The Effect of a Sexual and Reproductive Health Programme on Socio-Economic and Education-related Inequalities in the Use of Modern Contraceptives in Seven Sub-regions in Uganda: A Case of RISE Programme 2019-2023
Authors: Makumbi Fredrick , Nabukeera Sarah , Tumwesigye Nazarius Mbona , Namanda Cissie , Mukose Aggrey , Atuyambe Lynn , Ssenyonga Ronald , Tweheyo Ritah , Gidudu Andrew , Sekimpi Carole , Ddungu Peter 
Published: June 2024

Background: Universal health coverage is a key SDG3 strategy with no one left behind. Access and utilization of family planning services is important for addressing the needs of women and men for the children they want and when they want them. Although several FP programmes have been rolled out, there is limited evidence to determine their effect on inequality. We assess the effects of the “Reducing High Fertility Rates and Improving Sexual Reproductive Health Outcomes in Uganda (RISE)” on key indicators of sexual reproductive health, including the use of modern contraceptive methods in seven regions in Uganda.
Methods: Baseline and Endline data were obtained from two cross-sectional surveys conducted in 2019 and 2023, respectively. A total of 1341 and 1495 women of reproductive age (15-49 years) were interviewed in 2019 and 2023, respectively. Educated and Wealth-related inequality in the use of modern contraceptive methods (defined as using or not using modern FP methods) were assessed by dimensions of equity ( geography, rural/urban residence, age, and social-demographics characteristics. Inequality was determined using Erreygers Concentration Indices (ECI) at baseline and endline. The difference in ECI between the two survey periods was ascertained and assessed for statistical significance at 5%. We used Prevalence Ratios to compare the use of modern FP at the endline relative to the baseline using a modified Poisson regression run in STATA version 15.
Results: The distribution of participants between the surveys did not significantly vary by characteristics except for a decline in self-reported disability (32.2% to 14.5%, p<0.001) and an increase in per cent with lowest/lower wealth-quintile (36.3% to 43.4%, p=0.0035). The mCPR did not significantly change. However, positive changes were observed in West Nile, Central-1, and East-Central, urban, older women (40-49), the divorced/separated/widowed, and those with primary or no education. We observed no significant change in the use of modern contraceptives at the endline compared to baseline, adj.PR=1.026(0.90, 1.18), p=0.709). Overall, wealth-related inequality in the use of the modern contraceptive method in favor of the wealthiest (higher/highest wealth quintile) women was observed at baseline, ECI=0.172, p<0.001, but not at the endline, ECI=0.0573, p=0.1936. However, Wealth-related inequality declined at the endline. Similarly, overall education-related inequality was highest in favor of women with secondary or higher levels of education at baseline, ECI=0.146(0.035, p<0.001) but not at endline, ECI=0.0561(0.0342, p=0.1063). Although we observed a decline in education-related inequality between the two surveys, this was not statistically significant. The decline in wealth-related inequalities at the endline was more evident in urban, in central-1, East Central and Karamoja regions, among young (20-24) women and the married, while education-related inequality was more common in the rural, older (40-49 years) women, and the married.
Conclusion: The RISE programme provides evidence of a decline in socio-economic and education-related inequalities in selected equity dimensions, especially among older women in rural areas, young women in urban areas, and married women. However, inequalities persist and may need to be addressed with more targeted programmes to ensure that no one is left behind for UHC.