by Ine Collins
Myth, stigma, and taboo shroud family planning efforts in many villages. At Buwaiswa, one of Uganda Village Project's targeted Healthy Villages communities, the shroud was particularly opaque. As a field officer, I was assisting with family planning workshops, bringing nurses and contraceptives to women in remote villages that otherwise would have limited access to such services. Women gathered around outside the empty room where we sat with nurses, wanting the information and contraception, but scared of who might see them, especially their husbands. We’ve found that most husbands are against contraception, yet in most cases it is not acceptable for the wife to refuse sex. So, we position ourselves near wells so that women can pretend to fetch water, or make whatever excuse they need to make to leave the house. Others simply sneak out when the sun goes down. This issue is one of the major challenges that Uganda Village Project faces in its family planning program, and we are currently working on an awareness-raising program for men using respected village leaders to speak out on how family planning has helped them.
A tall, handsome young woman with high cheekbones, big eyes, even inky skin, and a cropped afro came into the room. Her youngest child, less than a year old, was wrapped to her back with a kitengi cloth. She was my age, with four children. Despite the women outside gossiping about whoever was trying to get birth control, the woman was one of four others in four hours who ventured in to see us. After weighing her options, she opted for Depo Provera, like most women, because of its inconspicuous nature. The nurse handed her a pregnancy test. Positive. She didn’t miss a beat, smiled gracefully, and left. I was floored by the composure with which she took the news. The average woman my age who has even experienced a false alarm for an unplanned pregnancy sees her life flashing before her eyes.
At Nabitovu, there was no room for us. We held the workshop under a tree, as we commonly must do when working in these remote areas. The village was more receptive to family planning, so everyone was enjoying their neighbors’ company, giggling at the condom demonstration. As things began to wind down, an 18 year old mustered up the courage to walk over. Most of the women who come to us are in their 20s/30s, and married with multiple children.
She had an older boyfriend in town. She had no idea whether they used condoms or not. “I never look,” she explained.
I was horrified for her. My first experience trying to get birth control in America is etched in the stone of my memory.The doctor stared expectantly over his spectacles, ready to record the personal details of my sex life. Sitting in a cold room smelling of rubbing alcohol, I squirmed in my examination gown, mortified. I managed one-word answers. I’d sooner suffer in silence than relive that experience while a group of my mother’s friends and neighbors sat nearby, watching, listening, and judging.
A woman at another village in her early thirties with nine children came to us seeking birth control. Pregnancy test = positive. Her face betrayed her devastation. She grew desperate. “I can’t have another child. I have to stop this pregnancy. Please help me stop it.“ Abortion is illegal in Uganda. Post-abortion care is widely, and legally publicized through clinics, yet clandestine abortion contributes to approximately one-third of Uganda’s maternal mortality. I wondered - with her limited options, what would this woman do?
Looking at that woman, I thought of my grandmother who gave birth to nine children in Nigeria. Though she is a devout Catholic who once studied to be a nun, I wondered if she had ever wanted contraceptives or if she actually intended to spend over 5 years of her life pregnant.
The week before I arrived, a woman in labor arrived at a hospital where she ended up waiting for hours, only to be referred to a different hospital. Before reaching the next hospital, she was hemorrhaging, as someone encouraged her to push while riding the boda boda, a motorcycle taxi. At the hospital, the fetal heartbeat was gone. Nevertheless, she had to deliver the baby. After seeing her dead child, she fainted and died shortly thereafter. And to think she was one of the few women who could actually afford to pay for the 2,000 shillings (~1 dollar) taxi to the hospital so that she didn’t have to deliver at home on a bare floor.
I often joke half-seriously that being a woman is the worst decision I’ve ever made. Not only is there the ubiquitous cultural and institutional discrimination, but also sex, the source of life, is disproportionately risky for women, and childbirth carries a very real risk of death, with a
lifetime risk of maternal mortality of 1 in 25. What’s more is that nothing I’ve said is really specific to Uganda. The stories would largely be the same, if not worse, if I were in rural Brazil, Nigeria, the Philippines, India, Afghanistan. Until access to healthcare improves across the world, it will remain dangerous to be a woman in these places.
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