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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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Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group

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An illustration of students from Nabisunsa Girls’ School during a memorable tour of the School of Public Health at Makerere University on June 12, 2025. Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.

Based on research led by Max Bobholz and colleagues from Makerere University in Uganda, Essentia Institute of Rural Health, and the Medical College of Wisconsin in the United States.

Adolescence is meant to be a time of holistic growth and self-discovery, but for many Ugandan teenagers, this period is becoming a season of silent mental health struggles. A new study published in PLOS Global Public Health has uncovered a silent but growing crisis: nearly one in five Ugandan secondary school students in the study areas have signs of an emotional disorder. These conditions included anxiety, depression, post-traumatic stress disorder (PTSD), and adjustment disorders often involving excessive worry, sadness, fear, or mood instability. Also, one in 20 adolescents exhibited behavioral issues ranging from attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder to substance use and other risky behaviors like alcohol use.

The study, led by Max Bobholz, a PhD candidate in Public and Community Health at the Medical College of Wisconsin, surveyed a sample of 1,953 students aged 10 to 18 years enrolled in eight secondary schools in Iganga district in Eastern Uganda and Mukono district in Central Uganda. This was one of the most comprehensive efforts yet to understand the prevalence and drivers of mental health challenges among school-going Ugandan adolescents.

“We are looking at a generation facing a complex blend of stressors, namely, academic, social, and emotional,” says Bobholz. “Our findings show that certain groups are especially vulnerable, and schools need to be equipped to respond.”

Max Bobholz, a PhD candidate in Public and Community Health at the Medical College of Wisconsin. Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Max Bobholz, a PhD candidate in Public and Community Health at the Medical College of Wisconsin.

This study results, published on June 12, 2025 was funded by the Swedish International Development Cooperation Agency (SIDA), a government agency of the Swedish Ministry for Foreign Affairs, through the Makerere University Postdoctoral Fellowship to one of the investigators, Dr. Catherine Abbo. Other researchers included Julia Dickson-Gomez, Arthur Kiconco, Abdul R. Shour, Simon Kasasa, Laura D. Cassidy, and Ronald Anguzu.

According to the study, girls bear a higher emotional burden. Researchers found that female students had nearly two times higher odds of suffering from emotional disorders such as anxiety or depression than their male peers.

Dr. Catherine Abbo, an Adolescent Psychiatrist and Associate Professor at Makerere University, attributes this to both biological and socio-cultural factors. “Puberty brings hormonal shifts that can heighten emotional sensitivity,” she explains. “But just as importantly, Ugandan girls often face intense pressure to conform to gender roles while also navigating issues like body image, harassment, and future uncertainty.” The researchers are calling for gender-sensitive mental health interventions, particularly in schools, where early support could help mitigate long-term mental health issues.

Dr. Catherine Abbo, an Adolescent Psychiatrist and Associate Professor at Makerere University. Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Dr. Catherine Abbo, an Adolescent Psychiatrist and Associate Professor at Makerere University.

Higher associations in older teens?

Age also emerged as a key associated factor, with each additional year increasing the odds of behavioral disorders by 20%. “As adolescents grow older, they are more prone to risk-taking, impulsivity, and resistance to authority,” explains Dr. Simon Kasasa, a senior lecturer and biostatistician at Makerere University School of Public Health.

Dr. Ronald Anguzu, an Assistant Professor in the Institute for Health and Humanity at the Medical College of Wisconsin. Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Dr. Ronald Anguzu, an Assistant Professor in the Institute for Health and Humanity at the Medical College of Wisconsin.

“Combine that with academic pressure and identity-related stress, and it’s no surprise we’re seeing more conduct issues in late adolescence,” Dr. Ronald Anguzu, an Assistant Professor in the Institute for Health and Humanity at the Medical College of Wisconsin, added. This study raises critical questions about whether and how Ugandan secondary schools support older students as they transition toward adulthood.

The unseen influence of family mental health

The study also found that adolescents with a family history of mental illness had twice the odds of exhibiting behavioral problems compared to those without such a history.

“This speaks to the intersection of genetics and environment,” says Bobholz. “Living in a household with people affected by mental illness can mean instability, stigma, and lack of emotional support, all of which weigh heavily on a developing mind.”

The authors recommend that school mental health screening include family mental health history and advocate for greater collaboration between education and health sectors to support at-risk households.

An illustration of students from Nabisunsa Girls’ School reconnect with their proud alumna during a memorable tour of the School of Public Health at Makerere University on June 12, 2025. A day of inspiration, mentorship, and shared dreams. Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
An illustration of students from Nabisunsa Girls’ School reconnect with their proud alumna during a memorable tour of the School of Public Health at Makerere University on June 12, 2025. A day of inspiration, mentorship, and shared dreams.

Private schools: High marks, higher stress?

Interestingly, students in private schools had 1.4 times the odds of experiencing emotional disorders compared to those in public schools. Private schools, often seen as academic havens, may inadvertently be cultivating high-pressure environments. “There’s an assumption that better facilities mean better well-being,” says Dr. Abbo. “But intense academic competition, social isolation, and a lack of trained counselors can create emotional pressure cookers.”

Previous research in 47 secondary schools across five districts (Rakai, Kyotera, Masaka, Lwengo, and Kalungu) in southwestern Uganda found that economic and family support helped reduce absenteeism among adolescent girls in secondary schools. However, this support did not significantly improve behavior or reduce grade repetition. The region, which includes districts like Rakai and Masaka, also faces a higher burden of HIV, adding to the challenges young people experience.

Meanwhile, a review of data from 42 primary schools in Luwero District identified school-based mental health interventions such as cognitive behavioral therapy and mindset-building approaches as being particularly effective. Researchers now suggest that integrating these strategies, along with efforts to reduce school violence, could go a long way in improving the mental health of Ugandan adolescents.

A-Level pressure: Academic ambition meets mental health strain

The study also found a correlation between advanced (A’level) education and increased risk of emotional disorders. “We selected one school district from each region based on population and past academic performance. As these students prepare for university or the job market, the pressure to succeed becomes enormous,” says Kasasa. “They’re facing a future full of uncertainty, with very little structured mental health support to help them cope.”

Dr. Simon Kasasa, a senior lecturer and biostatistician at Makerere University School of Public Health. Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Dr. Simon Kasasa, a senior lecturer and biostatistician at Makerere University School of Public Health.

A wake-up call for Uganda’s education and health systems

The authors of this study assert the urgent need for school-based mental health programs, especially in private and A-level institutions. These programs should offer routine screening, emotional support, and training for teachers to recognize warning signs of mental health disorders.

Importantly, this study adds weight to calls for a national adolescent mental health policy, tailored to Uganda’s context, with interventions that bridge health, education, and social services.

“Our data shows that mental health challenges are not a fringe issue,” says Bobholz. “They are widespread, significant, and deeply tied to school, home, and society.”

The COVID-19 school closures between 2020 and 2022 deepened feelings of isolation and financial strain, with out-of-school adolescents reporting depression rates as high as 21.5% to 50% higher than their peers who remained in class, according to research published in February 2025. Yet Uganda invests less than 1% of its health budget in mental health, with just one psychiatrist per million people, leaving many teens to cope through cheap alcohol used by 28% of urban youth or untrained healers, as reported by the government paper The New Vision in April 2025. With only 26% of students completing lower secondary school and 35% of the population under age 24, these mental health challenges now pose a serious threat to the country’s future.

Mercy Akankunda of Proven Foundation, a Ugandan NGO supporting vulnerable groups, warns that mental health struggles are quietly eroding the well-being of the country’s youth, over 12 million strong and making up 35% of the population. “These teens are not just statistics. They are the future of Uganda, she asserts. If Uganda hopes to reap the dividends of its young population, addressing adolescent mental health must become and remain a national priority, not just for treatment, but for prevention, resilience, and hope.

Reference:
Bobholz, M., Dickson-Gomez, J., Abbo, C., Kiconco, A., Shour, A.R., Kasasa, S., Cassidy, L.D., & Anguzu, R. (2025). Correlates of behavioral and emotional disorders among school-going adolescents in Uganda. PLOS Global Public Health. Read the study here

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Davidson Ndyabahika

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Call for Applications: Responsible Conduct of Research (RCR) Training Course

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An elevated shot of the School of Biomedical Sciences Building, College of Health Sciences (CHS), Makerere University. Kampala Uganda, East Africa

The Responsible Conduct of Research (RCR) Training Course, scheduled to take place from July 30th to August 1st, 2025, at the Makerere University College of Health Sciences’ Conference Room.

Background

The SUSTAIN: Advancing Makerere University Masters of Health Sciences in Bioethics program at Makerere University College of Health Sciences aims at developing and institutionalizing a mentorship program in research ethics that facilitates development of bioethics professionals and health researchers who are committed to the growth and application of research ethics in Uganda’s academic and research institutions to the highest possible degree. The Responsible Conduct of Research (RCR) course is one of the short courses that introduces trainees to a framework that involves application of established scientific, professional norms and ethical principles in the performance of all activities related to scientific research.

Course objectives

At the end of this course, trainees should be able to identify, manage and prevent research misconduct.

Course outline

Introduction to RCR; Introduction to Professionalism and Ethics; Human subject’s protection and regulatory framework in Uganda; Humane handling of animal research subjects; Conflict of interest;

Responsible laboratory practices; Mentor-mentee relationships; Collaborative research international, industry); Peer review; Research misconduct (including policies for handling misconduct); Community involvement during research in a low resource setting; Responsibility to society and environment; Responsible financial management; Data acquisition, management, sharing and ownership; Responsible authorship, publication and communication.

Target group

The Responsible Conduct of Research course is targeted at Researchers, Research administrators, Research assistants, Study coordinators, Graduate students and Student supervisors. Certificates will only be awarded to participants with 80% attendance.

Course fee: 205,000/=, or 56USD is payable.

The course fee will cater for meals and refreshments during the training period.

Payment & Registration procedure:

9030026194023, Stanbic Bank, Mulago, Makerere University Biomedical Research Center Limited

Dollar Currency:

9030026194147, Stanbic Bank, Mulago, Makerere University Biomedical Research Center Limited

Please Note: Share payment details on email/whatsup and a hardcopy deposit slip delivered on the first day of the training to Miriam Musazi, Department of anatomy, Bioethics Centre, Room C4,

Mob: +256 782 363 996/ +256 701 363 996, Email: mmusazi@gmail.com.

NB. Only those who will have paid by this date will be considered for the course

Venue: The training will take place at Makerere University College of Health Sciences’ Conference room

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Call For Applications: PhD Fellowship Training Position

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A newborn baby in an incubator in Neonatal Care Unit. Makerere University School of Public Health, Baylor Foundation Uganda, Adara Development Uganda, Nsambya Hospital, and the Ministry of Health with funding from ELMA Philanthropies national health systems strengthening initiative the Uganda Newborn Programme (UNP) launched 2022. Program uses regional approach to improve newborn care in three regions of Uganda namely Kampala, North Central and Western regions. Achievements 2025. Kampala, East Africa.

Background:

Makerere University College of Health Sciences (MakCHS), Kampala, Uganda and Global Health Uganda (GHU); in collaboration with other research consortium partner institutions, including, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya; Training and Research Unit of Excellence (TRUE), Blantyre, Malawi; University of Bergen, Bergen, Norway; University of Amsterdam, The Netherlands; and Liverpool School of Tropical Medicine (LSTM), UK have been conducting clinical research on Malaria Chemoprevention. This research has focused on Malaria Chemoprevention in vulnerable patient populations, including children with severe anaemia, children with sickle cell anaemia and pregnant women. As an example, two of our recently completed studies are “The post-discharge malaria chemoprevention in children with severe anaemia [https://pubmed.ncbi.nlm.nih.gov/33264546/] and Malaria chemoprevention in children with sickle cell anaemia [https://pubmed.ncbi.nlm.nih.gov/39718172/]”.

With support from the UK Research and Innovation (UKRI) body, the consortium is expanding these studies to children with severe acute malnutrition, by conducting a large multi-centre randomized controlled trial entitled “Chemoprevention of malaria in the postdischarge management of children with severe acute malnutrition in Malawi and Uganda”.

In Uganda, the study will be conducted at one or two of their study sites in Jinja Regional Referral Hospital, Hoima Regional Referral Hospital or Kitgum General Hospital. Makerere University College of Health Sciences (MakCHS) and Uganda and Global Health Uganda (GHU) seek to appoint a full-time PhD Fellow, on this study. This will be a 4-year post, tenured at Makerere University and hosted at MakCHS.

Expectations of the PhD fellowship:

The PhD fellow will:

  • Be a part of the main trial team, and participate fully in its implementation. However, he/she will be expected to design and develop his/her PhD research project, nested in the main trial.
  • The area of study will be around “interactions between anaemia and severe acute malnutrition (SAM) in children or the interactions between malaria and severe acute malnutrition in children”.
  • Conduct rigorous research, leading to high quality scientific publications.
  • Submit a full research concept and obtain registration in the University by end of year-one. As such, there be an initial appointment for one year, renewable upon satisfactory performance.
  • Academic mentorship and supervision will be provided by the research consortium (see above – composed of national and international researchers).
  • Doctoral scholarly support and training environment, as well as didactic training in research methods and scientific writing skills will be provided by Makerere University.
  • The funding support will cover tuition and a competitive monthly stipend for 4 years, scientific conferences fees/travel and other research-related costs.

Prospective candidates must:

  • Hold Master’s of Medicine in Paediatrics and Child Health from a recognized university, and licensed to practice medicine in Uganda by the UMDPC.
  • Possess undergraduate training in Medicine and Surgery (MBChB/MBBS/MD).
  • Willingness to fully commit time and effort to their PhD studies, expected to start immediately
  • Candidate should not hold other/concurrent fellowships
  • Having publication experience will be an added advantage.
  • Be highly motivated and willing to commit to a career in research and academia.

Application procedure:

Interested applicants should submit their application and supportive documents – listed here below, in one PDF document, in an email titled “PDMC-SAM–PhD Fellowship Application” to hr@globalhealthuganda.org [and cc – chdc.desk@mak.ac.ug] by 25th July 2025. The documents should include the following:

  • An application letter (Max. 1 page)
  • Motivation statement (Max. 500 words)
  • CV (Max. 2 pages), including a list of publications
  • Two (2) recommendation letters
  • Academic transcripts and certificates for all university qualifications
  • A synopsis focusing on the proposed PhD research work, describing briefly what is already known/burden, challenges, the gaps and potential interventions (include references) [Max. 800 words].

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