At 29, Rose Naigaga has already lived what feels like several lifetimes of responsibility. She is raising seven children in a small home in Bulalu Village, Bukooma Sub-county, in Luuka District, and every day is a quiet struggle to keep her family fed, clothed, and sheltered. She never planned to be here. She dropped out of school in Senior Two after an unintended pregnancy, and that single moment changed the course of her life. Looking back, she says she would have preferred to have fewer children, but fear has kept her from doing anything about it. She has heard the warnings from neighbours, relatives, and even other women: that contraceptives cause prolonged bleeding, that they make you sick, that once you start using them, you will never conceive again. “I fear family planning. People say once you start on it, you will never conceive again,” she says. Neither Rose nor her husband has proper employment. They depend on casual work, digging for other people’s gardens, to pay rent and put food on the table. Every coin is stretched thin, and there is little left over for school fees or emergencies. Her story is not unique. Across Busoga, countless women and adolescent girls are caught in the same painful cycle: limited access to family planning, widespread misinformation, fear of side effects, and pressure from partners and communities. The result is repeated unintended pregnancies, girls dropping out of school, poorly spaced births, deepening poverty, and sometimes dangerous, unsafe abortions. Rose’s life, shaped by a pregnancy she did not choose and a fear she cannot escape, reflects the hidden suffering of many women who want to plan their families but do not know how, or are too afraid to try.
A few compounds away, Ruth Elida carries a similar weight. At 32, she has seven children, the youngest just one month old and the oldest thirteen. Her husband, Benard Muwanguzi, opposes family planning because he wants more children, even though the family is already struggling to meet basic needs. Ruth once used Sayana Press, a three-month injectable contraceptive, secretly for three months, because she was terrified of her husband’s reaction. She hid the method, used it in silence, and lived with the anxiety of being discovered. But repeated pregnancies have taken a heavy toll on her body. She now suffers from leg swelling and chronic venous insufficiency, a painful condition in which damaged veins struggle to return blood to the heart. Her health has become a casualty of a decision that was never truly hers to make in the open. Ruth’s story illustrates a painful truth: for many women in Busoga, even the most basic reproductive choices are not choices at all. When men refuse to discuss how many children to have, reject male contraceptives, or dismiss their wives’ concerns, women are left to bear the burden alone, sometimes in secret, sometimes at the cost of their own bodies. It is a quiet form of suffering, hidden behind the walls of homes where the husband’s word often carries more weight than a woman’s health. No woman should have to hide birth control from the person sharing her bed, but too many do, because the fear of conflict, abandonment, or violence is greater than the fear of another pregnancy.
Even when women are ready and willing to use family planning, the health system itself is not always ready for them. Uganda offers a range of contraceptive options, including condoms, pills, injectables, implants, intrauterine devices, natural methods, and permanent procedures. But availability on paper does not mean access in practice. Many women face long distances to health facilities, high transport costs, stock-outs, and negative attitudes from health workers. Dr Ismail Wangubo, a medical officer at Mayuge Health Centre IV, admits that the facility sometimes runs out of contraceptives, especially short-term methods that are in high demand. To avoid interrupting services, health workers sometimes borrow supplies from neighbouring facilities, a temporary patch that cannot solve the underlying problem. He also points to a deeper issue: limited knowledge about menstruation, ovulation, and fertile periods. Many women, particularly adolescent girls, do not fully understand their own bodies, and this ignorance leads to unintended pregnancies. Sofia Kyakuwaire, in charge of Bwalula Health Centre IV in Mayuge District, sees this every day. She says misconceptions, especially among older women, discourage family planning uptake. Some women fear hormonal methods because they believe they cause prolonged bleeding; others think contraceptives and intrauterine devices cause cancer or permanent infertility. She estimates that three out of every ten women in her area do not use contraceptives because of these fears. “Some women experience prolonged bleeding after using hormonal methods and many believe that contraceptives cause cancer. But most side effects can be managed,” she explains. Poverty makes everything worse. Some teenage girls become trapped in transactional sex with older men, exchanging their bodies for money or basic needs, and their age and financial dependence make it impossible to negotiate condom use. They are not careless; they are desperate. The solution, as health workers repeatedly say, is more accurate information, stronger reproductive health education in schools, and open conversations on radio so that women can learn the truth about their bodies and the methods available to them.
Male involvement, or the lack of it, remains a quiet crisis. Esther Nantambi, a senior midwife at Bugaya Health Centre IV in Buyende District, says resistance from men is one of the biggest barriers to family planning. Although more women, especially in rural areas, are embracing contraceptives, many men still expect their wives to handle pregnancy prevention while refusing to take any responsibility themselves. They do not want to talk about the number of children a family should have, they do not want to discuss which contraceptive to use, and they are not willing to consider methods meant for men. This one-sided burden falls heavily on women, who must choose between obeying their husbands and protecting their own health. Dr Pontian Kiwanuka Kavuma, the head of obstetrics and gynaecology at Iganga General Hospital, sees the consequences every day. Some families have eight or ten children and cannot feed them or provide their basic needs. He describes how some pregnant women, fearing another child they cannot support, resort to unsafe abortions. They use local herbs or dangerous methods to end unintended pregnancies, and by the time they reach the hospital, they are bleeding heavily and need emergency evacuation and blood transfusions. The 2024/2025 Maternal and Perinatal Death Surveillance and Response Report confirms this tragedy: abortion-related complications account for seven percent of maternal deaths in Busoga, compared with four percent nationally. Dr Kavuma also notes that stigma and negative attitudes from health workers push adolescent girls away from seeking contraceptives. Some girls avoid health facilities altogether because they are afraid of being judged, and some health workers, instead of offering support, discourage them from using family planning. Ms Hajarah Namugoya, a midwife at Bukoova Health Centre III in Luuka District, once attended to a 38-year-old woman with eight children who could not even afford clothes for her newborn. That image, a mother exhausted after eight births, unable to wrap her new baby in something clean and warm, captures the true cost of denying women the power to plan their families. It is not simply about contraception; it is about survival, dignity, and the basic right to decide how many children one can care for.
At Bulalu Health Centre III, midwife Alice Suubi describes a familiar pattern: women arrive with hope, only to leave empty-handed. The facility mainly stocks Sayana Press, a three-month injectable contraceptive, while implants and oral pills are sometimes unavailable. When a woman has made up her mind, travelled to the facility, waited in line, and then discovers that her preferred method is not there, she goes back home with nothing. “Different women want different family planning methods. When she comes and her preferred method is not available, she will go back,” Ms Suubi says. Some supplies that had run out have since been received, but the uncertainty remains. The human cost is visible in the numbers. Last week alone, the facility received six women and teenage girls who had attempted to end pregnancies, and they were referred to Kiyunga Health Centre IV for further management. Some of these girls turned to abortion after their boyfriends rejected responsibility for the pregnancy. Married women, too, secretly seek contraceptives because their husbands oppose family planning, while others avoid implants because they are afraid their partners will notice the small device under their skin. The scale of the problem across Busoga is staggering. According to the Busoga Joint Health Sector Performance Review Report for 2025/2026, released in Jinja in September this year, 27,528 births were registered among adolescents aged 15 to 19, and 1,275 deliveries were among girls below 15. About 419 girls below 15 attended antenatal care. Teenage childbearing in Busoga stands at 28.4 percent, far above the national average of 23.5 percent. Behind every one of these statistics is a young girl whose education was interrupted, whose body was not ready, whose dreams were pushed aside. These are not distant figures; they are daughters, sisters, and students who deserved better information, better access, and better support.
At the heart of this crisis is a question of rights. Faith Nabunya, a communications officer at the Centre for Health, Human Rights and Development (Cehurd), argues that limited access to contraceptives increases unintended pregnancies, exposes women to health risks, and denies them the opportunity to make informed reproductive choices. She reminds us that the Ugandan government has a legal and moral obligation to protect women’s rights under the Constitution, including the National Objectives and Directive Principles of State Policy and Article 33, which specifically provides for women’s rights. That responsibility, she says, should be reflected in adequate funding, reliable contraceptive supplies, trained health workers, and affordable, quality family planning services for all. She advises women and girls who are denied contraceptives or who face stigma when seeking services to report the matter to the officers in charge of health facilities, district health offices, or Cehurd for support. Health facilities experiencing stock-outs should refer clients to other facilities where the required methods are available. Women who face coercion or violence should seek protection from the authorities. But beyond these immediate steps, there must be a fundamental change in how society views family planning. It is not a tool for limiting women, but a means of freeing them. It is not a woman’s secret burden, but a shared responsibility between partners, communities, and the state. Rose Naigaga might have had a different life if she had known the truth about contraception, if a health worker had spoken to her kindly, if her community had supported rather than frightened her. Ruth Elida might not be living with damaged veins from repeated pregnancies if her husband had listened. And the countless teenage mothers in Busoga might still be in school, dreaming of careers and futures, if accurate information and services had reached them in time. The way forward is not complicated, but it requires political will, compassion, and a commitment to treat every woman’s reproductive health as a right worth protecting. In the end, family planning is not just about preventing pregnancy; it is about giving women the power to shape their own lives, to raise children they can care for, and to wake up each morning not afraid of what their bodies will be forced to endure.