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(Created page with "{{setLocation |Country=Uganda |City=Gulu }} '''OVERVIEW''' ==Contraception (Birth Control)== '''General Note:''' There are many types of contraceptives, also known as "bir...") |
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'''OVERVIEW''' | '''OVERVIEW''' | ||
In Uganda, contraception can be purchased without a prescription. The rate of contraceptive use is not very high, though the rates have increased in the last two decades. If you want emergency contraception (the morning after pill), you typically don't need a prescription to purchase it in pharmacies (though, technically-speaking, it may be legally required). However, if you can't get a prescription, you can use regular oral contraceptives (birth control pills) as replacement emergency contraception. We explain how in the "Emergency Contraception (Morning After Pill)" section. You can get an HIV and STI test at health care centers throughout the city. There are some health organizations and NGOs that help people dealing with STIs, especially HIV. You can also access PEP and PrEP in Uganda (see "Medications & Vaccines" section for details). There is a national HPV vaccination program as well. Menstruation is often a taboo and socially awkward topic for women, and in poorer and rural parts of the country, menstrual products are difficult to access. There are many health organizations that aim to provide menstrual products and educate women about menstruation, and there has been an exciting effort to introduce more women to menstrual cups. Abortion is legal, except for when the woman's life is endangered by the pregnancy and, as its' generally interpreted, when the woman's mental or physical health is endangered by the pregnancy. However, due to the restrictive and unclear nature of Ugandan abortion laws, most women seek abortions from clandestine providers. Many women experience complications with these abortions, so it is recommended to exercise extreme caution. | |||
==Contraception (Birth Control)== | ==Contraception (Birth Control)== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Uganda, you can purchase contraception (birth control) without a prescription. It is estimated that 30% of married Ugandan women and 52% of sexually active unmarried Ugandan women use some form modern contraception.<ref>[http://mobile.businessinsider.com/how-birth-control-is-changing-lives-in-uganda-2016-8 How birth control changed everything for a young mother in Uganda]</ref> For married women, the most common contraceptive method were injectables (14-16%), implants (3.5%), male sterilization (2.3%) and condoms (2%).<ref>[http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf Trends in Contraceptive Use Worldwide 2015]</ref> For unmarried women, the most popular methods were condoms (19%) and injectables (18%).<ref>[http://mobile.businessinsider.com/how-birth-control-is-changing-lives-in-uganda-2016-8 How birth control changed everything for a young mother in Uganda]</ref> | |||
Ugandan women typically know about at least one contraceptive method, yet there isn't widespread contraceptive use. According to a 2015 report, 33.4% of Ugandan women (in marriages or in unions) have unmet family planning needs. In Uganda, the median age for first time mothers is 18.9 years old, and 18% of Ugandan teens have already had a child. This can be partially attributed to lack of access to contraceptives, especially in rural areas, and lack of information about family planning services. There is also some male prejudice against birth control, which is sometimes falsely claimed to cause cancer, cause infertility or promote promiscuity.<ref>[http://mobile.businessinsider.com/how-birth-control-is-changing-lives-in-uganda-2016-8 How birth control changed everything for a young mother in Uganda]</ref> | |||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* You can find condoms in pharmacies and chain stores. They're very common and easy to find. | |||
* [http://mariestopes.or.ug/services/ Marie Stopes Uganda]: "We provide both short and long term methods including contraceptive implant, IUD, contraceptive injection and press, condoms, contraceptive pills and voluntary surgical contraception (VSC). Family planning counseling, side effects management and removal services are also available at all of our service delivery points. MSU also markets the LifeGuard condom." Phone: +256 393 263 318/ 0414510337. Email: info@mariestopes.or.ug | |||
'''Warning:''' You should visit a pharmacy you trust. Some pharmacies (that are not vouched for) may sell fake pills. | |||
===Costs=== | ===Costs=== | ||
Birth control pills can be purchased for about $1 (though this information may be outdated; we'll need confirmation). | |||
==Emergency Contraception (Morning After Pill)== | ==Emergency Contraception (Morning After Pill)== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Uganda, you can purchase emergency contraception (the morning after pill) without a prescription at pharmacies. From a legal standpoint, you (may) need a prescription for EC (this is awaiting confirmation). However, in reality, this is not required by most pharmacists."According to a 2014 report, "Following a period of restrictions, national policies now support the use of emergency contraception (EC) in Uganda, and EC has been incorporated into national norms and guidelines, including the reproductive health commodity security plan. Although knowledge of EC in Uganda is higher than in many other African countries, more than two-thirds of Ugandan women have still never heard of EC, and EC use remains low."<ref>[http://www.cecinfo.org/custom-content/uploads/2014/04/ICEC_Uganda-Factsheet_2014.pdf COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION]</ref> | |||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* In Uganda, once you have a prescription, you can get emergency contraception (the morning after pill). You can find EC at pharmacies, public sector clinics and IPPF-affiliated systems. Some of the brands you may find are P2, Pill 72, Postinor-2, Pregnon, Revoke 1.5 and Revoke 72.<ref>[http://ec.princeton.edu/worldwide/ Princeton EC Website]</ref> | |||
* '''If you can't get a prescription for emergency contraception, or if you cannot access it, you can use regular birth control pills as EC.''' You can do this with progestin-only or combined progestin-estrogen pills. For progestin-only pills, you can take Ovrette (take 40 pills within 120 hours after unprotected sex). You can also take Microval (take 50 pills within 120 hours after unprotected sex). For combined progestin-estrogen pills, remember to only take the first 21 pills in 28-day packs. You can take Neogynon (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later). You can also take Lo-Femenal or Microgynon-30 (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).<ref>[http://ec.princeton.edu/worldwide/ Princeton EC Website]</ref> | |||
'''Warning:''' You should visit a pharmacy you trust. Some pharmacies (that are not vouched for) may sell fake pills. Some imported labels from Europe or the US provide a scratching field on the packing box that - when scratched with a coin - shows off a label. If the packing is intact you can be sure it contains the component you were asking for. | |||
===Costs=== | ===Costs=== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
== | There are no travel or residency restrictions attached to STI status. You don't need to present any medical certificate in order to enter the country.<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=187 UGANDA - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref> | ||
In Uganda, as of 2015, there are 1.5 million people living with HIV and 7.1% of adults (between the ages of 15-49) are HIV positive. You can access Post-exposure prophylaxis (PEP) and Pre-exposure prophylaxis (PrEP) in Uganda. Visit the "Medications & Vaccines" section of this page for details. The HIV epidemic disproportionally impacts young women, with higher infection rates for young women than young men. According to AVERT, "Robust treatment and prevention initiatives have been implemented in recent years, leading to improved conditions for people living with HIV. Due to the implementation of antiretroviral treatment throughout the country there has been a gradual increase in the number of people living with HIV receiving treatment. In 2013, Uganda reached a tipping point whereby the number of new infections per year was less than the number of people beginning to receive antiretroviral treatment. However, as of 2015 around 40% of adults living with HIV were still not on treatment. Persistent disparities remain around who is accessing treatment and many people living with HIV experience stigma and discrimination."<ref>[http://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/uganda HIV AND AIDS IN UGANDA]</ref> | |||
In Uganda, cervical cancer and HPV are also concerns for women. Each year, 3915 women in Uganda are diagnosed with cervical cancer and 2275 die from the disease. According to a 2016 report, cervical cancer is the common cancer for women in Uganda and 3.6% of women in the general population have HPV, which is a leading cause of cervical cancer. For these reasons, it's very important for women in Uganda to obtain the HPV vaccine (for more details, visit the "Medications & Vaccines" section).<ref>[http://www.hpvcentre.net/statistics/reports/UGA_FS.pdf Uganda: Human Papillomavirus and Related Cancers, Fact Sheet 2016]</ref> | |||
===Testing Facilities=== | |||
It's very easy to get an HIV and general STI test in Ugandan cities. They are offered at nearly all hospitals and clinics, and it costs around $2 for a series of tests. However, if you want to know a few places that offer tests, here are some options to consider: | |||
* [http://mariestopes.or.ug/services/ Marie Stopes Uganda]: "Our centres offer testing and syndromic management for STIs including gonorrhoea, genital herpes and syphilis. Voluntary, confidential HIV counselling and testing and prevention of mother to child transmission (PMTCT) services are also offered." Phone: +256 393 263 318/ 0414510337. Email: info@mariestopes.or.ug | |||
====Support==== | ====Support==== | ||
* Mulago Hospital: This may be the largest hospital in Uganda. They have HIV treatment/counseling. | |||
* Mild May Clinic: They have HIV treatment/counseling. | |||
* [http://www.unaids.org/en/regionscountries/countries/uganda UNAIDS Uganda]: Contact: Musa BunguduUNAIDS (Country Director). Telephone: + (256 41) 33 55 10, Fax: + (256 41) 34 01 13. Email: BUNGUDUM@UNAIDS.ORG. | |||
===Costs=== | ===Costs=== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* If you have a yeast infection, you can ask the pharmacist for Fluconazole. | |||
* "PEP (Post Exposure Prophylaxis) is available at many hospitals in Uganda, and may work up to 72 hours later. If taken within 24 hours it is your best bet to prevent HIV. Hep B immunization will also be needed, and a bunch of other invisible and predictable diseases can be prevented by a single dose of 2 tablets of an antibiotic."<ref>[http://www.livinginkampala.com/information/health-safety/health-in-kampala/ Health in Kampala]</ref> | |||
* PrEP (Pre-Exposure Prophylaxis) is available in Uganda and it's mentioned in the National Strategic Plan (though there are no specific policies for implementation, as of January 2017). Truvada is registered in Uganda for treatment. According to PrEpWatch: " Uganda has been the site of trials and demonstration projects of daily oral PrEP in serodiscordant couples; PrEP is slated to be included in the PEPFAR-supported DREAMS initiative focused on young women and adolescent girls." There are also many advocacy groups focusing on PrEP in Uganda, such as [http://www.avac.org/fellows/alumni?field_prevention_option_tid=4&field_country_tid=18&field_year_value%5Bvalue%5D%5Byear%5D= Global Advocacy for HIV Prevention]. Here's a [http://www.avac.org/blog/government-should-give-guidance-drugs-prevent-hiv study] from the group, published in 2015, focused on PrEP in Uganda. | |||
* Uganda has a national HPV vaccination program, launched in 2012, which targets girls at age 10.<ref>[http://www.hpvcentre.net/statistics/reports/UGA_FS.pdf Uganda: Human Papillomavirus and Related Cancers, Fact Sheet 2016]</ref> | |||
===Costs=== | ===Costs=== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Uganda, menstrual health can be an uncomfortable, even taboo, topic for girls. In rural areas, girls miss up to eight days of school each term due to their periods, as many girls lack sanitary pads or adequate washrooms. For rural women, it's common to use a piece of cloth, which is called a "kitenge," which they get from their mothers. Other young women make their own improvised sanitary pads out of cloth nappies or leaves. There are also social stigmas associated with menstruation, and many girls dread getting their periods. According to WaterAid Uganda, "In Uganda, menstruation is usually seen as a private issue and is not usually talked about in public, making it difficult for girls to manage their periods at school."<ref>[http://www.wateraid.org/uk/what-we-do/stories-from-our-work/breaking-the-silence-on-menstruation Breaking the Silence on Menstruation]</ref> There are many organizations in Uganda that are working to provide women with menstrual health solutions (like low-cost reusable pads or menstrual cups), both in urban and rural areas. Many of these organizations also aim to educate women on the options available to them, and they wish to make the conversation on menstruation more open and de-stigmatized. | |||
For more information, you can read this [https://www.theguardian.com/global-development-professionals-network/2014/may/28/menstruation-girls-education-uganda-sanitation article] on the challenges faced by menstruating girls in Uganda (and the organizations working to help them. You can [https://www.omprakash.org/blog/uganda-the-taboo-of-menstruation-and-an-exploration-of-womanhood read an account] of one volunteer's work in Uganda, which focused on menstrual health and education. You can also [http://www.ip-watch.org/2014/03/13/makapads-helping-disadvantaged-girls-and-women-in-uganda/ read about one doctor's work] to make pads for disadvantaged Ugandan women and girls. | |||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
In larger cities, you can easily find pads in stores. It's much more difficult to find tampons, though you can find them in some stores (try Game store in Lugogo, Shoprite and Nakumatt). If you want a menstrual cup, you can buy a FleurCup from [https://www.facebook.com/Menstrual-Cups-Better-than-Tampons-Pads-209841935862473/ Moyo Jena], a group based out of Kampala. They can be contacted through their Facebook page or by email: moyojena2013@gmail.com. There appears to be no official sellers of menstrual cup brands, like Lunette, MoonCup and DivaCup. There are also many sellers of RubyCup in [[Nairobi]], if you happen to make a trip to Kenya. | |||
Here are some organizations working on menstrual issues in Uganda: | |||
* [http://www.afripads.com/ AfriPads - Uganda Office]: "We are a social enterprise that specializes in the local manufacture and global supply of reusable sanitary pads as a cost-effective menstrual hygiene solution for millions of women and girls worldwide. AFRIpads is headquartered in Uganda, with sales offices in Kenya and Malawi." Address: Plot 28 Ntinda View Crescent, Naguru Kampala. Uganda. T +256 (0)392 174 561 | |||
* [http://womena.dk/ WoMena]: They provide education/counseling on menstrual health and they distribute RubyCup menstrual cups to women in Uganda. "WoMena is an NGO working with social issues in developing contexts, focusing on menstrual management, family planning and reproductive health." Phone: +256 (0) 200 902098. Email: info@womena.dk. Address: Mobutu Road, Makindye Hill, Kampala, Uganda | |||
* [https://www.facebook.com/menstrualcupuganda/ Menstrual Cup Uganda]: "MCU is a non-profit organization that distributes free menstrual cups to Ugandan girls and women from disadvantaged socioeconomic backgrounds, we also supply training in how to use and clean the cups in a safe and hygienic way. The training also include information about menstruation, adolescence and reproductive health and rights." Email: menstrualcupuganda@gmail.com | |||
* [http://www.wateraid.org/uk/what-we-do/stories-from-our-work/breaking-the-silence-on-menstruation Water Aid Uganda]: "WaterAid Uganda has been working with 40 schools in the slums of Kampala, the capital. As well as providing safe water and sanitation facilities, we’re promoting menstrual hygiene in schools to empower students and teachers to talk about the subject." | |||
* [http://graceworksinitiative.org/index.php/2016/10/24/feminine-health/ Feminine Health Management @ Grace Works Initiative]: "GWI implements a series of specially designed approaches to promote women’s health with specific focus on menstrual care and elimination of female Genital mutilation. This is a unique and innovative program which combines interactive education with training sessions for women and girls in emergency situations, prisons, schools and remote villages. Activities include; Equipping adolescent girls with basic skills on how to make low-cost sanitary pads with locally available materials and raising awareness of the health risks of female genital mutilation, as well as counseling and support to victims of FGM." Phone (+256) 414-665993. Email: uganda@graceworksinitiative.org. | |||
===Costs=== | ===Costs=== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* [http://mariestopes.or.ug/services/ Marie Stopes Uganda]: "MSU works in collaboration with the ministry of health to provide cervical cancer screening to hundreds of thousands of women in Uganda at heavily subsidised service prices." Phone: +256 393 263 318/ 0414510337. Email: info@mariestopes.or.ug | |||
===Costs=== | ===Costs=== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* [http://mariestopes.or.ug/services/ Marie Stopes Uganda]: "We provide antenatal and postnatal care through our network of centres. MSU also socially markets Misoclear, our brand of Misoprostol used to prevent post-partum hemorrhage." Phone: +256 393 263 318/ 0414510337. Email: info@mariestopes.or.ug | |||
===Costs=== | ===Costs=== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Uganda, abortion is generally illegal except when the woman's life is endangered by the pregnancy. The abortion law is also interpreted to cover when the woman's physical or mental health is endangered by the pregnancy. In all other circumstances, including when the pregnancy is the result of rape or incest, when there is risk of fetal impairment, social/economic reasons or when the woman requests an abortion, abortion is not permitted. | |||
From a legal perspective, Ugandan abortion law is not clear. This makes it very difficult for the Ugandan legal and medical community to understand what is truly acceptable on legal grounds. According to the Ugandan Constitution, "No person has the right to terminate the life of an unborn child except as may be authorised by law." Yet, the "authorised" behavior is not specified under the Constitution. In the Penal Code, the law specifies that abortions can be performed to save the life of a woman and, under Section 217, a person who performs an abortion is not responsible if they perform it with the reasonable faith that it preserves the mother's life. Furthermore, Uganda, as a Commonwealth country, follows the ruling of the 938 English Rex v. Bourne decision, which ruled in favor of an abortion that prevented a woman from becoming “a physical and mental wreck." This case set the precedent for other potential abortions that may be performed on the grounds of preserving the physical or mental health of the woman. | |||
Due to the restrictive and unclear nature of Ugandan abortion laws, many women seek clandestine abortion services. While there is no official data on the underground abortion rate in Uganda, a 2003 study found that 1 out of 19 women in Uganda had obtained an abortion annually, which was higher than the East African average. Wealthier Ugandan women are often able to find nurses, doctors and licensed health care professionals who can secretly help them obtain abortions. Poorer Ugandan women must often resort to more unsafe (i.e. less medically trained) abortion providers. It should be emphasized that all women, whether rich or poor, experience risk in seeking out clandestine abortions in Uganda, as they are by nature underground and often lack comprehensive medical resources. In 2008, the Ugandan Ministry of Health estimated that 26% of all maternity-related deaths were due to abortions. | |||
If you're in Uganda and need an abortion, you should first try to consult medical personnel or friends who you trust. There are many unsafe providers, so you should exercise extreme caution. If you have the financial means to leave Uganda, you may want to consider obtaining an abortion in [[South Africa]] or [[Mozambique]], where it is available upon request. In [[Zambia]], abortion is permitted for social or economic reasons, so that may also be a place to consider (but you should research the details first and get in contact with a health care provider in Zambia to confirm). | |||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
There is an underground network of abortion providers in Uganda. We cannot recommend any on this site, so we recommend that you consult with people you trust as a first step. You can also contact women's organizations that focus on family planning and reproductive health. Some of them may be able to help you out. | |||
===Costs=== | ===Costs=== | ||
There is no official data on the cost of clandestine abortions in Uganda. In 2003, an abortion was estimated to cost $25-$88 if it was performed by a doctor or $14-$31 if it was performed by a nurse or midwife. For women who went to traditional healers, it was estimated that they paid $12-$34. For women who self-induced abortions, the cost was typically $4-$14. However, this information is now more than a decade old, so you can expect that the prices have changed. | |||
==Advocacy & Counseling== | ==Advocacy & Counseling== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* [http://mariestopes.or.ug/our-hotline/ Marie Stopes Uganda Hotline]: "Our Hotlines – Call us free of charge on 0800 120 333 & 0800 220 333. Our client-focused hotline provides free, friendly and confidential counselling and information as well as referral for the following services: Family planning, Cervical Cancer, HIV/AIDS, Post Partum Hemorrhage, Condom use, Other products and services provided by MSU. Operating Hours: Monday-Friday, 7.00am – 10.00pm & Saturday, 8.00am – 5.00pm. CALL NOW: 0800 120 333 or 0800 220 333. Speak to our counselors in your preferred language of communication, with the assurance of confidentiality. You could also send us an SMS and we’ll respond to your question. Simply type FP leave a space then your message and send to 8228. | |||
===Costs=== | ===Costs=== | ||
==List of Additional Resources== | ==List of Additional Resources== | ||
* [http://graceworksinitiative.org/ Grace Works Initiative]: "Grace Works Initiative (GWI) is a registered not-for profit Organisation in Uganda, established in 2013. The Organization promotes delivery of health services and wellness support to isolated and impoverished rural communities focusing mainly on women and Children." | |||
==References== | ==References== | ||
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|title=Gynopedia | |title=Gynopedia | ||
|titlemode=append | |titlemode=append | ||
|keywords=contraception, birth control, emergency contraception, morning after pill, std test, sti test, hiv, treatment, medications, pharmacies, abortion, clinic, tampons, women's health, menstruation, menstrual, pregnancy | |keywords=gulu, uganda, contraception, birth control, emergency contraception, morning after pill, std test, sti test, hiv, treatment, medications, pharmacies, abortion, clinic, tampons, women's health, menstruation, menstrual, pregnancy | ||
|description=Find sexual, reproductive and women's health care in | |description=Find sexual, reproductive and women's health care in Gulu. | ||
}} | }} | ||