For most women in America, picking up birth control is as simple as swinging by the pharmacy. Yet this seemingly simple, run-of-the mill errand is not so simple in dozens of countries around the world. Globally, 225 million girls and women want to prevent or delay their next pregnancy but face barriers accessing birth control. These barriers include lack of access; living too far from the nearest clinic; for many, arriving and finding the contraceptives they need are not available or too expensive; opposition, often from family members; fear of side effects; and other reasons.
However, there is good news. Across the world, health workers are changing the game and helping women and girls to access the health care they want. Community health workers usually come from the communities in which they work, and so are trusted, and provide basic health care that requires less training and can be given outside a hospital or clinic.
I recently returned from a trip to Uganda, a country where 1 in 3 women face difficulties accessing family planning, and I saw first-hand the power community health workers have to transform the lives of girls and women. One community health worker I had the privilege of meeting, Jackqueline, shared her story and passion for improving the lives of the girls and women in her village.
Jackqueline Bwire Nabwire – “When I talk to the fellow women, I am moved to serve them, and that’s why I decided to do this kind of work.”
Jackqueline grew up in Sibona, a small village on Uganda’s border with Kenya, in a small hut with no electricity or running water, along with her five siblings. Her parents were smallholder farmers, and Jackqueline dropped out of school in 8th grade when her father passed away and her mother was unable to afford school fees for her and sisters. “Growing up, the priority was given to the boys … so my younger brother was educated, but they did not really care about the girl children,” Jackqueline explained. “I feel bad about that, because I really wanted to go to school, but I couldn’t go.”
With little education and limited employment options available to women in rural Uganda, Jackqueline followed in her mother’s footsteps. She married, had seven children, and works as a farmer in a village not far from the one where she grew up.
As her family grew larger, Jackqueline began to worry about growing enough food to feed her children and earning enough to send them to school: “I saw that the children were becoming more and I could not afford to take care of them.” This is when she decided to start using birth control, saying, “I think family planning is important because right now we do not have enough food in our gardens; we’ve had a very long dry spell … So family planning helps us to plan for the children to have a number that we can feed, a number that we can clothe, a number that we can comfort well.”
She didn’t stop there. Jackqueline was so moved by the importance of family planning to the lives of the women in her village, she decided to become trained by USAID-supported organization, FHI360, as a village heath worker. “I really feel it in my heart I should work for this community. When I am talking to the fellow women, I am moved to serve them, and that’s why I decided to do this kind of work,” she says.
Now Jackqueline distributes a whole range of contraceptive options from pills to three-month injections, while referring for long-term methods like IUDs, to women in her village. Some women were walking two hours roundtrip to reach a clinic to receive family planning, only to arrive to empty shelves, Jackqueline explained. Now she brings it right to their front doors.
I traveled with Jackqueline on a few of her home visits to meet the women in her village and learn how she has impacted their lives.
Immaculate – “Sometimes you would go [to the clinic] and there were many people, and you would have to wait. … Once I went and there were no [contraceptive] commodities.”
Immaculate lives a short walk from Jackqueline who she sees not only as a trusted neighbor, but also as the critical provider of her contraceptives.
Immaculate grew up with seven siblings. When she got pregnant at 15, her father, a small-scale fish trader, stopped paying school fees for Immaculate and her sisters, instead investing in the education of his sons. “My father had very many children, so he could not afford to take care of all of us. … I felt bad about it. I was really angry. … I loved to study and wanted to be a nurse,” said Immaculate.
Unable to finish school and pursue her dream, Immaculate followed her mother’s path and began making a local brew she sells for a small fee. Still, she and her husband, who works as a farmer, struggle to afford school for their five children. “Right now my biggest challenge is having my children educated. I am worried about my capability to pay for school fees,” she said.
Immaculate shared that she does not want to have any more children and is grateful to Jackqueline, who comes to her home every three months to provide her with Depo Provera, a three-month contraceptive injection.
Before she began receiving services from Jackqueline, Immaculate faced challenges accessing contraception. “Sometimes you would go [to the clinic] and there were many people, and you would have to wait. … Once I went and there were no [contraceptive] commodities,” she explained. “I honestly would have at least 15 children by now if I didn’t use family planning.”
She stressed that she wants her children’s lives to be different from hers, saying, “I would love to have my children go to school and become educated, as compared to how I was.”
Caroline Ouma – “If it hadn’t been for family planning, by now I would have 10 kids.”
A ten-minute walk from Immaculate ’s home down a red, dirt road, I met Caroline Ouma. “The reason why I did not go to school, the reason I did not have my dream of being a doctor, is I got pregnant when I was young. I don’t want you to mess up the way I did.” This is the advice Caroline gives to her oldest daughter and the reason she now uses a contraceptive injection delivered every three months by her neighbor and village health worker, Jackqueline.
Caroline earns an income running a small business that sells cooking oil, wheat flour, and homemade baked goods. She and her husband are also farmers. They have four children and do not plan to have more, saying, “life is hard.” Caroline began using family planning because, as she explains, “I want [my children] to study hard so they can have a good life. That’s why I spaced [my children], so I can earn some money and so they can go to school.”
Without access to the contraception Jackqueline provides, Caroline says, “By now I would have 10 kids … With 10 kids I wouldn’t be able to manage them. I want them to dress well. I want them to go to school. I want them to eat well …. I really want them to have a good life.”
Jackqueline’s life and the lives of the women and girls in her village are being transformed thanks to the training she received from a U.S.-funded NGO and contraceptives provided by the UN Population Fund. U.S. funding is vital in Uganda, where the U.S. provides almost $14 million for family planning, the backbone of Uganda’s reproductive health budget.
Despite these critical investments, demand is still outstripping supply in Uganda, where 1 in 3 women have an unmet need for family planning. Countries like Uganda have long relied on donor countries to cover the cost of contraceptives, but today the world is facing a contraceptive crisis, with a funding gap of at least $847 million.
The international community, with the U.S. in the lead, should increase its support for international family planning programs in Uganda and other countries to ensure Jackqueline, Immaculate, Caroline, and every woman around the world can choose when, whether, and how many children she has.
- Learn More + Take Action: To learn more about the global contraceptive crisis and find out how you can take action, visit this Thunderclap from UNFPA.
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- Hear from More Women: Read more stories from girls, women, and young people from around the world on the Universal Access Project’s Global Voices for Family Planning.