthly periods. In addion some women say they lose
appete for food and sexual pleasure when they use
contracepon. Women are aected dierently from each
other and it mostly depends on the type one uses. However
much as most women experience a lot of side eects, they
also acknowledge the advantage of spacing children, reducing
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14 This article is available from: www.hsj.gr
on aboron cases among women, good feeding and being able
to pay for the educaon of their children with the help of CU
in birth control. (Midwife, Lufuka Nursing Home).
Essenal services for reproducve health are mostly
provided in urban areas and cies whereby most women nd
it hard to obtain the transport costs to these health centers
which are mostly government aided and providing services at a
cheaper price. This therefore limits their ulizaon of
contracepve methods and contributes greatly to the growing
populaon in the rural areas of Uganda, because of the
uneven distribuon of these health services.
Wrong informaon or unhealthy educaon talks from the
community through negave atudes towards the use of
contracepves and the misconcepon on their use. Women
have a fear in them to ask for contracepves because of what
they hear from their networks in the communies which are
mostly against the use of contracepon, mostly myths and
norms that are against contracepve use.
Religious beliefs especially Catholics and Islam that are
against the use of contracepon and family planning methods
were also idened as major challenges to CU and uptake.
Problems at the household level where men refuse women to
adopt the use of contracepon.
Health service provider’s perspecve: Tradional methods
of birth control which have been adopted by women but are
not eecve enough to control ferlity. This is because most
women are sll conned in their tradional beliefs and
methods and some shun the modern methods of birth control
with so many misconcepons.
Lack of income and resources to cater for the reproducve
health of rural women; since most women are unemployed, it
becomes dicult for them to access reproducve technologies
or contracepon since most of them are for sale on the
market. It should also be noted that most women lack nancial
support from their husbands thus posing a major challenge to
their access and ulizaon of Contracepve use. One doctor at
a health Centre in Namasuba noted that in his own words
“Financial problems are the major challenges for these
women, some contracepves are way too expensive like the
injector plant and yet most women can't aord it”. These
words from the health service provider actually correspond to
the researcher’s views from the study as portrayed in Figures
4-6 above. Most women lack decent formal jobs that can help
them gain income to take care of themselves and their
families.
Poor health literacy is also another leading challenge in the
access and ulizaon of contracepon among most women.
Health literacy is the degree to which paents understand
basic health informaon such as following instrucons from a
health care provider, managing a chronic illness, or taking
medicaon properly. Rural residents especially women and
men are at risk for low health literacy because they have lower
educaonal levels as compared to residents of metropolitan
areas. Low health literacy is a parcular problem for people in
poverty and people with limited educaon or English
prociency. This thus aects their access to basic family
planning services because of the limited knowledge on how to
use the services.
How rural women cope with the challenges
The study was also interested in knowing how rural women
cope with the challenges they menoned in order to improve
access and ulizaon of CU. Rural women did menon a few
ways in which they cope with the challenges they face which
are explained as below:
Women have tried to change the negave atudes of the
society towards them. This they have done through advocacy
towards the promoon of their fundamental rights as women.
These rights are clearly stated in the Constuon of Uganda
(Arcle 33 and 35) respecvely and other internaonal
documents like the Universal Declaraon of Human Rights
(UDHR) among other Human Rights documents.
Women in Namasuba village have formed informal groups
(social support) in order to help raise some money in order to
access reproducve health services. These groups are mainly
formed by women inform of SACCOs and it came to the
researcher’s knowledge that they are somemes supported by
their networks for them to connue exisng. In this way, they
can be able to support themselves and their friends in the
networks to raise some money in case of emergencies like
sickness and childbirth. Each member in the group has to
contribute 1000 UGX (0.31 USD) per week in order to keep
money in the treasury and distributed weekly according to
who is to receive that parcular week.
Women in this area have also urged doctors to reduce on
the content of the medicaon in the contracepves in order to
reduce on the so many side eects among others related to
over bleeding. Doctors take a clear criterion in selecng a
suitable method for these women through the health history
examinaon.
Strategies to improve contracepve use from
the exisng policies
Uganda bales to address one of the most high ferlity
rates on the globe. According to Marie Stopes Internaonal
(MSI) strategic paper in 2009, the unsuitably high rate of
unmet requirement for family planning (41%) plainly
demonstrates the requirement for enhanced and extended
programmac development in underserved areas. Within this
context, greater contribuons have been made to ensure that
modern contracepve use in Uganda show targeted outreach
and social markeng iniaves which have had a direct impact
on shiing ferlity rates, and modern contracepve use in the
desired direcons. Specically, by giving lasng family
planning techniques beyond stac centers and taking services
into rural, hard-to-reach regions. It should be noted that NGOs
are playing a vital role to enhance provision of family planning
methods to the people although the pace is sll slowed down
by the tradional society norms and customs.
In October 2004, Uganda endorsed its rst extensive
Naonal Adolescent Health Policy. In a naon where more
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© Copyright iMedPub 15
than 50 percent of women are sexually acve by age 17, the
endorsement and usage of such a strategy was basic to
enhancing the RH of young people [26]. A number of CSOs
including NGOs have played a basic role in the
accomplishment of RH strategies and programs at the grass
root level especially in the rural areas which toiled for a long
me to pick up endorsement for the approach. However, the
decentralizaon of power and obligaon regarding RH has
displayed new dicules to compleng arrangements and
securing assets at the area level and beneath, where exisng
limit is frail. Likewise, destrucve convenonal pracces, for
example, limitaons on spouse legacy and sexual orientaon
segregaon, frustrate the execuon of key strategies [27,28].
Above gures shows some data from the health center
outreach acvies to extend services to the people. During the
outreach sessions, health workers are also informed of the
issues that the clients can’t aord to say at the health centers
due to accessibility and aordability issues in maers
concerning contracepve use and uptake.
Health workers in Namasuba village deliver reproducve
health services including contracepon following the RH
policies and strategies that help them to reach out to dierent
men and women though the process is sll slow due to the
fact that these technologies have not been embraced by the
people [29].
In order to reach out to clients, we organize community
health talks on maers concerning reproducve health. During
these talks, we carry out condom distribuon and
demonstraon and always encourage the people to visit the
health centre for more informaon about the availability of
other methods of birth control. This strategy is gaining
momentum and has helped the hospital know which method
is more desired by the people compared to the others. This is
done through keeping records of the technologies that are
distributed out and later we know which works best. Health
Service Provider, Namasuba Village [30].
In addion to community idencaon and registraon of
clients in the villages, another strategy to reaching out to
people is through massive sensizaon of the masses through
media campaigns, provision of IEC (Informaon, Educaon and
Communicaon) materials and community educave health
talks. This is also another strategy to ensure access and
ulizaon of contracepon among rural women in Namasuba
village.
In addion, during our outreaches we do blood tesng
among women before they start using contracepves
especially in family planning. It will help women adapt to
methods that are compable with their bodies and hence
minimize of all the side eects. Community sensizaon
through outreaches, community dialogues in form of health
service provisioning to see what the people want and also
form support organizaons to extend services closer to the
people, Community Outreach Ocer, Namasuba Village.
The health center normally sensizes both men and women
about contracepve use, however in most cases men don't
want to aend these trainings because they believe it’s a
woman thing. According to health service providers,
Counseling is also done among men and women as a way to
improve access to contracepon through encouraging them to
have small number of children. In addion, Health educaon
and advice, management of side eects, invesgaons and
follow-ups of clients is also ensured as a way to maintain
proper ulizaon of contracepon. Rural women rst receive
counseling, if they accept the methods; they are examined
according to their health history and bodies to ensure a
suitable method [31-36].
How the strategies have helped rural women
Women have gained knowledge on contracepve use and
the access rate has improved. According to health service
providers in Namasuba village, the numbers of women
accessing and ulizing contracepon has increased over the
past few years. Actual numbers at the me of the study wasn’t
available on how many women access on a daily basis but
according to health workers acknowledge great improvement
[37].
Registraon of success stories from some women who have
succeeded through use of contracepves. The health workers
acknowledged that there have been quite a good number of
success stories where women and men’s lives have changed
drascally aer the implementaon of family planning
strategies. In addion, couples are now able to plan for their
families and decide on when and how to have children.
Women have been empowered in the long run and they can
choose methods based on their choices and wisely through
the support of health care service providers [38].
Discussion
This chapter presents the summary, conclusions and
recommendaons of the study. The major aim of the study
was to analyze the access and ulizaon of Contracepve use
among rural women in Namasuba Village.
Summary of major ndings
The major purpose of this study was to explore the factors
inuencing access and ulizaon of contracepve use among
rural women so as to understand the prevalence in use
(methods) and constraints experienced by rural women in
Namasuba village Wakiso District. Data of 85 respondents was
analyzed. Fiy ve rural women were interviewed, coupled
with 20 male respondents and 10 key informants. Key
informants were the healthcare providers especially mid-wives
and doctors who provide health services to rural women. The
study was mostly qualitave but quantave methods were
borrowed to determine the prevalence in use of contracepve
methods. Data collecon methods included personal
interviews and key informant interviews which were
unstructured, and document reviews [39-41].
The study ndings revealed that various social and
economic factors can inuence women’s access to
Contracepon. This implies that negave circumstances that
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16 This article is available from: www.hsj.gr
impede access to informaon as a result from the above are
not favorable for rural women to CU. These circumstances may
include discriminaon or stereotyping, isolaon and denial of
informaon on the availability of contracepon provided on
the market. These results further reveal that rural women,
who had knowledge about contracepves and their usage,
ulized such knowledge to care for themselves and living a
safe sex life. Women who had less or no prior knowledge
about contracepves and their use were at a risk of poor
family planning methods, lack of child spacing and other risky
STDs above all HIV/AIDS. The study also found out that the use
of condoms and pills were the leading methods of
contracepon known by majority women and men. This was
under the pretext that these methods were the most
adversed and talked about by the public. In addion,
condoms and pills were considered more easily accessible and
dicult to run out of stock from pharmacies or hospitals.
Some respondents also acknowledged that condoms and pills
were easy to use with fewer complicaons as compared to the
other methods of birth control. It should be noted that some
rural women interviewed preferred the Tradional methods
provided by TBA because they are easy to administer and
culturally accepted [42-47].
Findings also revealed that rural women face some
challenges in the access and ulizaon of CU. These challenges
include, lack of informaon and knowledge about CU, negave
cultural (religion) and gender norms of the society towards
women use of contracepon, low levels of income (poverty),
illiteracy (in form of low levels of educaon aainment) and
language barriers, unfriendly reproducve health service
systems and care providers, and cost factors, like costs of
contracepon and transport costs to the health centers. Thus
the study observed that there was a great need to address
some of these aspects. Most importantly, there was need to
change the negave cultural and religious atudes of the
society towards women ulizaon of CU, sensizaon in order
to create awareness on issues concerning CU. Extension of RH
services to women in order to create proper ulizaon of CU,
spousal support and the provision of contracepves free of
charge to women. Key informants also idened some of the
challenges which they face in the delivery of contracepon to
rural women which include tradional beliefs, nances,
accessibility which is limited by transport means and costs of
CU, ignorance about RH issues by women, illiteracy and low
self-esteem by some women [48-50].
Relevance to development theory
Constung the largest part of Uganda’s populaon, rural
households are a highly important group of society. The
development of the country is mainly measured by people’s
wellbeing and mostly in terms of health issues. Empowerment
of women mainly encompasses giving them the necessary
gears to facilitate their own self development and that of their
families since they are the family care takers, through
educang them on limited ferlity measures with husbands or
men at the fore front [51].
Development strategies in Uganda should consider such
aspects that sideline women from making healthy decisions,
and draw intervenons based on the contextual factors that
limit them from taking necessary precauons in birth control.
This will result in the reduced populaon size and the burden
or extreme expenditures spent on the over growing populaon
in the country thus resulng in absolute poverty and higher
cases of infant, child and maternal mortality rates [52-58]. In
this context, the thesis contributes to a highly relevant,
broader discussion on how development should be achieved,
and who are the winners and losers of dominant development
strategies targeted at societal and human transformaon and
wellbeing. The study thereby interrogates mainstream
perspecves and invites a crical reecon on alternave
ways of approaching development.
Economic development mainly encompasses aspects of
ferlity control in order to boost the country’s economic
growth. This is to a greater extent due to over populaon
growth rates that mostly result into social and economic
problems which may retard the development process. This
therefore means that the idea of development should take
into consideraon ferlity reducon especially in the
developing countries not forgeng the aspects of gender
equality in ferlity and sexuality control. This is because
women are aected dierently from the men in maers
concerning ferlity and childbirth. In most cases women’s
sexuality is controlled by the man and this is mainly because if
the societal structure of pung men at a more privileged
posion as compared to the women [59-61].
Conclusion
The study ndings revealed that various social and
economic factors can inuence women’s access to
contracepon. This implies that negave circumstances that
impede access to informaon as a result from the above are
not favorable for rural women to CU. These circumstances may
include discriminaon or stereotyping, isolaon and denial of
informaon on the availability of contracepon provided on
the market. These results further revealed that rural women,
who had knowledge about contracepves and their usage,
ulized such knowledge to care for themselves and living a
safe sex life. Women who had less or no prior knowledge
about contracepves and their use were at a risk of poor
family planning methods, lack of child spacing and other risky
STDs above all HIV/AIDS.
The ndings indicate that certain variables like lack of
spousal support and lack of immediate knowledge on
contracepve use aect the decision to seek health services
care and aenon in maers concerning reproducve health
and these are mainly socially and economically constructed.
This sociological view of the problem at hand should help to
inuence policy and how policy makers can nd soluons to
address the adverse eects that can emerge from the
idened factors in the short and long run. These ndings are
consistent with the literature and suggest that the poor people
and especially those living in the rural areas have access
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© Copyright iMedPub 17
problems relave to those who can actually aord to access
these services.
Therefore, policy makers should use boom to top approach
in the provision of services especially contracepon to rural
women since they know beer the problems aecng them in
maers concerning reproducve health and also ensure
community involvement towards improving access and
ulizaon of contracepon among rural women, this would
help reduce the negave atudes aached to women access
to CU and will create a conducive environment for them.
Another alternave could be to lessen the prices aached
to these services so as to ensure ulizaon of contracepon.
This is because in the long run it’s the government highly
aected by the uncontrolled growing populaon with no basic
service provisioning. The number of children should at least be
reduced to 4 children per family as per now and concentrate
on addressing the eects already caused by the populaon
increase.
The study achieved all its objecves. Concerning the general
objecve which was to analyze the access and ulizaon of CU
among rural women, with the view of examining the socio-
economic factors and the challenges faced by rural women in
access to and ulizaon of CU, the following were achieved.
Many factors inuencing the access and ulizaon of CU
among rural women were idened and these included the
age, religion, marital status, employment and income levels,
role of the media (informaon), gender and cultural norms
and atude of the communality towards women’s use of
contracepon. Gender power relaons in the home where
women are subordinated most by their husbands in terms of
sexuality and RH were also idened. Aordability in terms of
incomes and resources, discriminaon and isolaon,
accessibility in terms of transport and the long distances to
health centers.
Respondents suggested possible ways in order to improve
access and ulizaon of CU which included; contracepves to
be provided free of charge to them, extend services of
reproducve health closer to them, change of the negave
atudes towards CU, access to informaon concerning
reproducve health and especially CU, eecve and aordable
methods of family planning (contracepon). Key informants
called upon government to increase awareness and
sensizaon of CU in order to reduce to the increasing
populaon and also to reduce costs in accessing the
contracepon.
Recommendaons
Basing on the preceding discussion of the ndings and in
parcular the possible ways to improve access and ulizaon
of CU among rural women, certain recommendaons were
advanced by the researcher and the health care providers,
which include:
Health workers
There’s need for greater understanding by the health service
providers and policy makers of the inuences underpinning
societal atudes towards sexuality and contracepve use in
this seng, and more extensive communicaon between
health care sta and women would facilitate posive acon
towards improving safe motherhood and reproducve health
services for rural women and reduce cases of unsafe aborons,
unintended or unwanted pregnancies, in addion to reducing
HIV/AIDS.
Addional research should address the gaps in knowledge
about the reproducve health care needs such as the unmet
need for contracepon for these rural women. Majority
women need greater educaon and sensizaon on
reproducve health and improved access to health care. This
can be done in the form of trainings, advocacy and lobbying in
order to improve access and ulizaon.
There should also be special delivery of reproducve health
services especially contracepves to women with disabilies
especially to the lame, and blind women. This will create easy
access and ulizaon of reproducve health technologies.
Lastly, women’s eecve access to health care involves the
interrelaonship of many complex factors. This can only be
assured if health services are considered available, aordable,
appropriate and acceptable by women especially in the rural
areas, since they are greatly aected by the negave eects
that come as a result of the above.
Government
There’s need for improvement in rural health service
systems through providing the necessary equipment’s in the
health centers. In addion more public hospitals should be
built in the rural areas to address the issues of inaccessibility
and transport costs to the urban centers by rural women.
The Government of Uganda should endeavor to equip rural
health service centers with necessary RH services. This is turn
will help to address the problems of lack of availability of
certain services when need by rural women.
Economic empowerment for rural women and men is also a
fundamental basic requirement for improve in rural women
and men’s livelihood. Rural women and men should be trained
in basic saving schemes in order to be able to have some
income set aside for health issues.
Government should create knowledge awareness programs
on the exisng reproducve health programs and policies
especially to the rural community. This should be done
through campaigns on birth control, health talks and
sensizaon of the masses on the importance of small family
sizes, as this will reduce on the extreme poverty at the
household and government levels.
Health Science Journal
ISSN 1791-809X Vol.12 No.6:608
2018
18 This article is available from: www.hsj.gr
Areas for Further Research
Since the study could not cover all areas in relaon to the
access and ulizaon of CU, the following are the
recommended areas for further research:
Research can be carried out to nd out how Government is
trying to respond to the accessibility and ulizaon of
reproducve health technologies among rural women
(married and unmarried). It could look at policies in place that
are trying to ensure that women access reproducve health
services. Evaluaon research could also be carried out on the
consequences of cultural and religious beliefs on rural women
in access to reproducve health and especially contracepve
use.
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