Sexual & Reproductive Health education in rural Uganda

Sexual & Reproductive Health education in rural Uganda
29th June 2017

written by Leah Kenny

I take a short boda ride from Busembatia to Bulogoda every week on a Wednesday morning. I have been living in Busembatia for one month now, where alongside Meg, I have been running the Sexual and Reproductive Health and Rights (SRHR) programme. Part of our programme involves delivering sessions to women at health centres, before they attend their antenatal clinics. We do not need a lot for these sessions, aside from a plan and a large box of condoms. As we pull away from the slightly hectic main street of Busembatia, it gets quieter and the houses increasingly sparse until much of what you pass are large fields with women and children busy working on them.

Bulugoda Health Centre appears to our right. It is a small two-roomed Level II Health Centre. This means that it is supposed to serve up to 5,000 people and provide preventive, promotive and outpatient services. Although it does not provide maternity services, we are told that sometimes emergency deliveries are performed here. Ruth shows us where the placentas are disposed of, out back. As you pull up to the health centre, you are distracted by a large tree with a scale attached, from which a group of women are taking turns to weigh their babies.

“Outreach by NGOs to the health centre has been at best erratic, at worst nonexistent”

Ruth is a midwife and the nurse in charge of Bulugoda Health Centre, where she runs the business almost single-handedly. She is a small woman, yet full of energy and shows us around her health centre. She points to the medical bed and peeling posters, left behind by previous health programmes and interventions. A number of contraceptive methods are available here, including the injectable, oral contraceptive pills and moon beads. You cannot get an IUD or implant here though, and provision of condoms has been infrequent. Many women who come to our sessions have never heard of, let alone seen, a female condom. Ruth tells us that outreach by NGOs to the health centre has been at best erratic, at worst nonexistent. The last organisation to reach out to them was Restless Development, 3 years ago. It leaves these women in the dark on issues for example related to family planning and sexually transmitted infections (STIs). She is proud of her health centre, but also concerned about the lack of support she receives and the number of women she needs to attend to. As we discover for ourselves, there are already many women and children patiently waiting to be treated by mid-morning.

Bulugoda 2

“As women we all have the same worries and questions when it comes to our sexual health”

A group of around 25 women sit in front of us. The large numbers mean women spill out onto the grass. Each woman is carrying a baby and usually another young child in tow. Women in Uganda give birth, on average, to nearly two more children than they desire, meaning that unintended pregnancy is common. I am surprised when I later learn from our participant list that many of these women are younger than me, some as young as 17. Back home I am used to teenage mothers being something of an anomaly. The first time we deliver our session, I am apprehensive that we may be providing these women with information they already have. Although many are younger than me, they have given birth to one (or multiple) children, and are therefore more experienced in the world of reproductive health. However, once we begin our session my fears are quickly assuaged. Our closeness in age helps bring us together, and as women we all have the same worries and questions when it comes to our sexual health. Showing a genuine interest in this small health centre, and more importantly, the women who access it, is one of the most important and rewarding parts of our programme.

“Many myths surround family planning methods”

The women have been gathered here by Ruth to listen to us deliver a session on sexual and reproductive health. Our first session focuses on the range of different family planning methods available to these women. The hope is that by equipping these women with vital information on the different methods and how they work, they will be able make their own reproductive decisions on how many children they want to have, when and through what means they would like to limit family size. We are lucky to have Suzan, a national volunteer for WIL Uganda, to translate our sessions into Lusoga and crucially to translate back to us the many questions these women have. The women are not afraid to ask questions. As we begin on the first contraceptive method, the condom, we are asked if condoms can be ‘washed out’ and ‘reused’. The women worry about the side-effects of other long-term methods of family planning such as ‘excessive bleeding’ and ‘disease’. A lack of awareness and accurate information helps to explain why in Uganda, less than ¼ of married women in rural areas use modern contraceptive methods. In this part of Uganda many myths surround family planning methods and people believe, for example, that using them can cause cancer. It is up to us to allay fear and a large component of our sessions focus on myth busting and ensuring women have accurate information. It is through these questions and misconceptions that you learn just how important it is for organisations to reach out to women living in remote areas.

“Giggles and laughter”

Most importantly, the sessions and discussions are filled with giggles and laughter. The women open up to us and each other about their concerns and personal experiences. As the jokes are often in Lusoga it is possible to feel left out, but seeing everyone learning while also having a good time is enough for me. Finally, there are no language barriers when the women enthusiastically share the condoms out amongst themselves and one of the women, who comes across as the leader of the group, informs us she will be taking a female condom with her and will let us all know how it feels like in the next session. I suppose we all have something left to learn.

 

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