To modernise, Uganda must start aggressively promoting and funding family planning services

When Sicola Nassuuna started living with her boyfriend, she had a dream, and a plan to secure this dream. She was 15, and in love. She believed that her husband would love her forever, and that if she gave him as many children as he wanted, he would love her even more. Despite counselling from a midwife at Mulago hospital’s ward 5B that she should use a family planning method to limit her births or space her children, Nassuuna stuck to her plan.

By 27, Nassuuna had seven children, a one-roomed rental in Katanga slum, in Kampala, no job and no husband. After the cost of looking after a big family shot up with each child, her lover ran off with another woman.

Now working as a tailor in a small shop in Katanga, Nassuuna says she waited for six years before falling in love again. By mid 2009, she had added her eighth child to Uganda’s estimated 33 million people. Yet her new relationship has no future.

“He cannot allow me to go (move into his house) with my children,” Nassuuna says of her new lover. “Where do I leave them?”

Nassuuna’s neighbour, Becca Katimbo, 45, knows all too well the problems that come with large families on meagre resources. When Katimbo’s parents died, they left behind 20 children, two houses and three wooden shacks on half an acre of land in Katanga. The boys, now men, insist the property belongs to them. The girls – married, divorced or single mums – often return home with children when they have nowhere else to go.

“Everyday they chase us from our home but where can we go? We just ignore them,” says Katimbo who shares one house with five families.

Yet it is not just Nassuuna or the Katimbo family. Experts warn that Uganda is sitting on a population time-bomb, producing many more children than we can cater for. On average, each Ugandan woman produces nearly seven children in her lifetime. If the population continues growing at 3.2%, Uganda will have 55 million people by 2025. That in itself is not a problem because any country would want young people to join the labour force; the problem, experts say, is that economic development will not match up. So, we are cruising into a future with a high quantity but poor quality population.

People will pour into urban centres with hope of finding a better life and the urban population is likely to reach 21.9 million. At current population growth projections, Uganda will require 4.3 million new urban housing units by 2037. The demand for land to accommodate the increase will reach 23 million hectares by 2025, yet Uganda’s geographical size remains 20.5 million hectares.

The situation with basic services is just as worrying. Although Uganda’s economy will grow at 8.4% this financial year, such impressive growth has not translated into development for people like Nassuuna or Katimbo. These are Ugandans who eat one meal a day, have to ration everything from water to costly toilet visits, and whose children’s schooling pinnacle is learning to read and write.

PIPE DREAM?

Although politicians like President Museveni want Uganda’s population to grow bigger, donors and experts are raising the red flag. Uganda, they say, needs a highly educated and productive labour force – not millions of unskilled people without money to buy goods and services.

While launching the National Development Plan recently, President Museveni spoke of his vision to transform Uganda from a peasant economy into a modern and prosperous society in 30 years. But available evidence suggests this will not happen if demographic issues continue to be ignored. A fast-growing population means slower improvements in health, education, agriculture, environment and urban development. Political intransigence on this matter is more puzzling when you consider that the richer people are having fewer children while the poor stretch village birth attendants and midwives.

Katimbo, too, would like her children to graduate from Makerere University. But she wishes she could afford better than Makerere Yellow Primary School, which is under the government’s tuition-free universal primary education. Today, the government can only afford to spend Shs 3,100 per UPE pupil per term, which is reflected in the poor performance in national exams.

UPE had about 7.5 million school pupils in 2007 and yet not enough teachers and classrooms to afford them quality education.

Population Secretariat figures show that UPE numbers will rise to 18.4 million pupils in 2037. Last financial year, the primary education budget stood at about Shs 451bn. By 2037, even before considering rising costs, this budget would rise to Shs 1.106 trillion.

But, according to the 2008 National Population Policy, if families had manageable numbers of children, the primary education budget would only rise slowly. This would free up hundreds of billions of shillings for enhancing teacher training, building more classrooms and improving the quality of education in government schools attended by majority of Uganda’s children.

In the health sector, the human resources situation is already critical, with only 51% of approved positions filled according to the 2009 National Health Policy.

For example, three years ago, Uganda had fewer than 8,000 nurses in service, which translated into one nurse for every 4,000 persons. This is below the national target of one nurse per 1,000 persons. Yet, if population growth remains unchecked, Uganda will need 88,800 nurses by 2037.

The country will also need 6,245 new health centres, to add to the existing 3,045 facilities. In the past, when Nassuuna went into labour, she had to wait in the corridors of Mulago hospital as labour progressed. Minutes after delivering, she moved to the floor, before being sent home hours later – so that other women could get in.

According to the Annual Health Sector Performance Report 2007–2008, only Shs 26,400 is budgeted for a Ugandan’s health every year. Not only is this amount too little, it is way off the policy’s target of reaching Shs 61,600 by 2007. So every time Nassuuna seeks treatment at Mulago, she has to pay for drugs.

PLAN FOR PROSPERITY

Nassuuna knows she could have ended up at least a little better off if she had planned her family better. So would millions of women and millions of children, if mothers could access, afford and embrace family planning methods.

According to the 2010 World Population Data Sheet by the Population Reference Bureau, only 24% of married women of reproductive age in Uganda use modern contraceptives. Yet 40% of those who want to space or stop having children don’t access them.

In keeping with its intransigence on population matters, the government contributes only 5% of the family planning budget, although even this fluctuates. For instance, in 2009 the government allocated Shs 1.5bn for contraceptives but only Shs 94m was actually released. The rest comes from donor agencies, which are frustrated with the government’s lack of commitment.

Dr Jotham Musinguzi, the Africa regional director of Partners in Population and Development, says Uganda will not achieve much unless it invests in the quality of its population.

Musinguzi, a former director of the Population Secretariat in the ministry of Finance, also knows that investing has to be accompanied by well planned families or else it will fail. To this end, President Museveni’s government should aggressively educate people about family planning and avail the services.

As Musinguzi says, the ideal situation is where parents have children “by choice not by chance.” That choice should be dictated by the capacity to properly feed, clothe and educate children, as well as give them good healthcare and employment. Otherwise for people like Nassuuna, Katimbo and their children, a prosperous modern Uganda will remain a pipe dream.

smwesigye@observer.ug