A banana tree with a few stalks is stronger

Southwest nonprofit makes connections in rural Uganda

On both sides of the road, going on forever it seems, are fields of banana trees. And as we drive to Nanseko, a village in rural Uganda, we avoid the deep ruts in the dirt road by swerving from one side and then to the other, veering so close that the long banana tree leaves brush the car’s window.

Some trees look as if any moment they will break and spill the fruit they hold, weakened by the weight of too many stalks. Others trees with fewer stalks stand tall and strong.

I’m accompanying the Ugandan staff of the Stevens Square-based nonprofit Minnesota International Health Volunteers (MIHV). MIHV helps improve the lives of rural women and children in East Africa and other emerging nations by providing maternal and child health services, including family planning education.  

MIHV, which has an office at 122 W. Franklin Ave., also works domestically in Minnesota with refugees and immigrants on community health issues. We have made the long, bumpy drive for the first "Family Planning Day" in Nanseko, Uganda, and as we turn into the school yard, we pass men on bicycles and families on foot, some having traveled for miles to attend the event.

Much like the banana trees that cover their land, Ugandan families can be overburdened when their family size grows too large. Forty-one percent of Ugandans report an unmet need for family planning. According to the Ugandan Demographic and Health Survey 2006, the average Ugandan woman has 6.7 children, the highest fertility rate of any country in eastern and southern Africa. By contrast, the average Minnesota family has 1.93 children. Although family planning awareness is high in Uganda, (96.6 percent of all women and 98.1 percent of all men can name at least one contraceptive method), usage of contraceptives is fairly low. Just 24 percent of women age 15–49 report using any method of family planning.

"Oftentimes in Uganda people say, ‘We need to have more children because all these children are dying and we need enough children to farm our land, to support us in our old age, and also because [having] more children is more prestigious,’" explained Paige Anderson Bowen, a Carleton College graduate and MIHV’s Uganda country director. "The thinking goes, if I have children dying, I need to have a lot of children so I still have enough children. Unfortunately, the more children you have, the more dangerous it is for the mother, and if the mother dies her children are at greater risk of dying. This leads to a higher infant mortality rate that, in turn, encourages other women to have more children."

To spread its message, MIHV is hosting "Family Planning Days" in rural Uganda. Performers sing about contraceptive options as part of a drum show and extol the benefits of family planning or child spacing. A play depicts some of the common crises facing large, Ugandan families, such as the inability to cover school fees for all their children. The performances are followed by a soccer match and movie. Throughout the afternoon, community health workers are on hand to answer questions and provide counseling and referrals.

Moses Kiro, 30, watched the soccer match in the afternoon sun. He and his wife are caring for 13 children; five of their own and eight nieces and nephews who were orphaned when Kiro’s brother George died of AIDS last June. Kiro explained that he has used condoms before, but that they "itched" so he did not use them regularly. He came Sunday to learn about his options, because he says he and his wife cannot afford to have another child.

Although some men like Kiro seek out family planning services, they often do so only once their family size is nearly unmanageable. More often, women are the ones who seek out counseling.

"Women just tell [their partners] that they go to the market [when they actually] go for family planning," explained Musoke Twaha, a social welfare officer in Ssembabule. "That’s the trend."

"There’s a misconception [among men] that it’s a negative thing to use family planning," said Bowen. "Many women in Uganda use family planning without their partner knowing. … If you want a woman to sustainably use family planning, her partner needs to be involved."

MIHV is seeking to raise awareness as boys enter puberty and become sexually active.  

"We usually get old people, women, but we tend to miss a big group," said Elijah Talemwa, MIHV’s community health specialist. "Men 17–25 — you cannot get them in any meeting organized by health workers."

Publicized on local radio stations, this "Family Planning Day" attracted more than 250 people, including many young men, MIHV believes that with more cooperation from young men, Ugandan families can plan together and space the births of their children, increasing the life chances for all.

"We should all be concerned with improving women’s health whether women are living here in Minnesota or in rural Uganda," said Laura Ehrlich, MIHV’s international program director. MIHV’s Executive Director Diana DuBois agrees, "Providing women with access to reproductive health care reduces unwanted pregnancies, decreases self-induced abortions, and improves the health of women and their families."

Sarah Schewe, a 2007 Blake School graduate from Eden Prairie, is volunteering with Minnesota International Health Volunteers in Uganda and Tanzania through December; you can keep up with her online at http://mihvblog.blogspot.com/.