Uganda - Counting What Counts: Tracking Access to Emergency Contraception

Publication date: 2015

January 2015 Following a period of restrictions, national policies now support the use of emergency contraception (EC) in Uganda, and EC has been incorporated into national norms and guidelines, including the reproductive health commodity security plan. Although knowledge of EC in Uganda is higher than in many other African countries, more than two-thirds of Ugandan women have still never heard of EC, and EC use remains low. ABOUT UGANDA Uganda is a land-locked country in East Africa with a population of 34,758,809, of which 15.6% live in urban areas.1 While 21.2% of women have some secondary education, only 1.3% of women have completed secondary schooling.2 CONTRACEPTIVE KNOWLEDGE AND USE POLICIES Essential Drug List: Levonorgestrel (LNG) in the dose needed for emergency contraceptive use is included in Uganda’s 2012 Essential Medicines and Health Supplies list.3 National norms and guidelines: The 2009/10- 2013/14 Reproductive Health Commodity Security Strategic Plan states that EC pills (ECPs) are among the contraceptives for which the Ministry of Health is prioritizing procurement.4 The 2004 National Adolescent Health Policy lists reproductive health targets, including integrating EC into family planning programs targeting adolescents.5 The National Policy Guidelines and Service Standards for Reproductive Health Services (2001) include EC among the family planning services that should be available.6 Prescription status and who is authorized to dispense: EC is available by prescription only. It is available in public sector clinics, pharmacies and IPPF-affiliated systems. Post-rape care: A 2014 review of post-rape care policies in Sub-Saharan Africa found that the 2007 national guidelines for the management of sexual assault in Uganda include EC as an essential element of care.7 A 2009 study conducted by the Population Council and USAID surveyed nine health facilities that provided sexual violence exams (including national, regional, district and military hospitals and health centers) and found that 89% of them had ECPs available. While facilities in the north had access to the dedicated EC pill Postinor-2, health facilities in other parts of the country used the Yuzpe method (a higher dose of certain regular oral contraceptive pills).8 Country-wide restriction for five years: The Ugandan Ministry of Health first introduced EC in 1998. In 2001, to increase awareness of the method, it was re-introduced as a socially Ug an da UGANDA COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION KNOWLEDGE AND EVER USE OF MODERN CONTRACEPTION AND EC 0 20 40 60 80 100 ECAny Modern Method Knowledge (DHS 2011) Ever Use (DHS 2006) % o f A ll W om en Type of Contraception 98.1 38.1 30.7 0.3 • Total fertility rate: 6.2 children per woman (6.8 rural, 3.8 urban) • Unmet need for contraception (among currently married women): 34.3% • Current contraceptive modern method use (among all women): 20.7% Source: Demographic and Health Surveys, Uganda 2011 Ug an da 2 marketed product with the official support of health commissioners and leading gynecologists.9 However, there was some backlash and religious leaders requested the government to stop efforts promoting EC and to deem EC as an abortifacient.10 In response, the Solicitor General issued an interpretation in which it declared EC illegal under the laws restricting abortion.8 The restriction on ECPs went into effect in 2002 and ended approximately five years later, as pharmacies in Kampala began to carry the product again.9,10 PRODUCT AVAILABILITY Registered Products: Two Levonorgestrel- alone EC pill (ECP) products are registered and distributed: Postinor 2 (Gedeon Richter) and P2 (FamyCare).11 Locally manufactured products: None available. Poor quality or counterfeit EC products: The Ugandan National Drug Authority (NDA) warned consumers in 2011 that counterfeit versions of Postinor-2 have been identified in Uganda; however, it is not clear how extensive this problem is.12 WHERE WOMEN CAN ACCESS EC EC in the commercial sector: 45.4% of current contraceptive users obtain their methods from the private medical sector, primarily from private hospitals or clinics.2 The proportion of women using EC who obtain it in the private sector is not known. EC in the public sector: The government sector remains a major provider of contraceptives, providing contraception for nearly half of the users of modern contraceptive methods (46.6%). 28.6% of users obtain their contraception from government health centers and 14.2% of users obtain their contraception from government hospitals.2 The Ministry of Health has purchased EC for public sector distribution and its 2009/10- 2013/14 Reproductive Health Commodity Security Strategic Plan indicates that it is prioritizing ECP procurement.4 The proportion of women using EC who obtain it in the public sector is not known. EC in the NGO, social marketing and social franchising sectors: ECPs are available through the IPPF affiliate, Reproductive Health Uganda.13 Community-based distribution of EC: Village health teams are authorized to provide emergency contraception services.14 Providers and key opinion leaders: A 2007 study from Uganda found that the majority of health care providers surveyed knew about EC and generally had favorable impressions, but some lacked important knowledge of its use and available methods.15 MEDIA COVERAGE OF EC 74% of women listen to the radio at least once a week, and 20% of women watch television at least once a week.2 The Ugandan NGO, Straight Talk Foundation, provides education on sexual and reproductive health topics via newspaper inserts, radio shows, and other mechanisms and has included information on EC.16 DONOR SUPPORT Donors have purchased EC for Uganda’s family planning programs. According to RHInterchange, between 2006 and 2010, four shipments of EC were made to Uganda. Funding sources were IPPF, DFID, UNFPA and the Ugandan MoH.17 REFERENCES 1 CIA The World Factbook. Africa: Uganda. Retrieved 11 October 2013, from https://www.cia.gov/library/publications/the-world- factbook/geos/ug.html. 2 Demographic and Health Surveys, Uganda 2011. ICF International and Uganda Bureau of Statistics. August 2012. (http://www. measuredhs.com/pubs/pdf/FR264/FR264.pdf). 3 Republic of Uganda, Ministry of Health. Essential Medicines and Health Supplies List for Uganda. 2012. 4 Republic of Uganda, Ministry of Health. Reproductive Health Commodity Security Strategic Plan 2009/10-2013/14. 2008. (http:// www.unfpa.org/webdav/site/global/shared/procurement/10_supply_ chain/Uganda_RHCS_Strategic2009.pdf). 5 Republic of Uganda, Ministry of Health, Reproductive Health Division. National Adolescent Health Policy for Uganda. October 2004. (http://www.youth-policy.com/Policies/UGAyouthpol2004.pdf). 6 Republic of Uganda, Ministry of Health, Reproductive Health Division, Community Health Department. The National Policy Guidelines and Service Standards for Reproductive Health Services. May 2001. (http://www.youth-policy.com/Policies/Uganda%20 National%20Policy%20Guidelines%20and%20Service%20 Standards%20for%20Reproductive%20Health%20Services.pdf). 7 Thompson J, Undie C, Askew I. Access to Emergency Contraception and Safe Abortion Services for Survivors of Rape: A Review of Policies, Programmes and Country Experiences in Sub-Saharan Africa. Population Council. September 2014. (http://www. popcouncil.org/uploads/pdfs/2014STEPUP_EC-SA_Report.pdf). 8 Keesbury J, Elson L. Health Care Providers in Uganda and Rwanda are knowledgeable about sexual violence and HIV, but few are equipped to provide comprehensive services. (http://www.svri.org/ healthcareproviders.pdf). 9 Byamugisha J. Emergency Contraception among Young People in Uganda: User and Provider Perspectives. Thesis for doctoral degree, Makerere University and Karolinska Institutet. 2007. (http://diss.kib. ki.se/2007/978-91-7357-433-4/thesis.pdf). 10 Skuster P. Advocacy in Whispers: The Impact of the USAID Global Gag Rule Upon Free Speech and Free Association in the Context of Abortion Law Reform in Three East African Countries. Michigan Journal of Gender and Law. 2004; 11:97. 11 ICEC Status and Availability Database. Retrieved 11 October 2013, from http://www.cecinfo.org/country-by-country-information/status- availability-database/pills/postinor-2/. 12 Lirri, E. Drug authority warns of fake contraceptive pills. Daily Monitor. 1 April 2011. (http://www.monitor.co.ug/News/ National/-/688334/1136740/-/c3b95mz/-/index.html). 13 Reproductive Health Uganda. About RHU Projects. 2013. Retrieved 6 December 2013, from http://www.rhu.or.ug/index. php?option=com_content&view=article&id=70:projects&catid=3:abo ut&Itemid=56. 14 Republic of Uganda, Ministry of Health. Policy Guidelines and Service Delivery Standards for Community Based Provision of Injectable Contraception in Uganda. Addendum to Uganda National Policy Guidelines and Service Standards for Sexual and Reproductive Health. December 2010. (http://www.k4health.org/ sites/default/files/Uganda_CBD_Guidelines_signed_0.pdf). 15 Byamugisha JK, Mirembe FM, Faxelid E, Gemzell-Danielsson K. Knowledge, attitudes and prescribing pattern of emergency contraceptives by health care workers in Kampala, Uganda. Acta Obstetricia et Gynecologica Scandinavica, 2007;86(9):1111-6. 16 Marie Stopes International. Straight-talking radio spreads awareness in Uganda. 9 August 2013. (http://www.mariestopes.org/what-we- do/young-people/youth-radio-uganda). 17 RHInterchange. Uganda-Summary of Shipments. Retrieved 11 October 2013, from http://www.myaccessrh. org/rhi-home?p_p_id=rhiuserportlet_WAR_rhiportlet&p_p_ lifecycle=1&p_p_state=normal&p_p_mode=view&p_p_col_ id=column-1&p_p_col_count=1&_rhiuserportlet_WAR_rhiportlet__ spage=%2Fquantitysummary.do&_rhiuserportlet_WAR_rhiportlet__ sorig=%2Fshipmentsummary.do . This fact sheet has been prepared by the International Consortium for Emergency Contraception and represents the best information we have been able to gather. We welcome your input for future revisions. Please contact us at info@cecinfo.org. Visit our website at www.emergencycontraception.org for more information on EC. Uganda 3

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