Increase accessibility, acceptability and use of the IUD in Uganda

Uganda will be celebrating Safe Motherhood day on 17th October, with a call to action to improve women and girl child health. This is a step in the right direction.

Here at PACE, we know that providing quality maternal health services is key especially making IUDs accessible as a way to support women plan and space their birth.

Current status

According to the Uganda Demographic and Health Survey 2012, currently in Uganda only 0.5% of women of reproductive age are using Intrauterine Contrateceptive Devices (IUDs) as a modern family planning method. Given the above, Uganda has 45% of family planning unmet need meaning there is still need for family planning services in Uganda. There is on going deliberate effort to increase demand and supply of IUD and such efforts should not stop

While the IUD is a safe and cost-effective method, use is very low in Uganda, and the reasons for this are not well understood. But according to studies conducted by Ministry of health there are three main Three main barriers impede IUD and other modern family planning methods use in Uganda include   rumors and myths about the method; insufficient attention to the method during counseling sessions; and insufficient provider experience with it

IUD can be provided in primary health centers and posts at low cost, it can complement female sterilization and vasectomy to help women achieve their fertility goals, especially in rural areas. Other advantages include; immediately reversible, can be used during lactation and menopause, no adverse reaction to medication, including antiretroviral therapy, few side effects

Low IUD use can be explained by a number of factors having to do with the delivery of IUD services the demand for IUDs:

The Burden

Not enough of equipment and trained staff to provide the services. In Uganda for example, public health centers have both the basic equipment and at least one trained staff member to provide IUDs. Although few providers have negative perceptions of the method, they seemed to lack confidence in their skills to deliver the method, suggesting the need for more extensive training to maintain competency among those who have been trained.

There is insufficient knowledge among providers. In Uganda about half of health care providers did not recognize that IUD use was contraindicated in the presence of sexually transmitted infections (STIs), and about one-fourth did not know the IUD’s effective duration.

There is insufficient information to given to simulate potential clients, for instance some providers mention little about IUDs during the counselling sessions.  There are also some Policy and programmatic barriers. Most times only doctors and nurses are allowed to provide IUD services, but other health providers if trained can bridge this gap.

 Large proportions of women in Uganda are unaware of the IUD; those who are aware have few factual knowledge about the advantages, disadvantages, side effects, sources of supply, and cost of IUD services. Further, a large proportion of women have heard negative rumors or hold inaccurate beliefs about the method. Some providers have come a cross cases where clients after insertion of the IUD come back for removal because they found out the client is pregnant. Thus providers tend not to use market this method. Most clinics like profam sites probe clients to rule out pregnancies before they insert the IUD.

There is need to  improve providers’ capacity to provide IUD services, training providers, increasing clients’ demand for IUDs, and identifying opportune times to offer IUDs.

IUD contribution to a women’s Health

The IUD is a safe, effective, and cost-effective method, but it is also one of the least well-known methods among both providers and potential clients. Thus to  increase use of the IUD, programs need to train providers appropriately both in counselling, contraception and conduct outreach activities to increase knowledge of the method among potential users.

 Also training providers’ onsite to provide IUD services is key in areas with low IUD Use, the IUD as a contraceptive option should be introduced to patients before they are discharged from the hospital after delivery. It helps address an unmet need here.

 In Uganda one can access family planning services include IUDs in a public health facility like health centers or private facility like profam clinics



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