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Tackling population key to fighting poverty

By Stephen Kafeero

The health of mothers and children is integral to sustainable development

On June 28, 2013 UN Secretary-General Ban Ki-moon presented the prestigious 2013 UN Population Award, which included a Diploma, Medal, and cash prize to Dr. Jotham Musinguzi at UN Headquarters in New York. Dr Musinguzi spoke to The Independent’s Stephen Kafeero about that and other population issues.

Now that your efforts have been recognised by the UN, what plans do you have for the future?

Well, it reminds me of the challenges that remain, that we advocates must do more; our work is not done. The award just tells me that we are still out there in the woods and our work is cut out for us.

You pledged to donate the monetary proceeds of your award towards fighting Obstetric Fistula. How do you plan to do this?

The monetary prize is going to go to an NGO in Uganda which will address comprehensively the prevention, treatment in terms of surgical intervention as well as making sure these cases involved are socially integrated. We want to make sure even after they have been repaired there is a mechanism to integrate them in society and an NGO which qualifies will get the donation.

You were quoted to have said that 200,000 young girls and women suffer from Obstetric Fistula yet only 1,300 cases get repaired each year in Uganda. Why is this so?

The problem of Obstetric fistula is a very big one not only in Uganda but also in other countries. It is a result of prolonged labor. When women especially young girls go in labor and the baby is too big to go through the normal pelvis and they last more than 20-24 hrs there, they develop a hole within the urinary system.

Even when they deliver the baby whether dead or alive-in most cases the baby dies, they develop continuous flow of urine without control.  These are young girls usually at their first birth and because they develop a nasty smell, their husbands leave them.

Even individual members of the family dissociate with or ostracize them. They suffer a lot physically and psychologically. In Uganda, there are 200,000 accumulated cases, with 1,900 new cases every year. Of these, only 1,300 cases are operated upon every year, leaving a huge backlog of unattended to cases.

It is very important that government and the civil society organisations make sure that there are doctors to prevent fistula from happening and when it does, doctors are able to repair it and they are socially rehabilitated. So far this has not been the case.

Reproductive health and family planning issues are not getting the attention that they deserve. What needs to be done?

Well reproductive health and family planning have some controversies, some people have issues and rightly so. When they use contraceptives, family planning, they get side effects. These things should not be completely disregarded. On the balance, family planning is very beneficial.

The idea is to educate people to know that some of these side effects are only temporary and others are minor. If people are given right choices to make, then we shall reduce on the myths, complications and the side effects so that we put the program on the right footing. Those are the type of things that we need to pay attention to.

You have keen interest in reproductive health, family planning, population and development. How do these relate in the context of Uganda.

The important thing is to relate reproductive health, family planning with the whole concept of sustainable development. If you have a rapidly growing population in a country where access to voluntary family planning is not universal then you have problems of reduction of poverty whether it is at an individual, household, family and even at the national level.

Linking the role of family planning, reproductive issues, the health of mothers and children is very integral to the whole concept of sustainable development for any nation.

How do you rate Uganda’s performance compared to other countries in Africa on Reproductive Health and Family Planning?

Uganda is among those that are in the middle. For the last five years, we are seeing some improvement; in particular since last year when the President made commitment to focus more on voluntary family planning for birth spacing and to make sure that the rights of women are exercised. There is more investment from both the government and the donors. Uganda is starting to do well but for a very long time we were a bit in a limbo.

It is said that information on family planning is elusive?

As you can imagine, Uganda’s health services are mainly concentrated in the urban rather than in rural areas and most of our population, more than 80% live in rural areas, the majority of the population don’t get information and services. This is a major problem. For family planning, you need good levels of education, so we hope as time goes the benefits of UPE and secondary education will trickle in.

You played a part at the London summit where Uganda made commitments on Family planning. What is your assessment of the performance of the country so far?

The London summit on family planning which took place one year ago was a huge success. Political leaders made commitments and pledges on behalf of their countries. Similarly the donors made pledges which we hope they’re going to make good of.

Uganda committed to provide more funds and this has been captured in the current budget. Uganda also promised that the donors would be persuaded to provide more money and this has also been done, the policies are changing for the better in terms of reproductive health.  Uganda is scoring quite well on this.

Many people need quality reproductive health services. What can be done to ensure that they get them?

First of all, everybody providing reproductive health services; whether its government or NGOs, needs to improve on quality. We don’t have good friendly youth services; most of the services are urban based instead of focusing on rural areas where most of our people are based.

We are hoping that the ministry of health will obviously continue to play the leadership role to ensure that they’re guiding the NGOs and make sure government services themselves improve. They should ensure that there is enough method mix i.e. if a woman wants to choose whatever method, they should let them choose voluntarily but they also need to make sure that the services are timely, the personnel are there when the people need them.

What is the danger in Ugandans producing too many children?

High fertility is very challenging for a relatively small economy like Uganda. A very high population strains the provision of services whether education, health, agriculture and adequate food security. It is good for the population to grow but if it grows at a very fast rate, it challenges every effort to reduce poverty. You have a youth bulge and if they don’t have employment, skills and good education, it becomes a challenge.

What are the opportunities?

The opportunities are conditional. For example, you can’t assume that a rising cohort of young people is going to be beneficial to the country unless they are educated, have skills, are healthy and also there are opportunities for them to engage in gainful employment.

As a person involved in population studies, what are the likely impacts of Uganda not carrying out a population census?

Without a population census, you cannot effectively plan for the country. I note that the Minister in charge of Planning, Hon. Kasaija made a statement to parliament and before the nation that the census will be carried out in 2014. Censuses are traditionally carried out every 10 years but for Uganda we are already late by about three years. Since government has promised to do that next year we are very happy.

Besides work, how do you spend your time?

Well, I spend much of my time reading, I read novels and I pay a lot of attention to news. I am an avid viewer of television to compare notes on what is happening elsewhere. Currently am reading `Silent Springs’ by Rachel Carson. It’s the story of the use of DDT in the fight against Malaria. Incredible story.

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