She Cares is a self-managed family planning initiative in Northern Uganda implemented by consortium partners International Rescue Committee, WORUDET and ACORD Uganda. From 2022 to 2024, She Cares partners used research, implementation and advocacy methods to bring self-managed contraception closer to adolescent girls and women living in Lamwo and Yumbe districts, many of whom are refugees from South Sudan.
The following stories, shared in Palabek refugee settlement and the neighboring host community, are told by a range of stakeholders who have taken part in She Cares program activities. Included in these perspectives are women and girls who are navigating the world of family planning and self-care, health care workers who have gained new knowledge and skills through training activities, community members who are stepping into leadership roles to advocate for self-managed family planning, and other community perspectives.
Abalongo Sharon
Sharon is a 19-year-old woman who has adopted self-injectable contraception because of the She Cares program. After the birth of her first child earlier this year, she knew she wanted time to recover from her pregnancy and space out her next child. She attended a She Cares health education session in June of this year, where she learned about the benefits of child spacing and options for self-managed family planning. She and a friend both decided to take up Sayana Press after speaking with a midwife at that session, and each successfully injected themselves under the supervision of a midwife. Sharon describes the experience as surprisingly easy, and she has no fear about self-injecting on her own for her next dose in September, because now she knows how to do it.
Now, she says both she and her friend are living well, their children are thriving, and they are planning their dreams and their families because they aren’t occupied with consecutively producing children. They are creating awareness among their friends and neighbors about the benefits of Sayana Press, and several have already come to Akworo Health Center to receive the method. Sharon has had no side effects from Sayana Press, and prefers it over the rest of the FP options because she lives quite far from the health center, and she won’t have to make the long walk every few months to maintain care since she was given three additional doses. She recognizes that a huge barrier for women in accessing family planning is that male partners often do not accept family planning as an option, and women have to decide if they will act against their partners’ wishes, either openly or in secret. Luckily, Sharon’s husband is a proponent of family planning and encouraged her to use Sayana Press so that they can more easily space their children.
Amito Lillian
Lillian is a member of the Village Health Team (VHT) in Zone 9 of Palabek refugee settlement. She is 26 years old, and has served as a VHT since 2022, when she moved to Palabek from South Sudan. At the beginning it was difficult for Lillian to be a VHT, because some of the practices of the refugee community were so different from what she had been taught (such as maximum childbearing from a young age). She had to become skilled in mindset change in order to encourage people to stop harmful health practices. Since the beginning of the She Cares program implementation a few months ago, she has learned how to counsel women and girls on choosing the right family planning (FP) method for them, and how they can become competent in self-administering the Sayana Press injectable if they choose that self-care method. She has faced some challenges due to the many myths and misconceptions about family planning in the refugee community, and the negative attitudes of some people towards the SRH messages that she had been trained to share. But she and her fellow VHTs are trying to demystify SRH in Palabek settlement by providing accurate information. Lillian has helped many women already to take up contraceptive methods, most commonly Sayana Press and implants. One client in her zone stands out to her – a mother of 3 very young children expressed to Lillian that she didn’t want to have more children until her current ones were more grown, however her husband was not supportive of FP. Lillian supported her with confidential SRH services, and she was able to receive an implant to keep her from bearing more children for the time being. Her kids have grown more now, and she is very grateful to have been able to space her children. Lillian is happy that the She Cares program is shifting community attitudes about FP, and ultimately will result in her neighbors being healthier and happier with their lives.
Laker Christine
Christine has been a midwife for 4 years, coming to Awich Health Center two years ago from Agago district. She enjoys her work as a midwife, being surrounded by babies and providing support for mothers brings her great joy. Here in Palabek settlement, she has noted a dramatic increase in the uptake of family planning since the beginning of the She Cares program. She attributes this change to a variety of efforts: community dialogues, health education sessions, and the work of newly trained VHTs are contributing to greater awareness about the FP methods that are available in the settlement and surrounding host community. She has personally distributed many FP eligibility cards to women at education sessions, only to later see those same women coming to the health center to seek FP. Word of the She Cares program is spreading, with many women coming to the health center because their friend or neighbor attended a session, and told them about the newly available methods. Women are seeking both self-managed and provider-managed methods, but Christine is personally excited by the expanding interest in Sayana Press as she herself has been using the self-injectable method since 2020. She loves the convenience of self-injection, the ease given the small needle compared to Depo, and the discreteness, and feels like she can recommend Sayana Press to eligible women from personal experience. She hopes that more women come to understand the benefits of self-managed contraception with the She Cares program.
Angelina Nyabor Lok
Angelina is a newly-trained Youth Champion for the She Cares program. She was only trained two weeks ago, but in that time has hit the ground running, mobilizing her community members to attend two health education sessions that have been held in her zone. Angelina walks around her zone on the morning of the session, using her megaphone to give out important details about the session and encouraging people to attend. She also tries calling everybody she knows in a five-block radius of the session location, but she knows that for some people it is simply too far to walk so they aren’t able to attend. For those neighbors who are close enough, she says people have heard that these local community engagement sessions will be coming to their neighborhood, and they are eager to see what they are all about.
Angelina’s mobilization strategies are clearly working. For her first session as part of the She Cares team, she recruited 40 young girls from her community to attend a session on adolescent sexual and reproductive health. And for today’s session, 70 community members have shown up to receive information about SRH self-care and to engage in a dialogue about family planning.
Angelina came to Palabek in 2023 from South Sudan. She has two children and has used the Depo injectable in the past, but her husband is currently back in South Sudan so she has taken a break from family planning for now.
Amony Lilly
Lilly is a Ugandan host community member of Palabek settlement. She is 37 years old and has three children between the ages of 7 and 14. After her youngest child was born, she knew she did not want more children. She used provider-administered injectable contraception (Depo-Provera) to keep from getting pregnant. She liked the injectable method, as she had no side effects. After three injections, however, her midwife recommended that she stop using the injectable method, incorrectly advising that it was not healthy to use for more than 9 months. Not knowing that this was a myth, Lilly stopped using the injectable and switched to the implant which she liked much less than the injectable. Now, midwives in Palabek are trained on accurate family planning information with She Cares, and they are no longer recommending women stop receiving injectable contraception after 9 months. Addressing myths at the health provider-level is allowing more women to get appropriate reproductive health care. Now that Lilly is aware, she plans to switch her method to the Sayana Press self-injectable as she likes the idea of being able to manage her own family planning. As she knows she does not want more children, she has even considered the permanent contraceptive method of tubal ligation (TL), but she says that she has heard of providers refusing to complete TL on women due to the procedure being irreversible.
Apio Rose
Rose has been a VHT in Zone 7 for the past four years. Part of her role as a VHT is to counsel women who are seeking family planning methods and, if they select the self-injectable Sayana Press, to teach them how to self-administer the method. She says that this is easy – women want the method and are willing to overcome any fear or hesitation that may accompany the process of self-injection. She says one or two women per week approach her about family planning. Currently, she is out of stock of Sayana Press so she uses the appropriate referral pathways when women come to her, and she directs them to the midwives at the health center. Recently, she has helped several women living with mental health issues seek family planning and other reproductive health care at the health center, an important role she plays for her community.
Rose is a new Sayana Press user herself, having given herself her first injection two months ago. She looks forward to giving herself her next injection in the comfort of her own home rather than having to travel to the health center. Her husband is very supportive of family planning, he is the one who first heard of Sayana Press and suggested that Rose use the method to keep them from having more children.
Arik Patrick and Oriama Peter
Patrick, 26, and Peter, 19, recently attended a She Cares health education session in Zone 7. They attended the session because they were curious about what was going on in their community center, and they were interested in learning more about family planning. Previously they have received some information from the health center, but this was the first time they had joined a larger community dialogue on sexual and reproductive health. Both young men, Patrick and Peter know that family planning is important to protect themselves and their partners from unintended pregnancy, but they weren’t aware of all the self-managed family planning methods currently available. Patrick is married and has a five year old child, and his wife is currently using an implant to protect their family from an unintended pregnancy. He hopes more young men will join him in supporting their partners in using family planning like he does. Both men say that the young people they know are using condoms whenever they are available to them, and that both boys and girls seek condoms from the health center. After today’s health education session, Peter requested and was given a box of condoms that he now plans to distribute to other young men in his community that are seeking condoms for family planning and sexually-transmitted disease protection.
Adokorach Sharon
Sharon is 28 years old, and we recently caught up with her at the training session for She Cares Youth Champions in Palabek Ogili. She is a member of the host community surrounding Palabek refugee settlement. She has been excited about family planning for a while, and is happy that she can help advocate for adolescent sexual and reproductive health in her role as a Youth Champion. Besides advocacy, she will serve as a liaison to young people in the Palabek host community, confidentially connecting them with family planning services at the community level. She believes that FP provides opportunities for young people to have a future that involves more than solely parenthood, and she personally used family planning to space her two children by 5 years.
For young women and girls, she sees oral contraceptive pills or Sayana Press as great options due to their ease and discreteness. She sees implants being more frequently used by married women as they are more easily detectable, and unmarried women often choose to avoid stigma associated with the community knowing that they are using family planning. Because of this stigma, younger unmarried women and girls need convenient and confidential places to get SRH services. Sharon aced her post-training test and is excited to get to work as a Youth Champion.
Aleppo Lona Grace
Lona is a midwife at Awich Health Center II in Zone 5 of Palabek refugee settlement. She has been involved with the She Cares program since 2023, when she attended several trainings for midwives on family planning (FP) counseling and referral pathways. She says the trainings taught her a lot about new family planning methods, including the self-injectable Sayana Press, and how to screen women for self-managed methods. Self-managed FP methods, as well as the She Cares FP eligibility card, are putting power into women’s hands to make informed decisions about their own family planning. Now, Lona sees more and more women every day who are interested in a self-managed method, particularly younger women. She has noticed that while many women are initially fearful to self-inject, once they are shown how to do it and complete their first self-injection, their fear reduces substantially and is replaced by great confidence in themselves. The women whom Lona has counseled have all proven to be capable of self-injection, and walk away with a year’s worth of contraception that they can administer on their own. Participating in the She Cares program has reinforced Lona’s pride in being a midwife, noting: “Serving women has always been a call to me, it is my top priority. I feel so happy to empower women in my community through She Cares.”
Angwech Pasqueena
Pasqueena is 31 years old and has seven children. She is a refugee who came to Palabek from South Sudan in 2017. She did not start using family planning until after her fifth baby, when she learned about available family planning methods. With her last two babies, she has used an implant to control when she gets pregnant, spacing her last two births five years apart. After having her seventh baby, she came back to Awich health facility in search of family planning. A midwife trained by She Cares counseled her on her options and gave her a family planning eligibility card, which she says was a helpful tool for her to understand what options were available to her. She notes that many women have so many things to think about as they navigate motherhood, that it is easy to forget things like who to contact for questions about reproductive health. For busy mothers, especially, having a simple card with helpful reference information makes seeking contraceptive care much easier. However, she also recognizes that for some women whose partners are not supportive of family planning, they may not want a physical card to bring home with them for their partners to find, preferring more discrete ways of managing their family planning. Through the She Cares process she decided she wanted to maintain her same family planning method, and again received an implant to keep her from having any more children at this time.
Amony Evaline
Evaline is a She Cares representative from the host community of Palabek Ogili. She was nominated to serve as both a youth champion and a community mobilizer through the several community-based organizations she has worked with in Palabek settlement. Through the two She Cares trainings she has now attended, she has learned a lot about family planning and self-care. She was fascinated to learn about self-managed family planning methods like Sayana Press and emergency contraceptive pills, which she thinks are great resources for young people who want to avoid unintended pregnancy. She has personally used the self-managed method of oral contraceptive pills, and appreciates that she can control her own family planning without having to go back to the health center too regularly.
Evaline sees the relationship between refugee and host community members as a positive one, as they end up sharing the same spaces and facilities, like the health center and the marketplace. She says good rapport is created through these small interactions in shared spaces, and refugee and host community members cooperate with each other. During her training to be a youth champion, she sat alongside refugees and host community members alike, and says she is leaving the training with new friends. She looks forward to sharing the knowledge she has gained from She Cares with as many people from her community as possible.
Akim Joseph
Akim serves as the head cultural leader for Palabek settlement. Having come from Juba, South Sudan in 2019, he is from the Bari tribe, one of 13 tribes in the settlement. Within these tribes there are 38 clans, each with different cultures and traditions. Palabek settlement currently houses over 80,000 refugees, and new refugees are coming from South Sudan every day. Cultural leaders play a crucial role because for many refugees who have been separated from their community, the cultural leaders are the first people they meet in the settlement who share their culture and can serve as their connection to home. Akim recognizes that one issue which cultural leaders should familiarize themselves with is family planning, in order to improve the reproductive health of their communities. With such a diverse population of refugees, training cultural leaders on how to talk about family planning is extremely important for meeting people at the most grassroots level – their local clan – to reach them with SRH information.
Coming from a context of conflict and the loss of many lives, Akim says many refugees enter the settlement with a mindset of “producing children to replace those lost in South Sudan”. She Cares is helping the community understand the many benefits that come along with family planning, especially for refugees who have lost their livelihoods coming to Uganda and can’t afford the school fees to educate their children, nutritious food to feed them, etc. This is why cultural and religious leaders are partnering with She Cares to go door to door to convince the community to prioritize family planning. Akim is excited that cultural leaders are speaking with each of their clans about reproductive health, because he says “Health is teamwork – we cannot rely on one or two people to improve the health of the population, it will take the whole community to prioritize reproductive health for us to see change.”
Jessica Atim
Jessica has owned her drug shop, Good Health, in Palabek settlement for 7 years. She was approached to be a part of the She Cares project in 2023 and was invited to a training session, which she attended. She learned a lot of new information about self-managed family planning and how to counsel women on Sayana Press. Her participation in She Cares as a private drug shop owner involves accepting new clients who bring family planning eligibility cards and providing them with their selected method of family planning. These days, she feels one of her main roles at her shop is to provide family planning methods to women. She sees between 6 and 10 women per day who are seeking family planning methods, many of them seeking Sayana Press or another self-managed method. She feels more comfortable administering or helping women self-administer Sayana Press than the Depo injectable, and sees that more women prefer it, as well. She sees positive changes happening in the community with the rollout of She Cares, particularly because the program is educating both women and men on the benefits of family planning, increasing the number of family planning clients who come to her as a couple. She loves to see husbands who are supporting their partners’ desires to seek family planning, and hopes this trend continues with further rollout of She Cares.
Atoo Concy
Concy is a 21-year-old advocate of family planning (FP). She has one child, but she says when she looks around to others in her community she sees families with many young children only one year apart from each other. Concy knows she does not want that for herself: she wants to provide her daughter with every opportunity for a good life. She plans to wait until her daughter is 5 or 6 years old before conceiving again. Things like school fees and nutritious food for children are expensive, and spacing her children will allow Concy to better budget for these items. Previously, Concy used provider-administered injectable contraception but she experienced side effects with excess menstrual bleeding, so today she received a contraceptive implant at Akworo Health Center II. She is looking forward to this new method, and appreciates that she has the power to choose which FP method is right for her body. Her husband is supportive of family planning, encouraging her to pursue the implant method. She notes that other women in the community face challenges due to the negative attitudes of their husbands towards FP, as well as perceived misconceptions about side effects from FP. She hopes that these barriers are reducing with the health education component of programs like She Cares. Concy sees young women in her community making decisions for themselves, however she notes that decision-making power is often as hindered by men, especially when it comes to FP. Couples tend to make FP decisions together, or the man has the final say, rather than women having total agency over their FP decisions.
