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Opinion: In Uganda, condoms hard to come by

Making contraceptives available to every woman who wants them would prevent about 53 million unintended pregnancies.

Uganda Red Cross worker hands out condoms
A Ugandan Red Cross volunteer distributes condoms in the northern town of Lira, Aug. 5, 2006. Sub-Saharan Africa has only one-eighth of the funding required to meet its demand for contraceptives. (Hudson Apunyo/Reuters)

KAMPALA, Uganda — In her one-room house in Kampala, Faridah Nalubega calculates what it costs to take care of a child. “School fees, meals, treatment, clothing …” Then, she multiplies by six.

“I’m still young, but I have many children …” she said. Faridah thinks about the fish she will have to sell. The money she will make. She worries if it will be enough. “The way they eat, there are many and the more they grow, the more they consume … And yet I earn very little.”

Faridah, 26, didn’t want it to be this way. She planned to have two or three children — a number she felt she could afford with the money from her small fried fish business. But when she tried to get a contraceptive injection to prevent additional pregnancies, local health workers told her they had only pills available.

Faridah couldn’t use pills. Her husband wouldn’t allow her to take them. She returned home empty-handed.

“I felt so bad because they couldn’t provide what I wanted,” she said. “And because I was provided a method I didn’t want, I ended up being pregnant. I didn’t want another baby.”

Faridah is one of an estimated 215 million women worldwide who want to space or prevent childbearing but lack access to modern contraception. In sub-Saharan Africa, where health facilities can be scarce and travel difficult, women tend to seek out longer-lasting methods such as intrauterine devices, injectables and implants — only to find too often they are not available.

The result is unintended pregnancies and bigger families. Faridah is not an anomaly. A Ugandan woman will give birth to an average of 6.7 children in her lifetime. Such large family sizes in developing countries are linked to poverty, poor nutrition, low education levels and even health dangers, as a woman’s risk of maternal death increases with each birth.

In the developed world, only one in 7,300 women die in pregnancy or childbirth. In sub-Saharan Africa, that rate is one in 22. Family planning is effective in reducing maternal mortality, but right now the region has just one-eighth of the funding required to meet its demand for contraceptives.