On December 1st, the Family Medical Point (FMP) team commemorated World AIDS Day with women and girls at the Kigungu landing site in Wakiso District, Uganda. The event provided essential Sexual and Reproductive Health and Rights (SRHR) information and vital commodities, including male and female condoms and lubricants. FMP is committed to reaching marginalized communities, particularly women, girls, and sex workers, with the support and care they need to make informed decisions about their sexual and reproductive health.
Fishing communities in Uganda, particularly those along Lake Victoria, face immense challenges in accessing quality healthcare. These communities are among the most underserved in the country, with limited healthcare infrastructure and services. According to the Uganda Ministry of Health, about 70% of people in fishing communities lack access to basic healthcare services, including family planning, maternal health care, and HIV prevention. The lack of resources and health facilities leaves these populations vulnerable to various health risks, including unintended pregnancies, unsafe abortions, and sexually transmitted infections (STIs), including HIV.
Sex workers in these communities face even greater challenges due to stigma and discrimination. HIV prevalence among sex workers in Uganda is alarmingly high, with rates estimated between 40% and 60% (Uganda AIDS Commission, 2021). Many sex workers cannot access essential SRH services due to stigma, discrimination, and fear of violence. The Uganda HIV/AIDS Sero-Behavioral Survey 2016-2017 highlights that sex workers are one of the highest-risk groups for HIV due to factors such as unprotected sex, violence, and limited access to health services.
However, the situation extends beyond HIV. A significant number of women in fishing communities experience unintended pregnancies due to a lack of access to contraception, coupled with issues of coercion and violence. According to the Uganda Demographic and Health Survey (2016), 28% of all pregnancies in Uganda are unintended, with fishing communities experiencing even higher rates due to limited access to family planning services and information. The challenges surrounding family planning are compounded by the high rates of violence faced by women, including sexual violence and intimate partner violence, which prevent them from making autonomous decisions about their reproductive health.
Unsafe abortion is also a grave concern. The Uganda Ministry of Health estimates that approximately 26% of maternal deaths in Uganda are due to unsafe abortions. This is exacerbated in fishing communities, where many women cannot afford safe abortion services and resort to dangerous methods. Some turn to unqualified practitioners, while others attempt self-abortions, often resulting in severe health complications or death. According to the World Health Organization (WHO), complications from unsafe abortions are a leading cause of maternal mortality in sub-Saharan Africa, with the rate of unsafe abortions disproportionately affecting young women and girls in marginalized communities.
During our Musawo session, a safe space where women, girls, and sex workers gather to discuss their SRHR challenges, we heard firsthand about the barriers they face in accessing healthcare. Women shared stories about the difficulty in negotiating condom use with their partners, with some even facing violence when they insisted on condom use. Others described being raped, and in some cases, condoms were forcibly removed during intercourse, putting them at high risk for HIV and unintended pregnancies. One woman shared the heartbreaking story of her friend, who was raped despite insisting on condom use and suffered severe injuries that left her reproductive organs damaged. Several women also spoke of the emotional and physical abuse they faced when they tried to protect themselves.
These barriers have led to high rates of unintended pregnancies, unsafe abortions, and increased vulnerability to HIV. The consequences are devastating—many women suffer from infections, long-term complications, and in some cases, death. Some women also described the shame and stigma they faced after undergoing unsafe abortions or when they sought healthcare services. The fear of being judged often prevents them from accessing the care they need.
However, the Musawo session also provided a platform to empower these women and men with SRHR information and to connect them with essential services. By educating the participants about the importance of condom use, family planning, and available resources for HIV prevention and Safe abortion services, FMP aims to reduce the stigma and health risks they face.
The need for improved healthcare access in Uganda’s fishing communities has never been more urgent. The Uganda Ministry of Health must prioritize these underserved populations by improving access to essential healthcare services. Strengthening healthcare infrastructure and training healthcare workers to engage with these communities is critical in ensuring these vulnerable groups receive the support they need.
We also call on international donors, NGOs, and community leaders to support initiatives that address these urgent health issues in fishing communities. By investing in the health and well-being of women, girls, and sex workers, we can reduce the devastating effects of unintended pregnancies, unsafe abortions, and HIV transmission.
Furthermore, these women and girls must be given the space and support to advocate for their rights and access to healthcare. They deserve to live free from fear, violence, and stigma. Through collective action, we can build a future where all women and girls, regardless of their occupation or location, can access the SRHR services they deserve.
The time to act is now. We urge all stakeholders—government, donors, healthcare providers, and community leaders—to work together and ensure that no one, especially those in the most marginalized communities, is left behind in the fight for better sexual and reproductive health.
