Sarah Arawo is aware of the problems of having more children. The mother of seven is HIV-positive and knows there is a risk of passing on the virus to a child (one of her children already has the virus), and because of the recent drought she and her husband, Francis Esweu, would struggle to feed any extra mouths.

Arawo, from Obiol village in Katine, north-east Uganda, wants to stop having children altogether, but she does not know how. She wants to find out more about family planning, but fears it could lead to conflict with her husband, whom she says is reluctant to use a condom when they have sex. At the same time, because of her condition, she fears she might experience complications if she takes another form of contraceptive.

Arawo is not alone. Limited access to family planning services, fears about side effects, opposition from partners and religious beliefs have led to Uganda having the highest unmet need for contraception in east Africa. And research indicates that this unmet need for family planning is highest among illiterate women like Arawo.

According to Dr Moses Muwonge, the national reproductive health commodity security coordinator at Uganda's Ministry of Health, 41% of women in Uganda have an unmet need for contraception. Rates in neighbouring countries Kenya and Tanzania stand at 25% and 22% respectively. Rwanda has a rate 38%, while Ethiopia's is 34%.

Rates keep increasing, but Muwonge says the ministry has not got enough resources to tackle the problem. The government will need up to US$25m to adequately meet the contraception needs of its population by 2015, he added.

"Uganda's contribution towards funding family planning is negligible. It is less than 5%. Unless donors increase funding, it might not be easy for the country to meet the unmet needs," Muwonge warned at a health workshop for journalists in Kampala last month, organised by the Uganda Health Communication Alliance (UHCA), with funding from the US-based Population Reference Bureau.

The conference was told that almost half of the country's one million births a year were unwanted.

Uganda's annual population growth rate is estimated to be 3.2%, according to the Uganda Bureau of Statistics. On average women give birth to seven children, which is already putting a strain on the country's resources.

The Ugandan government has published a road map to accelerate the reduction of maternal and neonatal mortality and morbidity over the next five years and part of that plan is to see the unmet need for family planning cut to 5% by 2015.

Presenting a paper, entitled Stopping stock-outs: What is Uganda doing to ensure a reliable supply of contraceptives, Muwonge said the government was over dependent on donor funding in this area and even the meagre resources allocated to finance family planning programmes was not always received by the ministry.

"We do not usually get the 100% allocation. Out of what is allocated to family planning, only 20% is actually delivered," he said.

But it's not just a question of finance. Some of the challenges affecting the low take up of contraception include poor adherence to contraceptive procurement schedules by donors and weak supply chains, especially at district levels, where contraceptives are procured by chance, Muwonge said.

Education also plays a part. Family planning services at government health centres are free, but at times health workers do not prioritise procurement of contraceptives because they believe there to be little demand for family planning services in their area. That low demand, however, could be because women are not aware of the available options.

Making changes

In Katine, the sub-county in which the African Medical and Research Foundation (Amref) is implementing a three-year development project funded by Guardian readers and Barclays, access to family planning has increased over the last year largely thanks to education.

According to Amref, since September 2008, the number of women accessing family planning services has increased from 1% to 4.3%, from 63 to 251 of the 5,909 women of child bearing age in the sub-county.

Village health teams have been trained by Amref on the advantages of family planning as a way of cutting infant and maternal mortality rates, and on the different methods available. They are now able to advise the community and are also helping to distribute condoms.

In August around 60 women and men attended a session on tubal ligation – female sterilisation - at Tiriri health centre in Katine, run by officials from the reproductive health NGO Marie Stopes.

But there is still a huge unmet need in the sub-county. Teddy Akello, the nursing officer in charge of antenatal services at Tiriri health centre, said there is a lack of skilled personnel to provide the services.

"Yes we have unmet need for contraceptives here - especially for permanent methods [female and male sterilisation], which result from the fact that there is no skilled personnel to provide that service," she said.

Instead the health centre is reliant on the contraceptives it orders from the national medical stores, which is limited to condoms, pills and injections. To help their clients get a wider choice, the health centre recommends them to Marie Stopes in the nearest town Soroti or Mbale.

Last month, 16 mothers received contraceptives from Tiriri. The most popular method was a course of injections.

Significantly, Akello said she had noticed an improvement in men's attitude towards family planning.