Health
Research Links Social Support to Improved Contraceptive Decision-Making for Women
Published
10 months agoon

Researchers at Makerere University School of Public Health (MakSPH) are urging the Ugandan government to boost healthcare funding to enhance reproductive health services. Dr. Dinah Amongin, an obstetrics and gynecology expert at MakSPH, has expressed concern about the lack of access to family planning methods, which forces women to use less preferred options due to unavailability.
Dr. Amongin notes that within just six months to a year of using contraception, some women encountered issues and switched methods. This highlights the need for the Ministry of Health to improve the availability of various contraceptive options. A rights-based approach to contraception ensures that women have access to a range of methods, preventing situations where desired options are unavailable at health facilities.

“Stockouts are a significant issue, and this extends to parliamentary discussions on health sector budgets. As we focus on human capital development and improving maternal and newborn health outcomes, we must consider crucial components like preventing unwanted pregnancies through family planning. The budget allocation for the health sector directly impacts this issue. When women cannot access their preferred contraceptive methods due to stockouts, it reflects a failure in our legislative and budgeting processes. This situation forces women to switch to fewer desirable methods, which is not acceptable,” says Dr. Amongin.
Adding that; “These are things we need to continue discussing as a country but we must invest into family planning. We can talk about human capital development but until we step up and actually support women to prevent unwanted pregnancies, support them in their decisions of whether she wants to use a method for contraception or not. That is her choice. We must make sure access to the methods of her choice is actually addressed.”

Dr. Amongin’s comments follow a recent study on the I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023. The study highlights that social support significantly improves women’s ability to make informed contraceptive choices, potentially leading to better reproductive health outcomes.
Part of the Innovations for Choice and Autonomy (ICAN) project, the study shows that self-injection with DMPA-SC (Sayana Press) could increase contraceptive use, especially among women with limited access to healthcare. Despite the rollout of this method in 2017, its use remains low in Uganda. Sayana Press as popularly known is a subcutaneous depot medroxyprogesterone acetate (DMPA-SC). It is a hormonal birth control shot, administered under the skin and is an all-in-one contraceptive that puts women in charge of their reproductive health.
Social support boosts self-efficacy, enhances privacy, and reduces access barriers, making self-management easier. Family planning helps manage the number and timing of children, lowering maternal and infant mortality rates and reducing complications from pregnancy. Conversely, unmet contraceptive needs can lead to unintended pregnancies and their associated risks.

In Uganda, 52% of pregnancies are unwanted or mistimed, with over 43% due to unmet family planning needs. The country’s youthful population complicates the issue, with 50% under 17 years old, at least according to the recent National Population Census. Notably, 10% of girls, one in every 10 girls you encounter, has already had sex before she turns 15 years, and 20% of boys, two in 10 boys have engaged in sexual intercourse by the same age.

Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness-based methods.
Global statistics show that 77.5% of women aged 15–49 had their family planning needs met with modern methods in 2022, up from 67% in 1990. In sub-Saharan Africa, the proportion of women who have their need for family planning satisfied with modern methods (SDG indicator 3.7.1) continues to be among the lowest in the world at 56 per cent. Nevertheless, it also increased faster than in any other region of the world, having more than doubled since 1990, when this proportion was only 24 per cent.
Among 1.9 billion women of reproductive age (15-49 years), an estimated 874 million women use a modern contraceptive method and 92 million, a traditional contraceptive method. The number of modern contraceptive users has nearly doubled worldwide since 1990 (from 467 million). Yet, there are still 164 million women who want to delay or avoid pregnancy and are not using any contraceptive method, and thus are considered to have an unmet need for family planning.

Slow progress is due to factors like limited method choices, restricted access, fear of side effects, cultural opposition, and gender-based barriers.
Between 2015 and 2019, there were 121 million unintended pregnancies annually worldwide – 48 per cent of all pregnancies. Despite decreases in the rate of unintended pregnancy in all regions over the past three decades, nearly one in 10 women in sub-Saharan Africa, Western Asia and Northern Africa, and Oceania (excluding Australia and New Zealand) continue to experience an unintended pregnancy every year

In Uganda, where healthcare services are stretched thin and women juggle numerous responsibilities, accessing contraceptives can be challenging.
Dr. Amongin emphasizes that self-injection methods like DMPA-SC, also known as Sayana Press could ease the burden on women facing long queues and logistical challenges at health facilities. “This method allows for discretion and reduces the need for frequent visits, which is crucial for women with busy lives,” she says.
Researchers argue that the health sector’s budget should include substantial funding for family planning. The high cost of inaction is evident: neglecting family planning leads to unplanned pregnancies, which ultimately burdens families and the nation. Addressing this issue early in the life cycle is crucial to prevent these long-term consequences.
“This is the gist of the matter behind all our research, that a woman’s preference needs to be respected. The health facilities must stock commodities so that when a woman is in need, she actually gets it,” noted Dr. Amongin.

Dr. Peter Waiswa, an Associate Professor at MakSPH, stresses the importance of informed choice in family planning. ICAN studies across Kenya, Malawi, Nigeria, and Uganda show that self-injection benefits all women, including young adolescents. “Supporting young people to make informed choices helps prevent unintended pregnancies,” says Prof. Waiswa.
“We spent four years trying to understand which women benefit from injecting themselves. And we found that all women benefit from it, including younger children. Because younger children in Uganda, whether we hide our heads in the sand or not, especially those 12 years and above are having sex and some of them using contraceptives,” Professor Waiswa says.

What is factually true is that by age 18, 60% of Ugandans have reported having sexual intercourse. Despite the benefits, dropout rates from family planning methods remain high due to side effects and lack of support. Dr. Waiswa also, a Public Health specialist, critique and dreamer for better health systems for mothers, newborns and children in Africa calls for better education and support to address these issues.
“As a way of being supported in a safe space whereby people are not asking questions, they are not fearing parents, they are not fearing other people, then they can use the methods. What we did in Mayuge and Oyam, we trained women who are users of family planning. To identify people who need to use family planning but are not currently using and then they go and see whether they can use or not. And we found that when people are supported, those groups which are currently not being reached can be reached by family planning,” argues Prof. Waiswa.

A 2021 study found that contraceptive discontinuation significantly impacts the effectiveness of family planning services, leading to higher fertility rates, unwanted pregnancies, and induced abortions.
Analysis of data from PMA 2020 show that 6.8% of women discontinued contraceptive use, with discontinuation linked to factors such as age, marital status, method type, and health concerns. The study suggests prioritizing interventions to encourage contraceptive use among young people and promoting partner involvement and awareness, as many contraceptive methods are not discreet.
Prof. Waiswa is concerned of the high dropout rate from family planning methods, where many women discontinue use due to side effects, a need for better education and support.
“We need to see how to educate women so that they are informed when they are choosing a method to use. They need to have enough information because when they discontinue, the method can be ineffective, can cause side effects, but also these methods are expensive, so they waste money. There are a lot of those who change to other methods. We are learning a lot on the use of family planning why we still have a large unmet need,” says Prof. Waiswa.

Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health, hailed the MakSPH study on self-injection contraception. She noted that the findings will help her enhance support for self-care initiatives. However, she expressed that only 29% of women willing to self-inject as indicated in the study is still low, highlighting a need to address barriers to increase acceptance as well as managing sexually active adolecents. “We must discuss how to handle minors seeking contraception to prevent unintended pregnancies,” she says.
On Friday August 23, 2024, the Daily Monitor reported, an increase in young girls adopting family planning to combat teenage pregnancies and school dropouts. Quoting data from the Uganda Health Information System, statistics show that between March 2023 and March 2024, 2,476 girls under 15 had their first antenatal care visit, and 1,755 gave birth. The highest number of pregnancies among this age group was in Oyam district.
In this period, Lango subregion saw 52 pregnancies among this age group, with Oyam district recording the highest at 10 cases. The 2021 UNFPA fact sheet indicates that Busoga region, particularly Kamuli and Mayuge districts, has the highest rates of teenage pregnancies, with 6,535 and 6,205 cases respectively.

“As the country, it’s clear that adolescents are limited to access to contraception because of so many reasons. For us as a Ministry, any woman between the age of 15 to 49 is a woman of reproductive age and that tells you that she is capable of getting pregnant and when such a girl of probably 15 years goes to a facility to seek for contraception, it rings a message that actually she is sexually active. So how do we handle her? So that is a matter of discussion for the country.
It is a matter that the nation needs to decide on, because we all know the girls are getting pregnant, the girls want to use contraception, but they have no access because of the fact that they are children,” wondered Achola.

Unintended pregnancies and Uganda’s abortion paradox
Abortion in Uganda, is largely illegal except in specific circumstances. It contributes to maternal death due to unsafe practices. Between 2010 and 2014, WHO reported that 30.6million abortions conducted were safe and 25.1million were unsafe. 97% of these occurred in developing countries. In East Africa, the total number of abortions per year according to the Lancet are around 2.65million.
The Ministry of Health’s HMIS data show a rise in abortion cases, with 96,620 reported between July 2020 and June 2021in both government and private health facilities.
Another recent study on the quality of post-abortion care by MakSPH researchers Assoc. Prof. Lynn Atuyambe, Dr. Justine Bukenya, Dr. Arthur Bagonza and Mr. Sam Etajak highlights the need for accurate post-abortion care data to improve healthcare planning and policymaking.
Dr. Arthur Bagonza, a Public Health Consultant and Research fellow with specialization in health systems at MakSPH and one of the uality of post-abortion care has called for accurate abortion data to improve healthcare planning and policymaking. He notes that health workers often avoid documenting abortion data due to legal fears and calls for reforms to restrictive laws to ensure accurate reporting without legal repercussions.
“All assessed health facilities reviewed in our study achieved a 100% timeliness rate for report submissions. However, significant disparities were observed in data accuracy between different levels of health facilities, with lower-level facilities (HC IIs and HC IIIs) showing higher rates of data discrepancies,” says Dr. Bagonza.

According to Dr. Amongin, the high incidence of early sexual activity among Uganda’s youth is a pressing public health issue.
“We know as a country many women continue to die following unsafe abortions; abortions for pregnancies that they did not want. And these abortions are highest among adolescents and also other women categories.
We would want to ensure that we actually enhance access to contraceptives, but making it easier for them to have it and putting the power in the hands of a woman to as much extent as we can. So that a woman can practice what we call self-care, but of course she also will need the support of the healthcare system. But we want this power in women’s hands because of all the challenges that the women actually can encounter in accessing these methods,” she said.
On her part, Achola insists that abortion should not be a last resort for women and urges them to abstain or use protective means in order to avoid unwanted pregnancies. She notes that as long as abortion remains illegal in Uganda, many health workers will avoid addressing it, leading people to unsafe alternatives.
“I can’t be happy because abortion means we have failed to give people a method of their choice to prevent that pregnancy. Or the people are not able to access contraception to prevent unintended pregnancies. Abortion is not the last resort, it’s not a solution because it has its own complications as well,” says Achola.

Despite this, Achola, notes most of the women who walk in health facilities with post-abortion complications must be attended to. “Whereas we don’t encourage people to do abortions, as Ministry of Health we are mandated to handle all complications for anyone who walks in our facilities because our priority is to save life. We want to urge women to avoid certain things. Why should you wait for unintended pregnancy to occur and then abort?”
Dr. Charles Olaro, a Senior Consultant Surgeon and the Director Health services – Curative in the Ministry of Health highlights the financial burden on individuals seeking health services and suggests exploring private sector opportunities and community-based approaches to improve access. “We need to balance values and rights while addressing access barriers,” he notes.
According to Dr. Olaro, the autonomy and agency of women in sexual and reproductive health, particularly in African cultures remain a challenge where social norms may require women to defer decisions to their partners.

He notes that there is a high burden of abortion and self-harm, with a significant portion of maternal mortality attributed to sepsis, which is often a result of unsafe abortions in Uganda.
“We still need evidence to ensure that access barriers are addressed. And this is a question I keep on asking Makerere University, yes, we have a young population but how are these people accessing contraceptives. Other issue we have to deal with is complex. I know we have to do a balance between values and rights, but we will be able to look at that when they gain the success to do it.”
Dr. Olaro points out that individuals often face a financial burden in health services, spending more on prescriptions than on the medications themselves. He suggests exploring private sector opportunities and a community-based approach to improve access to healthcare.
NB: The PMA surveys are spearheaded by Associate Professor Fredrick Makumbi and Dr. Simon Kibira of MakSPH, with support from the Uganda Bureau of Statistics and the Ministry of Health. The initiative also receives funding from the Bill & Melinda Gates Foundation, The Children’s Investment Fund Foundation (CIFF), and is supported by the Bill & Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University and Jhpiego.
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Health
Call for Abstracts: 2nd East African Symposium and Expo on Trauma, Injuries, and Emergency Care – 2025
Published
2 days agoon
June 19, 2025By
Mak Editor
The Makerere University School of Public Health (MakSPH) is excited to invite researchers, professionals, and students to be part of an inspiring and impactful event!
Venue: School of Public Health Auditorium, Makerere University Main Campus
Dates: August 7–8, 2025
Theme: “Understanding the burden and impact of injuries in East Africa to improve Emergency Care preparedness, mitigation, and response.”
Submit Your Abstracts Now!
Join the conversation that drives change in trauma and emergency care across East Africa. Share your research, innovations, and insights that can shape the future of healthcare response in our region.
Submission Deadline: July 10, 2025
Submit here: triadcommunications@musph.ac.ug
Register to Attend: https://aapug.org/east-african-symposium-and-expo-on-trauma-injury-disability-and-emergency-care-2025/
Together, let’s drive change and improve lives through research and collaboration. Don’t miss this opportunity to make a difference!
Health
Scholarship Opportunity: Impact of Food Supplementation
Published
5 days agoon
June 16, 2025By
Mak Editor
MAKERERE UNIVERSITY CHILD HEALTH AND DEVELOPMENT CENTER
PhD SCHOLARSHIP FELLOWSHIP TRAINING ADVERTISEMENT
Impact of Food Supplementation on Health, Growth, and Development for Stunted
Children
We are seeking to appoint a full-time PhD Fellow to conduct a randomized controlled clinical trial (RCT) among 300 young children with stunting to assess the effect of Soy Lipid-based Nutrient Supplement with high versus low levels of antinutrients on growth and health of children on a DANIDA-supported project entitled “Climate-resilient soybean for improved growth and health of children in Uganda” (Healthy Soy). The PhD fellow will coordinate the RCT protocol development and its implementation, develop and nest his/her PhD protocol as part-of the RCT study. The PhD student will be hosted at the Child Health and Development Center School of Medicine College of Health Sciences, Makerere University. The PhD student will take part in literature review; designing, planning and conducting of studies; analysing results; writing reports and contributing to technical and policy briefs, journal articles and thesis; project management; organizing research seminars and stakeholder workshops; and guiding junior researchers and teaching. The PhD student will have access to online libraries, scientific databases and software for data analysis throughout their work. In addition, the student will be mentored by national and international researchers to develop scientific research and project management skills with three months stay in Denmark. By the end of the project, the selected candidate will have obtained significant competencies to explain the interactions between nutrition and health of children, growth and development. In addition, the student will gain skills in assessment of body composition, development and conduct of clinical trials design, scholarly writing and presentations, data analysis and interdisciplinary research.
Prospective candidates must:
- Hold Masters in any of the following or equivalents: Human Nutrition, Dietetics, Public
Health Nutrition, Medicine in Paediatrics and Child Health, Public Health or - Epidemiology with undergraduate training in Medicine and Surgery (MBChB/MBBS/MD).
- Having publication experience will be an added advantage.
- Be highly motivated and interested in pursuing rigorous research
- Be committed to a long-term research career in Human Nutrition and Health
- Be of untainted integrity
- Be able to use different software for data analysis and graphics.
Successful fellow will be expected to:
- Conduct high quality research leading to publications in high-impact journals (must be
ready to work towards publishing a minimum of one quality paper per year). - Contribute to research capacity building including training of undergraduate and M.Sc.
students in the host department. - The project will avail financial support to the successful PhD Fellow for 4 years. Funds
will cover: PhD tuition for 4 years; monthly stipend; research supplies and reagents;
conference participation and other research-related costs.
Interested applicants should send an application letter, motivation statement, two
recommendation letters, CV and academic transcripts and certificates for all university
qualifications in an email titled “PhD Fellowship Application – Healthy Soy Project” to
chdc.desk@mak.ac.ug by 26th June 20205.
Female candidates are strongly encouraged to apply. Only shortlisted applicants will be
contacted for interviews.

At a ceremony held on 30th May 2025, themed ‘They taught us without saying a word’, the Makerere University College of Health Sciences (MakCHS) commemorated the silent teacher which are the cadavers (bodies) used in anatomy classes for medical students. In addition to a commemoration service, the event was used to create awareness and sensitise the public about the the importance of whole body donation.
The chief guest at the commemoration was Professor Mukadasi Buyinza, Deputy Vice Chancellor – Academic Affairs representing the Vice Chancellor, Professor Barnabas Nawangwe. The event attended by MakCHS students, staff and alumni was organised by students under Anatomy Society of MakCHS supported by Department of Anatomy and MakCHS leadership.

Welcoming guests to the event, Waziwu Mordecai–final year student of medicine and surgery who serves as President of the Anatomy Society, MakCHS explained that the reason for the gathering is three-pronged: to commemorate the silent teachers who make a profound contribution to medical education; to instill knowledge, compassion, and professionalism in future healthcare providers; and call on the community to support this noble act through awareness, advocacy, or future donation. ‘May the memory of our silent teachers live on in every life we will one day save’, he said.
The Anatomy society was founded in 2013 with aim of students providing peer mentorship to fellow students in lower years, such mentorship sessions help students appreciate better the anatomy of the human body. The society has supported:enhanced learning and mentorship; promoted academic participation including internal and external quizzes; and fostered connections including strengthen relationships between students across classes and with alumni.

Professor Elisa Mwaka, Head – Department of Human Anatomy welcomed all present for attending the ceremony. He thanked the College management led by the Principal, Professor Bruce Kirenga for the support provided in organizing the ceremony. He also expressed utmost appreciation to the Vice Chancellor for attending despite the competing priorities requiring his attention.
Professor Mwaka highlighted that we are here today, to pay our respect to the individuals whose bodies have been used for medical examination and research at MakCHS through offering prayers as well as sensitize people about willful/consented whole body donation.

Professor Mwaka explained that globally, sources of whole bodies for medical education and research are got through willed whole-body donation, unclaimed bodies in hospitals, imported bodies, executed persons among other means. In Uganda, unclaimed bodies in hospitals are used for medical as determined by the Uganda National Rules in the Penal Code Act of 1957.
In 2012 International Federation of Anatomy Associations (IFAA) recommended voluntary donation as the desirable and the only acceptable source for acquiring bodies. Almost all Africa countries and some European countries lack national body donation programs.

Speaking at the event, Professor Bruce Kirenga, Principal – MakCHS thanked Professor Mwaka for the insightful presentation. He welcomed Professor Buyinza to MakCHS and for accepting to attend despite the late invitation. He recognized the presence of the staff present and support towards the college activities.
Professor Kirenga underlined the importance of biomedical science under which human anatomy falls in medical education. ‘Biomedical sciences play a key role, once someone in grounded in the area, then he will be a good doctor’, he said.

The Principal also stressed that during his term of office operation efficiency will remain key ingredient for service delivery as well as rebuilding and rehabilitation of teaching and learning facilities. ‘Works to make the Biochemistry laboratory a model lab has commenced with a contract awarded to service provider; the refurbishment will be in phases’.
Professor Buyinza Mukadasi thanked the College, Human Anatomy department and the students for organizing the commemoration. ‘The amount of joy I have this morning, we should have done this a long time ago’, he said.

He expressed happiness at this commemoration for the silent teachers who unknowingly give so much to medical education and therefore mankind. He advised that community engagement to create awareness about the need for whole-body donation, regulatory compliance, and alignment to best practices.
He noted that disciplines like medicine is more like charity because medical practitioners give so much of themselves. ‘The number of people attending this ceremony is show of love for the discipline and commitment to the calling’ he said.

Professor Buyinza reiterated the commitment of Makerere University management to support MakCHS endeavours including this culture of commemorating the silent teacher. ‘Well-trained and season doctors are a result of the process explained here and the absence of bodies affects the quality of education provided and therefore the doctors produced’, he added.
Candles for the cadavers were lit and services representative of Anglican, Catholics and Muslims were conducted to remember the souls of the departed and wish them a peaceful rest. Ordinand Cosmas Ddembe for Anglican, Father Valentine Amuneke for Catholic and Dr. Haruna Kiryowa for Muslim preached the importance of respect for the dead and sacrifices of the dead for advancement of research and education in the medical field and health services.



Giving closing remarks, Professor Mwaka noted that setting up whole-body donation programs in Africa requires a holistic approach involving education, cultural sensitivity, legal structures, and partnerships with medical institutions.
Reasons why Africa has failed to establish body donation programs:
- Low awareness and willingness to donate bodies.
- Cultural and traditional beliefs
- Religious beliefs
- Fear of mishanding bodies
- Lack of legislation/ ambiguous regulations
- Lack of institutional policies and standard operating procedures
- Institutions should be encouraged to hold Services of thanksgiving or commemoration for those who have donated their bodies for medical education and research.

The following is required to change the current status:
- Cultural sensitivity and awareness
- Community engagement and awareness creation
- Educational campaigns
- Developing legal and ethical frameworks
- Building partnerships between hospitals and medical institutions
- Establishing local body donation systems i.e.,
- donation registration process,
- consent documentation,
- Logistical infrastructure necessary for the
- donation process.
- Effective communication, public trust,transparency.
- Training and professional development of healthcare providers.
- Global collaboration and funding: to share knowledge, best practices, and resources.
- Government support
- Funding and incentives
- Inclusion of body donation in national health strategies.


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