Health
Research Links Social Support to Improved Contraceptive Decision-Making for Women
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.
On 27th November 2025 the Makerere University Infectious Diseases Institute (IDI) unveiled the second cohort of fellows—marking a significant step forward in strengthening global health security across the region. The cohort brings together five exceptional emerging scientists whose research areas reflect the continent’s most urgent health priorities. They include Mr. Dickson Aruhomukama in Antimicrobial Resistance (AMR); Dr. Rodgers Ayebare in Case Management, Infection Prevention and Control; Mr. Julius Okwir in Epidemic Intelligence and Community Health; Dr. Robert Zavuga in Vaccines and Medical Counter Measures; and Ms. Phionah Tushabe in Planetary Health, Water, Sanitation and Hygiene (WASH). Their selection marks a new chapter in nurturing homegrown expertise capable of safeguarding Africa’s health systems for generations to come.
The Acting Vice Chancellor, Prof. Sarah Ssali while presiding over the event emphasized the significance of launching the Sewankambo Training Program for Global Health Security as a milestone not only for IDI but for Makerere University and the continent at large. She highlighted the urgency of strengthening Africa’s capacity to predict, prevent, and respond to emerging epidemics, noting the rapid rise in zoonotic disease outbreaks and the persistent weaknesses exposed by crises like Ebola and COVID-19. She celebrated the legacy of Prof. Nelson Sewankambo and the scholars shaped by his leadership, stressing that the program embodies the university’s commitment to producing transformative health leaders grounded in multidisciplinary expertise and One Health principles.
She also called for stronger collaboration across colleges—particularly with the College of Veterinary Medicine, Animal Resources and Biosecurity (CoVAB)’s Center for Biosecurity and the College of Health Sciences (CHS) to ensure that scarce scientific resources are fully utilized and that future health professionals are prepared for an evolving global landscape. In closing, she reaffirmed Makerere University’s dedication to advancing research excellence, nurturing responsible stewardship, and upholding the values that define the Sewankambo legacy.
The Academic Registrar Prof. Buyinza Mukadasi also conveyed his heartfelt congratulations to IDI and Prof. Nelson Sewankambo upon this remarkable milestone. He reflected on his recent engagements with the Institute—most notably the launch of the African Centre of Excellence in Bioinformatics—and expressed his admiration for the world-class research emerging from IDI, including publications in leading journals such as The Lancet and Nature. He noted that Makerere takes great pride in IDI’s work across multiple initiatives, from THRiVE to ongoing research collaborations, and wished the newly launched fellows a rewarding and impactful journey in research.
The Deputy Principal CHS, Prof. Richard Idro congratulated the new cohort and welcomed them into what he fondly referred to as “the cookhouse,” where future scientific leaders are shaped. Drawing from his own formative encounters with Prof. Nelson Sewankambo, he reflected on the deep mentorship culture that has defined generations of clinicians and researchers at Makerere—sharing stories of being challenged, supported, and pushed toward excellence. He reminded the fellows that their research will influence health policy and clinical practice far beyond individual patients, carrying long-term implications for national and global health.
Prof. Idro also acknowledged the critical challenges facing clinical disciplines, especially the constraints of promotion pathways that disadvantage highly skilled specialists without PhDs. He appealed for reforms to safeguard the future of key fields like anesthesia and surgery. Closing his remarks, he celebrated the College’s 100-year legacy, expressed gratitude for the university’s continued support, and invited alumni and partners to contribute ideas that will shape the next century of innovation, training, and service.
Dr. Charles Olaro, the Director General of Health Services, highlighted the essential role of academia in strengthening Uganda’s global health security, noting how recent outbreaks—from COVID-19 to Ebola—have revealed both the country’s progress and remaining gaps. He emphasized that programs like the Sewankambo Training Program are vital for building resilient health systems, advancing research, and shaping policies that can respond swiftly and effectively to public health threats.
Reflecting on the strong collaboration between the Ministry of Health and institutions such as Makerere University and IDI, he pointed out how research emerging from academia continually informs national policy, including work presented at recent conferences on non-communicable diseases and community health. Dr. Olaro congratulated the new cohort, reminding them that their work carries significant responsibility, as their research and leadership will influence health outcomes far beyond individual clinical care. He also underscored the need for stronger regional capacity, improved emergency response systems, and sustained mentorship to ensure that communities across Uganda—and the region—benefit from timely, coordinated outbreak preparedness.
In his address, Prof. Nelson Sewankambo commended the achievements of the first cohort and challenged the new fellows to uphold—and even surpass—the high standards already set. Reflecting on the rigorous selection process, he reminded the cohort that they were chosen because they demonstrated exceptional promise in a highly competitive field. He noted that the launch of this program comes at a particularly critical moment, as Africa CDC has just established a new Division for Health Security and Sovereignty, even as global financing for health research continues to decline. This, he said, makes the commitment to sustaining the program both bold and necessary.
Prof. Sewankambo also addressed concerns about the future of clinical scholars at Makerere, arguing that rigid promotion policies risk driving away talented specialists who are vital to the university’s mission. Emphasizing that “it is wise people who change direction when it is necessary,” he urged university leadership to protect pathways that allow clinicians to grow, serve, and undertake PhDs without being pushed out of the system. His message underscored both the responsibility carried by the new fellows and the collective duty to safeguard the future of medical education and research.
Dr. Andrew Kambugu, Executive Director (ED) of IDI, warmly welcomed all guests and reflected on the Institute’s long-standing culture of adaptation and innovation in response to Africa’s evolving health challenges. He celebrated the presence of Prof. Nelson Sewankambo—honoring his legacy as a founder, mentor, and active research collaborator—and acknowledged the strength of Cohort One as a living example of what the program can produce.
The ED emphasized that the Sewankambo Program stands on three pillars: rigorous selection, structured support with clear accountability, and strong alignment with national health priorities. He reminded the new fellows that IDI itself was born from the principle “adapt or perish,” and urged them to carry forward that spirit as they confront emerging threats like antimicrobial resistance and disease outbreaks across the continent. He also reflected on the power of mentorship, sharing personal experiences that illustrated how deeply mentorship can shape a scientific career. In closing, he expressed confidence that the five new fellows will honor the name they bear and continue building a legacy that inspires future generations.
Prof. Harriet Mayanja-Kizza reminded the newly selected fellows that while this achievement is significant, it marks only the beginning of a demanding but deeply meaningful journey. She expressed pride in the diversity of the cohort—drawn from ten African countries—and noted with delight that one of the brightest candidates emerged from the smallest country represented.
Reflecting on the evolution of impactful careers, she encouraged young people to embrace emerging fields such as bioinformatics, biotechnology, AI, molecular biology, and biostatistics, which she believes will define the future of science and global health. Prof. Mayanja spoke passionately about the diseases the fellows will tackle, highlighting the severe threat of antimicrobial resistance, the persistent burden of malaria, the dangers of resurfacing viral infections, and the transformative power of immunization. She urged the fellows to stay grounded, stay committed, and embrace the modern, data-driven tools now shaping global health research. In closing, she celebrated their potential to make a global impact and welcomed them formally into a field where their work will shape healthier futures for generations to come.
Prof. Ponsiano Ochama, one of the pioneers from the first cohort, reflected on the journey of the Sewankambo clinical scholarship from its early days in the “cookhouse” to the strong, structured program it has become. He recounted how the scholarship began as a mentorship-driven initiative aimed at nurturing future researchers and how sustained advocacy eventually removed barriers that once limited clinical scholars’ progression.
Prof. Ochama shared the impactful work he and his colleagues have since undertaken—highlighting, for example, a national study on hepatitis B mother-to-child transmission that shaped recent Ministry of Health policy. He encouraged the incoming cohort to embrace the program fully, assuring them that the “cookhouse” experience will transform them into strong, skilled scientists whose work will influence health policy and improve lives across the country.
Dr. Byonanebye Dathan, Deputy Head of the Global Health Security Department, outlined the strong rationale behind the Sewankambo Global Health Security Program, noting Africa’s rising burden of zoonotic and viral hemorrhagic fevers and the continent’s limited capacity for early detection and response. He emphasized that despite competing health priorities—HIV, TB, malaria, maternal health—there remain significant gaps in surveillance systems, workforce capacity, and research preparedness.
The program, he said, is designed to fill these gaps by strengthening research training, developing a skilled outbreak response workforce, and building a network of experts across Africa capable of generating evidence that directly informs policy and improves health systems. Dr. Dathan highlighted the rigorous selection process, the program’s alignment with WHO and national public health frameworks, and its integration of emerging technologies such as AI and machine learning. He affirmed that the fellows will receive structured mentorship, leadership development, and hands-on experience using existing data and real-world outbreak response systems—ensuring that their work leads not only to publications, but to meaningful impact across the continent.
Dr. Francis Kakooza, Acting Head of Global Health Security, traced the remarkable evolution of IDI’s Global Health Security work over the past decade, from its early CDC-funded surveillance efforts in 2015 to its expansion into biosecurity, AMR, epidemic research, policy development, and regional outbreak support. He highlighted IDI’s role in major national initiatives—including COVID-19 response, vaccination rollouts, risk management, lab accreditation, and the establishment of Regional Emergency Operations Centers—as well as its growing continental footprint through partnerships with Africa CDC, Mastercard Foundation, and Resolve to Save Lives.
Dr. Kakooza emphasized that the launch of the Prof. Nelson Sewankambo Global Health Security PhD Program is the culmination of years of investment in strengthening African research capacity and supporting fellows whose work is already shaping policy. He expressed gratitude to all partners, mentors, and leaders who contributed to the program’s development, acknowledged the rigorous selection that yielded five fellows from ten countries, and reaffirmed IDI’s commitment to nurturing a new generation of scientists equipped to protect the continent from infectious disease threats.
-
General2 weeks agoMakerere University officially commences implementation of its Mentorship Policy
-
General5 days agoIn Honor of the Life and Legacy of Mr. Francis Seletze Ngabirano-A Steady Hand through the Storms
-
Engineering, Art & Tech6 days agoErasmus Exchange Prof.’s Mak Photo wins Poland National Prize
-
Health3 days agoIDI launches the Sewankambo Training Program for Global Health Security in Africa
-
Agriculture & Environment2 weeks agoStrengthening Capacity and Shaping Policy: Makerere University Reviews Progress of MERIT and Environmental Risk Research Programs