Uganda has one of the highest fertility rates in the world at 6.7 children per woman, and has the youngest population on the planet with a median age of less than fifteen. Large families trap people in poverty with not enough money for food, schooling and health care for their children. High fertility rates are dangerous for women, and make it hard for them to escape traditional childbearing roles. A 3% annual population growth rate is unsustainable for the environment, and leaves younger generations without enough water or land for cultivation. Three years ago, we were providing short-term methods of family planning, currently 60% of the services offered every month are long term. Now the contraceptive prevalence rate (proportion of women of childbearing age using some form of contraception) is 46% the Bwindi area. Our target is 70% by 2020.
Our family planning department operates every day, providing services and each department in the hospital has a family planning ambassador/champion to talk about family planning to the clients. Our services are not only given to the married women but also teenagers have turned up for the services because they are sexually active. So far, the youngest conception age in our catchment area has been 13 years and average conception age is 18 years.
Bwindi Community Hospital in partnership with the Royal College of General Practitioners was awarded funding to increase the number of health workers who are trained to give counselling about the benefits of family planning and where appropriate provide methods of modern contraception. The initiative, known as U-SHAPE (Uganda Sexual Health and Pastoral Education) also includes training for local teachers and Village Health Teams. The aim is to reduce unmet need for family planning, by dispelling the many fears and misconceptions that people have. We have a particular emphasis on preventing unwanted teenage pregnancies and helping mothers to space their children, both of which are known to reduce maternal and infant mortality.
BCH in partnership with Family Health International, has trained 40 village health workers to be able to give contraceptive pills and injections. This has had a stunning impact on use of birth control, and now more than 500 women a month access their contraception through this network. The Hospital integrates family planning into all the services and departments through a whole institution approach and all staff are trained to provide family planning education, counselling and all clinicians can provide the methods. Through our HIV and postnatal clinics, we run Family Planning Camps where we insert an implant that lasts for five years.
We also offer postpartum family planning to mothers who opt for a method before leaving the hospital after giving birth.
Our team engages in debate on the radio, in villages and in trading centres, particularly with the men of the area who are the real decision makers and often those who are most opposed to reducing family sizes.
The family planning work in Bwindi is probably the most valuable contribution that we make to the long-term health of the community and the environment. None of our patients is charged, so we rely entirely on donations. We are supplied with drugs from the Government of Uganda but the salaries of our staff, transport costs and all of the training and support given to the village health workers relies on donations. The Hospital has written a three-year plan describing how we can reach our target of 70% contraceptive prevalence, a goal that will require about $20,000 per year. Any contribution, however large or small, will go directly to helping those most in need.
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