MSH Expands Family Planning with Integrated HIV and TB Services in Uganda

{Photo credit: MSH staff}Photo credit: MSH staff

The average Ugandan woman gives birth to 6.2 children—a national fertility rate that is among the five highest in sub-Saharan Africa—increasing the chances of complicated pregnancies and deliveries. If all unmet need for modern contraceptive methods in Uganda were satisfied, it is estimated that maternal mortality would drop by 40 percent, and unplanned births and induced abortions would decline by about 85 percent. 

Uganda’s population, estimated at 34.9 million in 2014, is one of the fastest growing in the world. But women are often reluctant to seek family planning services because of myths, misconceptions, spousal disapproval, or religious or cultural beliefs. Men have similar ideas that prevent them from supporting family planning. Therefore, community outreach and counseling women visiting health facilities are among the most effective means of education.

The Government of Uganda provides 44 percent of contraceptives to Ugandans, but most people first seek services in the private sector, largely because of bureaucracy, delays at public facilities, and a poor attitude among health workers. In addition, a lack of skills and equipment in the public sector limits long-term family planning opportunities, such as bilateral tubal ligation (BTL).

Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E), a US Agency for International Development (USAID) project funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR), supports health facilities and community outreach in its efforts to provide comprehensive and quality HIV and tuberculosis (TB) services. STAR-E (2009–2016), implemented by a Management Sciences for Health (MSH)-led consortium of international and Ugandan partners, provides technical and other assistance to 12 districts and 154 of their health facilities in Eastern Uganda.

STAR-E’s outreach and facility work includes family planning counseling linked to HIV and TB care through Positive Health, Dignity, and Prevention (PHPD) services, which involve supporting HIV-infected people to learn and practice how to live healthily and minimize the risks of spreading the virus to others. This includes preventing unwanted pregnancies among HIV-infected women, which STAR-E supports through Option B+, a test-and-treat strategy for pregnant and breastfeeding women. 

When mothers who visit antenatal clinics test positive for HIV, they receive family planning counseling so they can make informed decisions. In the meantime, the women are started on lifelong antiretroviral therapy and receive nutrition counseling, care for opportunistic infections, and care for the HIV-exposed infant.

Aisha Nantumbe benefited from family planning services while receiving counseling for HIV through STAR-E at Busolwe Hospital in Butalejja District. She used an intrauterine device (IUD) for two years before having it removed to conceive her last child—her fourth.

"The IUD worked well for me,” she said, holding her one-month-old baby. “I never got any complications and when I wanted to get pregnant again I came here for the doctors to remove it. This is my fourth baby."  

Now Nantumbe is planning to undergo bilateral tubal ligation (BTL) at Busolwe Hospital as a permanent method of family planning, deciding with her partner that it would be a stretch to care for more children.

Marie Stopes International, a global nonprofit that focuses on reproductive health, plays a major role in supporting family planning in the STAR-E-supported districts. With the support of Marie Stopes and STAR-E, the project-supported district health facilities achieved the following between 2013 and 2014:

  • First-time family planning users increased by 29 percent, from 27,845 to 35,822
  • First time HIV-infected family planning users increased by 14 percent, from 1,444 to 1,653

Family planning is also integrated with special outreach days, such as International Women’s Day and immunization days, along with HIV counseling and testing and cervical cancer screening services. STAR-E also supports family planning through training, mentoring, and coaching health workers; improving physical workspaces; donating equipment; and improving data collection.