By Dr. Milly Kaggwa, Senior Clinical Advisor for Africa, PSI
My mother raised me to believe that I am in charge of my own life, including my sexual and reproductive health. So, when at the age of 12 I decided that I would have four children, I made a plan to do just that. As I continued with my education, my career and became a medical doctor, I never lost track of that goal. Today, I am a proud mother of four.
The choices I made leading up to motherhood were based on access to information and the support of those around me who helped me feel empowered enough to make my own decisions. This should be every woman’s story.
Yet, in many cases, women lack the access, voice, power and/or agency to make informed decisions about their well-being, including their sexual and reproductive health. For many years I worked in an obstetrician-gynecology clinical setting in Uganda and was witness to the difficulties that women face in accessing basic sexual and reproductive health information and services. Even a subsidized injectable contraceptive which costs around $1 is not always affordable, especially for younger women. Sometimes, these difficulties have to do with the challenges of visiting a clinic or drug shop every month to obtain a family planning product. In some communities, women do not have the voice to communicate their needs and desires. Some do not even know they are able to make decisions about their bodies and their health. Instead, they rely on norms established by men or community leaders. These social structures have guided generations, and breaking the mold is not easy.
The truth is that no one knows a woman’s journey better than a woman herself. Even within my own country, women’s needs, desires and aspirations are not uniform—a woman in Kampala and a woman in the rural north of the country might be faced with completely different realities. Her involvement is so crucial to finding lasting solutions to the challenges she faces.
That’s why I see such potential in self-care, which in this context refers to adapting interventions that are usually provided in a clinic so that women can provide these for themselves. This is particularly acute when it comes to sexual and reproductive health, where stigma or the need for privacy may prevent them from seeking care in a clinic. By finding ways to move services that are normally delivered in a clinical setting closer to women, we are empowering them to play a more active role in their own health, and future. Self-care gives women the ability, and power, to manage their own needs instead of waiting on a health system that is often overwhelmed. When I talk to women in my community, they are excited about simple innovations they can use such as dialing a code on their mobile phone to access a pharmacy, purchasing their family planning method of choice and then having it delivered to their home. They explain how this has helped reduce the amount of time they spend at crowded clinics.
Last year, when the COVID-19 pandemic led to a curfew and a lockdown in Uganda, there was a real fear that essential services, including sexual and reproductive health care, would not be accessible. Recognizing this, and to bring services closer to women, Uganda’s Ministry of Health approved a self-care policy that accommodated some of the emerging needs that came with COVID-19 based government restrictions.
The new policy allows medical providers to train women on how to use self-injectable contraception. After the initial training, a woman can self-inject in the comfort of her home, preventing unwanted pregnancies without having to visit a clinic every few months. She has the access, knowledge and skills she needs to decide what she wants for her life and for her health.
Self-injectable contraception is a perfect example of how self-care allows women to become agents of their own health. It gives women the power to meet their own needs without having to constantly rely on others.
In my role as Senior Clinical Advisor for Africa at PSI, I’ve had the opportunity to learn from workshops organized by the Delivering Innovation in Self-Care (DISC) in Uganda to provide women with a space to share their thoughts and insights on self-injectables and for health care specialists to hear these women’s experiences. By bringing women to the table and making their voices heard, we’re helping to bridge existing health care gaps, something I am very passionate about.
Because I was fortunate enough to be empowered to think about my future, I feel it is my duty to help other women achieve the same. Access to knowledge, especially at a young age, is key to ensuring that a woman knows she has the power to determine the trajectory of her life, including—and beyond—motherhood. In Uganda, where the average age of the female population is 14, we have an opportunity to provide young girls with the information they need, to realize that they have the power and ability to determine their lives.
I have two daughters and much like my mother taught me, I am raising them to believe that they have a voice and they are in a position to forge their own paths. Through my work, I’m hoping to help other young girls and women have the same opportunity.
