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New study: 46% of Women in Uganda say they had unintended pregnancies in 2021

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Women in Uganda continue to report high levels of unintended pregnancies. Results from Phase 2 cross-sectional survey of the Performance Monitoring for Action -PMA Uganda project at Makerere University School of Public Health (MakSPH) show that 46 percent of pregnancies in 2021 were unintended.

Of the 2,159 women of ages 15-49 from across the 141 enumeration areas (villages) in 15 sub regions of Uganda interviewed by the study team, at least 54% said their current/ recent pregnancy was intended.

The women were asked whether they were pregnant by intention of their most recent birth or current pregnancy. 33% said they wanted a pregnancy later while a total of 13% said they wanted no more children but ended up getting pregnant.

The proportion of those who had unintended pregnancy varied from the those that were in urban and rural areas. For instance, a whopping 48.5% of those who had unintended pregnancies were rural based women while 35.9% were in urban areas.

Also, results show that more than 50% of women who said they never wanted to be pregnant or wished to delay child birth were aged 35 and above. A higher proportion (more than 60%) of women who experienced unintended pregnancy in 2021 were teenagers aged between 15 and 19.

MakSPH, PMA Uganda project  Co-Principal Investigator Dr. Simon Peter Kibira
MakSPH, PMA Uganda project Co-Principal Investigator Dr. Simon Peter Kibira addressing media after the dissemination of the results at Golden Tulip Hotel in Kampala.

The enumeration areas are sampled by the Uganda Bureau of statistics (UBOS). The survey was conducted together with the Ministry of Health, supported by Jhpiego, a Johns Hopkins University Affiliate, MakSPH and the Uganda Bureau of Statistics – UBOS and the overall technical guidance from the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.

At MakSPH, PMA Uganda project is led by Principal Investigator Dr. Fredrick Makumbi and Co-Principal Investigator Dr. Simon Peter Kibira. The results were released on February 15, during a stakeholder breakfast engagement meeting at Golden Tulip in Kampala.

For trends in use of contraceptives among married women, the prevalence stands at 50.2%. “It is the first time we are hitting this indicator and the modern method of family planning standing at 43%. So, we are rising though not first enough given the Covid-19 implications for the last 1-3 years. But it is amazing that we have had some adoption from the Ministry of Health and the implementing partners and the results show that at least, there is progress,” says Dr. Simon Peter Kibira, the PMA Uganda Co-Principal Investigator.

Dr. Kibira cites that among a few challenges Uganda has faced is the struggle with the quality of services provided. For instance, data shows that only 43% of women were told about the side effects of a modern contraceptive method they were using, how to cope up with them, and the availability of other alternative methods.

“This is not a good indicator and we still have a long way to go around that,” he says.    

The survey interrogated service delivery points offering Family Planning services in 255 public health facilities and 118 private facilities that included 46 hospitals, 58 Health Center 4s and 96 Health Center IIIs and 55 Health Center 2s.

There was a general drop in stock outs for family planning services. For instance, Oral contraceptive pills in public health facilities stood at 48% in 2021 down from 68% in 2020.

According to the Principal Investigator Dr. Fredrick Makumbi the study team assessed availability of family planning services largely in public health facilities because they are many and can give stable statistics.

PMA Uganda project Principal Investigator Dr. Fredrick Makumbi presenting results of the PMA family planning survey 2021
PMA Uganda project Principal Investigator Dr. Fredrick Makumbi presenting results of the PMA family planning survey 2021

“Implant stockouts were very common compared to the IUDs which had lower use. What about Oral contraceptive pills stockouts, I daresay nearly half of the facilities were stocked out either at the time of the survey or in the past three months,” Dr. Makumbi.

The reasons advanced for stock out of FP commodities in Public Service Delivery Points, a higher percentage (46%) of the facilities said they had ordered but not received shipment. At least 20% said they had ordered but not received right quantities while 9% said there was unexpected increased consumption and just 2.8% said they lacked stock due to COVID-19 disruption.

“For as long as Family Planning partners, Ministry of Health and the rest as mobilizing and creating awareness, people are coming and using the methods and particularly in this study 9% said they did not have enough pills,” Dr. Makumbi says.

In terms of education background, the study noticed a difference in women of primary and secondary levels of education in terms of contraceptive use.

“The highly educated have a significantly high proportion of use of modern planning methods implying that education is key, factor and we need to make sure that women, men and couples using family planning are educated,” says Dr. Kibira.

The Uganda Family Planning Costed Implementation Plan, 2015–2020, launched by the government in November 2014 sought to increase the modern contraceptive prevalence rate among married women to 50 percent by 2020. This target was however not met.

According to Dr. Kibira, we have not yet reached it even in 2022 currently at 47.7%. “We are still struggling a little bit and if we work on that we, shall make sure that we hit on the target of 50%, and that’s for 2020. Much as we set a conservative target, there are adaptations we have seen otherwise we wouldn’t see any usage of family planning methods during Covid-19,” he said.  

He adds that what has contributed to the high prevalence rate for contraceptives has been   the use of modern methods and therefore the adaptations by the Ministry of Health and other implementing partners worked citing that if they did not work, Uganda would have seen worse indicators.

“Regardless of the effects of Covid-19, I am glad we had good indicators. I think this Covid-19 situation could have been a speed jump because couples stayed at home hence exposed to having more sex and that would lead them to take on the modern family planning method. And sometimes you have the challenges and the same challenge propel you to better indicators,” he noted.

In each of the 141 numeration areas the research team interviewed all eligible women aged 15 and 49 years in 35 households.

“We interview and we ask them issues about sex, and if there is any form of pregnancy control method being used. If someone says condom, implants or any other method, we don’t go ahead to interrogate why they are using that method. We are actually interested in asking, if you are not using, then why are you not using,” says Dr. Kibira.  

There are various family planning methods and women / couples should be at liberty to choose with full information at the facility where you are receiving the method, for example among the pills, injectables, IUDs.

Notably Dr. Kibira asserts that implants and IUDs are long acting reversible methods and they are the most active compared to the short-term methods that are recommendable for people who want longer time delays for example space for 5 years.

He adds that; “The beauty with long term methods is that they are cheaper, effective and offer long years of protection and it should be ideal that people use what is ideal to their needs either short term and long term and it’s a choice.”

Dr. Makumbi says each development partner has a role to play in ensuring access to family planning services to Ugandans. “I think everyone of us has an opportunity to play their role, we generate evidence, we work with Ministry of Health, implementing partners, Population Council and everybody so that we can have evidence-informed decisions and that can make a significant difference and I am glad to see members of parliament who can help us support when all this information comes to parliament.”

Dr. Charles Ayume the Chair of the Committee on Health in Parliament of Uganda interacts with journalists after the release of the findings of PMA results at Golden Tulip Hotel in Kampala
Dr. Charles Ayume the Chair of the Committee on Health in Parliament of Uganda interacts with journalists after the release of the findings of PMA results at Golden Tulip Hotel in Kampala

Dr. Charles Ayume the Chair of the Committee on Health in Parliament of Uganda said they (committee) were extremely happy to engaging in a dissemination of PMA results citing that it sharpens the way they tackle issues on the floor of parliament.

“We really want a parliament that articulates issues based on evidence and very strong data. We do not only represent our constituencies, we are also dutybound to represent the views of health workers on the floor of parliament and good enough we have health workers on the committee,” said Dr. Ayume.

Adding that; “this is where data is produced. But then fortunately or unfortunately the policies are made on the floor of parliament. So if you don’t arm us well, then we do a poor job on the floor. We pledge total support.”

Davidson Ndyabahika

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Makerere University’s Prof. Peter Waiswa Appointed to WHO Technical Working Group on Essential Child Health Services

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Prof. Peter Waiswa (C) with participants at the World Health Regional Summit on 29 April 2026 in Nairobi Kenya. Photo: MNCH. Makerere University Center of Excellence for Maternal, Newborn and Child Health (MNCH), based at the Makerere University School of Public Health in Kampala Uganda

Makerere University’s Professor Peter Waiswa has been appointed to the World Health Organization (WHO) Technical Working Group of Experts tasked with developing the Essential Child Health Services (ECHS) framework.

The appointment, communicated in an official letter dated October 21, 2026, and signed by Dr. Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child, Adolescent and Ageing Health, runs until December 31, 2027.

The technical working group will support WHO in defining a core package of essential health services for newborns, older children and adolescents, alongside practical approaches for delivering these services effectively and equitably to improve their health and well-being.

As a member of the working group, Prof. Waiswa will contribute scientific and technical expertise to the development of the framework. His responsibilities will include participating in technical consultations, reviewing draft documents, providing written feedback and contributing to consensus-building on key technical issues.

The group is expected to hold approximately five online meetings between November 2026 and mid-2027. Members will serve in their individual capacities as independent experts rather than as representatives of their respective governments or institutions.

The appointment builds on Prof. Waiswa’s longstanding service and contributions to WHO. He previously served for seven years on WHO’s Strategic and Technical Advisory Group of Experts (STAGE) on Maternal, Newborn, Child and Adolescent Health and Nutrition, with his tenure concluding in June 2026.

Congratulations Prof. Peter Waiswa.

Mak Editor

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Mak Staff Receive Prestigious International “Future of the Field” Recognition in Global Research Administration Class of 2026.

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Mr. Mordecai Tayebwa (L) and Ms. Bonny Tusiime(R)

Makerere University proudly celebrates the recognition of Mr. Mordecai Tayebwa, Senior Grants Manager, Makerere University Lung Institute and Ms. Bonny Tusiime, Grants and Contracts Officer, Makerere University College of Health of Sciences (MakCHS) as recipients of the prestigious Future of the Field Award of Society of Research Administrators International (SRAI), an international recognition that Honors emerging leaders making outstanding contributions to the advancement of research administration. This year’s ‘Future of the Field’ honorees were formally recognized at SRAI’s Annual Meeting held in Honolulu, Hawaii, USA in October, 2026.

The Future of the Field Award recognizes professionals who demonstrate exceptional leadership, innovation, and commitment to strengthening research management and administration. The award celebrates individuals whose work is shaping the future of the profession by improving research support systems, fostering collaboration, and advancing excellence in research administration.

At Makerere University, Mr. Tayebwa and Ms. Tusiime have played key roles in strengthening grants and contracts management, supporting researchers throughout the grant lifecycle, promoting compliance with sponsor requirements, and contributing to the development of sustainable research management systems. Their efforts have enhanced institutional capacity to attract, manage, and administer competitive research funding while ensuring accountability and excellence. Commenting on the recognition, the award recipients expressed their gratitude for the opportunity to contribute to the growth of research administration. “This recognition reflects not only our individual efforts but also the collaborative environment at  MakCHS and Makerere University. It inspires us to continue strengthening research administration and supporting researchers in generating impactful scientific discoveries that improve lives.” They said.

The achievement highlights the growing international recognition of research administration professionals in Africa and underscores Makerere University and MakCHS’s  general commitment to building strong research support systems that enable world-class research. This also reflects the institution’s investment in professional development and its dedication to advancing research excellence through effective grants management.

Commenting on the award, Dara C. Little, President, (SRAI) said “In a field as dynamic and rapidly evolving as research administration, the need for visionary,adaptable leaders have never been greater,” . “SRAI’s Future of the Field recipients represent the next generation of changemakers – those who will not only navigate complexity but shape the future of our profession. To embrace change, is to lead your innovation, resilience, and leadership are exactly what this moment demands. Rise to the opportunity and you will do great things!”

Makerere University congratulates Mr. Mordecai Tayebwa and Ms. Bonny Tusiime on this significant achievement and wishes them continued success as they contribute to shaping the future of research administration both regionally and globally

Zaam Ssali
Zaam Ssali

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Mayuge Study Finds NCD Risks Emerging in Adolescence, and Shows Early Action Can Help

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Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Adolescence is a consequential period for health, when diets, behaviours and other risks can form and persist into adulthood. In Mayuge District, new evidence from Makerere University School of Public Health is showing how some of these early vulnerabilities could contribute to the later risk of non-communicable diseases (NCDs), and what can change when interventions begin early.

The evidence comes from the ARISE-NUTRINT project, a three-year EU-funded study led by Prof. David Guwatudde and Dr. Justine Bukenya. The project examines health and behavioural risks among adolescents and young adults, with a particular focus on nutrition-related NCD risks, and tests interventions designed to improve nutrition fluency and diet quality.

The work comes against a substantial NCD burden in a country where 73.2% of the population is below 30. WHO estimates that NCDs accounted for 42.2% of deaths in Uganda in 2023, while the country’s latest national NCD risk-factor survey found significant risk factors persisting in the population, with little overall change from the previous survey in 2014. Together, the evidence strengthens the case for prevention much earlier in life.

“There is strong evidence from literature demonstrating that most behavioral NCD risk factors, including nutrition-related, are established during childhood, persisting into adulthood. This may lead to development of actual NCDs if such risks are not reversed early,” Prof. Guwatudde said.

The study, he explained, linked assessment of young people’s health risks with developing responses suited to their circumstances. Since enrolling 1,206 participants aged 10–24 in Mayuge District in March 2024, the team has conducted three annual rounds of data collection, with young people and local stakeholders also helping evaluate interventions to reduce the risks identified.

Prof. David Guwatudde (right) addresses stakeholders alongside the ARISE-NUTRINT study team in Iganga on 1 October 2026.

A problem that starts early

The findings, shared with community and district stakeholders in Iganga on October 1, 2026, show that some vulnerabilities were already evident at baseline. Nearly one in three participants had anaemia, 49% had low nutrition literacy, while about one in ten reported symptoms of anxiety and a similar proportion reported depressive symptoms.

Anaemia, a condition in which the blood does not have enough healthy red blood cells or haemoglobin to carry adequate oxygen around the body, was highest among the youngest participants. Overall, 375, or 31%, had anaemia, rising to 35.7 per cent among 10–14-year-olds, compared with 18.9% among those aged 15–19 and 10.6 per cent among young adults aged 20–24.

Nutrition presented another challenge. At baseline, 49% of participants had low nutrition literacy and 13% had poor overall diet quality. Low nutrition literacy was associated with more than four times the odds of poor diet quality.

Gaps also emerged in sexual and reproductive health knowledge and behaviour. About 14 per cent of participants did not know that HIV cannot be transmitted by sharing food with a person living with HIV, 10% believed a condom could be used more than once, and 13 per cent did not know pregnancy could occur during first sexual intercourse. Among 168 participants who reported having had sex, more than half reported using no method to prevent pregnancy during their first or most recent sexual intercourse.

Mental health findings added another dimension. Anxiety symptoms were reported by 10 per cent of participants, depressive symptoms by 9.5% and loneliness by 6.3 per cent. Among 534 participants aged 13–24 assessed for suicidal ideation, 1.9% reported suicidal thoughts.

Together, the baseline findings show that vulnerabilities extended beyond any single health issue. For nutrition, the study went further to examine what shaped everyday food choices and whether those influences could be changed.

Nutrition literacy goes beyond knowing which foods are healthy. It includes understanding nutrition information and applying it to everyday choices. The study found those choices were also shaped by parents, peers, food vendors, culture, prices, seasons, and what was available locally. Improving diets, therefore, required reaching beyond individual knowledge to the households and communities where food choices are made.

What early action changed

The baseline evidence informed the Adolescent Nutrition Fluency Intervention. Working with adolescents and young adults, caregivers, Community Health Workers (CHWs), district teams and other stakeholders, the project adapted nutrition messages to local foods, language and household realities. Ten trained CHWs delivered nine monthly household sessions covering balanced diets, physical activity, vitamins and minerals, meal planning and anaemia prevention.

The household approach reached young people in and out of school. The nutrition literacy, diet-quality and intervention analyses form part of the PhD research of Mr. Thomas Buyinza, supported through ARISE-NUTRINT. At endline, participants who received the sessions recorded higher nutrition literacy and overall diet-quality scores.

“The improvement in nutrition literacy and diet quality suggests that practical education, grounded in local foods and household realities, can support healthier choices among adolescents and young adults. In addition, involving parents and caregivers is important because they influence what families buy, prepare, and eat,” Dr. Bukenya said.

She stressed that nutrition education needed to be complemented by better access to affordable, nutritious foods. Dr. Bukenya also called for continued follow-up, including the use of nutrition and dietary data from DHIS2, to assess whether improvements were maintained and guide district planning.

Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.
Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.

Changes in other outcomes were mixed. Participants reporting no physical activity fell from 22.6% to 7.4%, while those active on four to seven days a week increased from 46% to 54.8%. But activity duration did not improve: those reporting more than 60 minutes a day declined from 28.2% to 21.1%. Underweight fell modestly from 6.2% to 5%, while overweight and obesity did not change significantly.

Anaemia recorded the largest change, falling from 31.1% before the intervention to 9.9% afterwards. During the intervention period, participants received weekly iron and folic acid supplementation and deworming alongside nutrition education on iron-rich foods, dietary diversity and practices that improve iron absorption.

Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.
Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, said the findings reflected problems recognised locally and highlighted the need for a response involving families and other stakeholders.

“There is a serious challenge that needs to be tackled with many stakeholders, with parents at the centre because these are children. We also learnt that many parents, I think, lack the skills to communicate with their adolescents,” she said.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.
Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.

She said the findings had been shared with colleagues and described integrating health education and sensitisation into services. She also called for departments to use the evidence when planning activities in their workplans.

Beyond Mayuge

Seen alongside Uganda’s 2023 STEPS survey, the Mayuge findings add an earlier-life dimension to the national evidence. Makerere University School of Public Health contributed to both studies, with Prof. Guwatudde contributing to the national STEPS survey and now leading ARISE-NUTRINT. While STEPS found significant NCD risk factors persisting among adults, ARISE-NUTRINT shows that some behaviours and vulnerabilities relevant to later NCD risk are already evident during adolescence and young adulthood. The Mayuge research goes further by testing what can change when interventions begin during this period.

The findings leave Mayuge with more than a measure of the problem. They show where vulnerabilities are emerging, what changed when interventions were introduced and where challenges remain. For ARISE-NUTRINT, the evidence now turns attention to which approaches can be sustained and how lessons from Mayuge can inform efforts to support healthier transitions from adolescence into adulthood.

John Okeya

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