Uganda’s Growing Maternity Burden Renews Call for Stronger Family Planning Services

With Uganda recording an estimated 1.6 million to 1.7 million deliveries annually, health officials are urging stronger family planning services to help women safely space pregnancies and ease pressure on maternity facilities.

Uganda's growing number of pregnancies and deliveries is renewing calls for stronger family planning services, as health experts warn that the country cannot address mounting pressure on maternity facilities without also helping women and families make informed decisions about when to have children and how far apart to space pregnancies.

An estimated 1.6 million to 1.7 million deliveries are being recorded in Uganda each year, placing considerable demands on antenatal, maternity and postnatal services. At Kawempe National Referral Hospital, one of the country's busiest maternity facilities, the volume of mothers passing through the hospital illustrates the scale of the challenge facing the health system.

For health officials, however, every maternity visit should be viewed not only as an opportunity to provide care for a mother and her newborn, but also as a chance to discuss her reproductive health needs after delivery.

Dr Richard Mugahi, Commissioner for Reproductive, Maternal, Newborn, Child and Adolescent Health at the Ministry of Health, has argued that family planning should be integrated into the wider package of maternal healthcare rather than treated as a separate service.

The principle is straightforward: a woman should receive care during pregnancy and childbirth, but she should also leave the health facility with access to accurate information and appropriate family planning options if she wants to delay or avoid another pregnancy.

Uganda has made progress in expanding access to reproductive health services, but a substantial proportion of women who want to prevent or delay pregnancy still lack access to an appropriate method. Estimates put the unmet need for family planning at about 22%, while more than two million unintended pregnancies are reported in the country.

The consequences extend beyond individual families. An unintended pregnancy can mean another demand for antenatal care, delivery and postnatal services in a health system already dealing with shortages of health workers, limited infrastructure and heavy workloads in major maternity facilities.

Family planning, therefore, is not simply a question of contraception. Pregnancy spacing can give a woman more time to recover physically between pregnancies and allow families to prepare for the financial and social responsibilities that come with raising children.

For the health system, it can also help reduce some of the pressures associated with closely spaced and unintended pregnancies, although family planning is only one part of the much broader effort required to improve maternal and newborn outcomes.

Kawempe National Referral Hospital offers a particularly important entry point. A woman who has just delivered is already in contact with trained health workers and can be counselled on postpartum family planning before she returns home.

Such counselling is most useful when it is based on informed choice rather than simply encouraging women to use contraception. Mothers need to understand the available methods, their benefits and possible side effects, and be given the freedom to choose whether and when to use them.

That also means ensuring that health facilities have adequate supplies and that health workers have the time and skills required to provide meaningful counselling.

A family planning programme can fail even when contraceptive methods are officially available if facilities experience stock-outs, women cannot access services easily or counselling is rushed because health workers are overwhelmed.

Privacy and informed consent are equally important. Decisions about pregnancy and contraception are deeply personal, and women should be able to make them without coercion or pressure from health workers, partners or other family members.

The renewed focus on family planning comes as Uganda grapples with the broader implications of its rapidly growing population. A large and youthful population can provide a significant economic opportunity if people are healthy, educated and able to participate productively in the economy. But rapid population growth also increases demand for schools, hospitals, housing, jobs and other public services.

This makes reproductive health an important part of population planning, but experts have repeatedly emphasised that family planning should be approached primarily through the rights and health needs of individuals and families rather than simply as a means of controlling population growth.

For Uganda's health system, the immediate opportunity is perhaps the most practical one: use every contact with women before, during and after pregnancy to ensure that they receive the information and services they need.

At a busy maternity facility such as Kawempe, where thousands of women interact with the health system, integrating postpartum family planning into routine maternal care could help turn a moment of intense contact with the health system into an opportunity for longer-term reproductive health support.

The challenge is ensuring that this happens consistently across the country, including in lower-level health centres where many women receive antenatal and maternity services.

As Uganda continues to grapple with a heavy maternity burden, strengthening family planning services will not by itself solve the country's maternal and newborn health challenges. But ensuring that women can make informed decisions about the timing and spacing of pregnancies could reduce some avoidable pressure on families and health facilities while giving mothers more control over their reproductive lives.

The question, therefore, is no longer simply whether Uganda can deliver enough babies safely. It is whether the health system can also give women the support they need to decide when the next pregnancy should happen.