Health
New study: 46% of Women in Uganda say they had unintended pregnancies in 2021
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.
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.
“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 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.”
By Okeya John and Primrose Nabankema
The intensive one-month course, running for the first time from June 5 to July 24, 2025, is jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC) at the School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa.
It seeks to equip healthcare providers at the community level, public health and environmental health practitioners, communication specialists, health educators, community development officers, social scientists, and policy makers, among others, with strategic communication skills to improve public health messaging, strengthen community engagement, and support evidence-based interventions, ultimately empowering participants to effectively engage communities and improve population health outcomes across Uganda and the region.
Launching the course, the heads of the Department of Journalism and Communication and the Department of Community Health and Behavioural Sciences noted that participants who complete the short course will gain practical tools to influence behaviour change, build trust, and deliver timely, accurate, and relevant health information to the communities they serve. The first cohort attracted more than 60 applicants, with 36 reporting for the opening in-person session on June 5, 2025, at MakSPH in Mulago. Between now and July, participants will undergo a hands-on, multidisciplinary learning experience within the Certificate in Health Communication and Community Engagement program, which combines theory and practice.
Among the participants in the first cohort of the certificate course, designed as a pilot for the anticipated Master of Health Promotion and Communication to be jointly offered by the two departments at Makerere University, is Ms. Maureen Kisaakye, a medical laboratory technologist specialising in microbiology and antimicrobial resistance (AMR), and currently pursuing a Master’s in Immunology and Clinical Microbiology at Makerere. She is driven by a passion to help reverse the rising tide of AMR, a growing global health threat where drugs that once worked are no longer effective. Kisaakye is particularly concerned about common infections, like urinary tract infections, becoming increasingly resistant and harder to treat.
“I enrolled in this course because I’m an advocate against antimicrobial resistance, and it came at a time when I needed to deepen my knowledge on how to implement our projects more effectively and engage with communities. The experience has broadened my understanding of AMR and its impact on society, and strengthened my passion for community-driven health initiatives and advocacy,” Kisaakye said, explaining why she enrolled for the short course.
Kisaakye’s work in antimicrobial resistance extends beyond the lab. Having earned her degree in medical laboratory science from Mbarara University of Science and Technology, she founded Impala Tech Research in 2024 to drive impact and save lives. She has led grassroots AMR campaigns that integrate antimicrobial stewardship with water, sanitation, and hygiene (WASH) education in underserved urban communities, including the informal settlements in Kampala. She also has since designed peer-led initiatives that empower university students as AMR Champions, building a network of informed youth advocates. Kisaakye believes the health communication course will sharpen her ability to design and deliver impactful, community-centred interventions in response to the growing threat of drug resistance.
“The department collaborates with many partners within and beyond the University, including the School of Public Health, where we are working to develop the subfield of health communication and promotion. Our goal is to train specialists in this area and build a community of practice, something we have each been doing in our own spaces. There’s a lot of work ahead, and COVID-19 showed us just how urgently we need a generation trained to do this kind of work, and to do it very well,” said Dr. Aisha Nakiwala, Head of the Department of Journalism and Communication, during the opening of the short course on June 5.
She assured participants they were in good hands and underscored the importance of the partnership between the Department of Journalism and Communication and the School of Public Health, describing it as a vital collaboration that brings together strategic communication and public health expertise. This dynamic, multidisciplinary approach, she noted, is essential to developing practical solutions that empower communities, strengthen health systems, and ultimately improve livelihoods.
The course offers a hands-on, multidisciplinary learning experience, with participants intended to explore key modules including Health Communication and Promotion, Risk Communication, Smart Advocacy, Community Mapping, Community Mobilisation and Empowerment, and Strategies for Community Engagement. The course combines theory with real-world application, and its assessment includes a field-based project and a final exam.
“You are our first cohort. We are seeing the fruits of our efforts in bringing this short course to life. It was born out of a joint initiative to develop a Master’s programme in Health Promotion and Communication,” said Dr. Christine Nalwadda, Head of the Department of Community Health and Behavioural Sciences. “We carried out extensive consultations with our different key stakeholders during the process and discovered a real need for such a course. It was the stakeholders who even named it; this course name didn’t come from us.”
For Kisaakye, by the end of the course in July, she hopes to have sharpened her skills in health promotion and strategic communication, particularly in crafting targeted messages that help individuals and communities effectively respond to threats such as antimicrobial resistance. She also aims to gain practical experience in designing, implementing, and evaluating community health initiatives that can strengthen her advocacy and drive lasting impact.
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