What patients want: New approaches to providing reproductive healthcare

Winnie Sanyu Nakimbuggwe, a nurse and health educator, has spent 13 years and hundreds of hours speaking to teenage girls at her clinic in Mityana district, Uganda. She knows the challenges they face when trying to access reproductive health services.

Facilities don’t always have the space and privacy to provide counselling and services, often run out of necessary supplies, including contraceptives, and healthcare workers can bring with them personal biases, such as judging youth for being sexually active.

Girls look to their health providers for empathetic, confidential, same-day care. Yet, too often, health centers cannot provide this, and girls are left without the tools and support they need to protect their health.

In low- and middle-income countries, 43 percent of teenage girls want to avoid pregnancy but cannot access modern contraception. In Uganda, that statistic jumps to six in ten.

A nurse sits at her desk, consulting with a patient.

Winnie sits at her desk, consulting with a patient.

Winnie’s experiences exemplify two enormous unmet needs: health workers who are trained to respect young people’s choices and facilities connected to high-functioning supply chains, so they can provide contraceptives when girls need them.

CHAI has worked with the Ministry of Health and six district health teams in Uganda since 2018 to develop solutions to the barriers teenagers face when trying to access contraceptives. In response to insights from health workers like Winnie and feedback from girls themselves, CHAI worked with the Ministry to roll out mentorship for health providers in 131 facilities.

As a result, 60 percent of facilities have created private, dedicated spaces for appointments and 90 percent have at least one health provider who is trained to provide sexual and reproductive health services for youth – without the stigmas previously attached.

In parallel, through strengthening communication channels and performance management systems used by health workers, facility managers, and district staff, CHAI helped improve routine availability of a wide range of contraceptives, reducing stockouts by 58 percent.

Over the last three years, this approach has led to a 96 percent increase in new contraceptive users between the ages of 10 and 24 in the six districts, culminating in 34,782 new users in 2020.

Reflecting on the changes she has seen in her community, Winnie says she is thrilled that the health system can finally meet the needs of the girls she cares about – and she hopes this encourages decision-makers to continue to ask girls what they want in order to shape future approaches.

Learn about our work on maternal, newborn, and reproductive health

With contributions from Racheal Najjemba and Winnie Sanyu Nakimbuggwe (Sexual, Reproductive, Maternal, Newborn, and Child Health – Uganda), Chloe Legaspi Cavin (Global Sexual Reproductive Health), and Melinda Stanley (Essential Medicines).