Almost one in three Ugandan births are unwanted or mistimed, but few women practice contraception

International Family Planning Perspectives, Mar 1998 by Breslin, Megan

Ugandan women can expect to have an average of almost seven births, about 1.5 births more than their mean ideal family size, if current rates of childbearing continue. According to findings from the 1995 Uganda Demographic and Health Survey (UDHS),1 only one in seven married women are practicing contraception, although one in three say they want no more children. Infant and childhood mortality levels remain high: Almost 150 of every 1,000 infants die before their fifth birthday.

The UDHS was conducted from March to August 1995 among 7,070 women aged 15-49 and 1,996 men aged 1554. More than eight in 10 respondents lived in rural areas, and about one in three women and one in nine men had had no formal schooling.

Marriage

Marriage is almost universal in Uganda: Fewer than 2% of women and 4% of men aged 30 or older have never been married. At the time of the survey, 73% of women of childbearing age were married or living with a man; 12% were widowed, divorced or separated; and 16% had never been married. In Uganda, women marry at younger ages than men (17.4 vs. 23.1 years). Nevertheless, the proportion who marry before age 15 has declined over time, from 27% among women aged 45-49 to 14% among those aged 15-19. Age at first marriage differs by women's level of education, rising from 16.6 years among women with no schooling to 20.5 years among those with at least a secondary education. Moreover, urban women marry at a median age of 18.7, compared with 17.2 among rural women.

Thirty percent of married Ugandan women are in polygynous unions; that proportion is slightly higher in rural than in urban areas (30% vs. 28%). Married women with at least a secondary level of education are less likely than those with less schooling to be in a polygynous union (27% vs. 29-32%).

Fertility and Fertility Preferences

The total fertility rate (TFR) for Uganda during the period 1992-1995 is estimated at 6.9 births for each woman in her lifetime. The TFR is almost 50% higher in rural areas than in urban areas (7.2 vs. 5.0 births). It also differs by education, decreasing from 7.0 births among women with no formal schooling to 5.2 among those with secondary or higher education.

Childbearing begins early in Uganda: The median age at first birth among women aged 25-49 is 18.6 years, and two in three women have had their first child by age 20. However, the proportion of women having their first birth before age 15 has declined over time, from 14% of those aged 45-49 to 4% of those aged 15-19.

The median age at first birth is only slightly higher in urban areas than in rural areas (19.1 vs. 18.5 years), but rises from 18.0 years among women with no schooling to 20.0 years among those with a secondary or higher education.

Ugandans want large families: On average, women consider 5.3 children ideal, while men prefer 5.8. The ideal family size is lower among women with a secondary or higher education than among those who have had no formal schooling (4.0 and 6.3 children, respectively).

Twenty-two percent of births in the five years before the survey were reported as mistimed and 8% as unwanted. The wanted fertility rate-a composite measure calculated in the same way as the TFR but excluding births that exceed the number women consider ideal-is 5.6 births per woman. Thus, if all unwanted births were avoided, total fertility in Uganda would decline by 19%.

Contraceptive Knowledge and Use

Overall, 92% of women and 96% of men know of at least one contraceptive method. Women know of a mean of 4.9 methods, compared with 4.6 for men. The pill and the condom are the methods most widely known among women (82% and 78%, respectively) and among men (94% and 88%, respectively).

Thirty-four percent of married women have ever used a contraceptive method, but only 15% were doing so at the time of the survey. Eight percent were using a modern method, 4% a traditional method and 3% a folk method. The three most widely used methods are periodic abstinence, the pill and the injectable (about 3% for each).

Contraceptive prevalence is more than twice as high among sexually active unmarried women (36%): Twenty-seven percent report use of a modern method, including 15% who use the condom and 7% who rely on the pill. Married men are nearly twice as likely as married women to report contraceptive use (25% vs. 15%). They are most likely to rely on periodic abstinence (11%), but small proportions use the pill, the condom or the injectable (3% each). Contraceptive prevalence is higher among sexually active unmarried men (35%), with the condom accounting for almost all use (32%).

Contraceptive prevalence varies sharply by residence and educational level. It is three times as high among married women in urban areas as among those in rural areas (35% vs. 12%). The urban-rural difference in prevalence is particularly great for modern methods (28% vs. 5%).

Education and number of living children are positively associated with contraceptive use. Prevalence increases from 8% among married women with no education to 38% among those with a secondary or higher education. It also rises from 5% among women with no living children to 20% among those with four or more.