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Posted on Categories News

350,000 abortions in Uganda are induced – experts

Article by Catherine Mwesigwa Kizza ( New Vision)

Infanticide, child abandonment and abuse — the Ugandan media is full of the stories. The missing story though is that the abused and murdered children are most probably survivors of induced abortion.

“There are over two million conceptions in Uganda every year. 200,000 to 300,000 of these miscarry or abort spontaneously but 350,000 abortions in Uganda are induced,” said Dr. Charles Kiggundu an obstetrician and gynecologist at a breakfast meeting convened by the Center for Reproductive Rights and Centre for Human Rights and Development in Kampala Wednesday, to discuss the laws and policies on abortion in Uganda.

“90,000 of the induced abortions end up with severe complications but only a half of them access post abortion services,” he added.

“Only half of the women with complications seek medical care. A few survive but many others die,” he added.

Joy Asaasira of CEHURD said of the 20 women in Uganda who die due to pregnancy and childbirth-related complications every day, four to five of these are due to induced abortion.

Dr. Kiggundu says these are needless deaths. The policy environment allows women to receive healthcare for post- abortion complications, however, studies have shown that when they seek care, it takes about 44 hours for them to get attention compared to 35 to 45 minutes other women spend in hospital before getting a service.

“Health workers do not want to treat women with abortion complications because they do not want to be seen to be accomplices to the termination of pregnancy,” he said.

He also pointed out that phrases on hospital documents like “Police notify” worry health workers and are a deterrent to provision of care for women.

‘Health workers do not want to get involved with police. They want to do their work unencumbered,” he said.

Women induce abortions due to unwanted pregnancies due to wrong timing of pregnancy or economic and social hardships.

“Some men tell their wives to abort because ‘they stopped having children’ and yet did nothing about it,” Dr. Kiggundu said.

Those who survive death end up with chronic pain, anemia, and infertility among other complications.

He said safe abortion services were available but hidden to the poor.

“You must be connected and well-oiled to access the services. Some women fly to South Africa to terminate pregnancies and return,” he revealed.

The consequences for the majority who go to quacks or unskilled medical workers working undercover are dire.

“We recover forks, pens, knitting needles, bed springs, sticks, herbs from women who run to us with botched abortions. Some of these things kill the woman before they even kill the foetus,” he said.

Treatment for those who survive death is expensive. According to CEHURD, sh17.6bn is spent on treating abortion complications.

Not only can this money be saved and spent on worthwhile health causes but women’s lives can be saved as well.

According to Dr. Kiggundu, the Ministry of Health’s comprehensive abortion care includes sexuality education to promote safe sex practices, family planning use including access to emergency contraception, reducing fertility, providing safe abortion services and quality post-abortion care.

Government is also training nurses and giving them skills to perform manual evacuation procedures to attend to women with incomplete abortions.

“There are still many gaps,” said Dr. Kiggundu. “Uganda still produces health workers for export and retains only a few.”

He revealed that only 30% of the vacancies for skilled health personnel required to provide safe motherhood are filled.

It is no wonder that despite government commitments, advocacy efforts, plans and policies to reduce maternal deaths in the country, there has been no progress in this indicator in the past five years.

New data from the Uganda Demographic Health Survey report of 2011 show that the maternal mortality ratio increased from 435 deaths per 100,000 live births in 2006 to 438 deaths, though other international studies show a decline to 310 deaths per 100,000 live births.

“26% of these deaths are due to unsafe abortion,” said Elisa Slattery the Regional Director, Africa Program Center for Reproductive Rights.

Once addressed, reduction in unsafe abortion contributes to reduction in maternal death.

Slattery said studies on the law on abortion in Uganda have found that “abortion is permitted where a mother has severe illnesses threatening her health like cardiac disease, renal disease, eclampsia.”

The Centre for Reproductive Rights study also found that healthcare providers are not required under the Uganda law to consult one or more providers to get their consent before terminating pregnancy as has been previously believed.

The organization is calling on government to broaden access of information among healthcare professionals and the public as a means of stopping the tragedy.

source:http://www.newvision.co.ug/news/634689-350-000-abortions-in-Uganda-are-induced—experts.html

Posted on Categories News 63 Comments on Activists to Pursue Maternal Health Case Against Government

Activists to Pursue Maternal Health Case Against Government

By Andrew Green

Kampala — A petition backed by over 50 NGOs and charging Uganda’s government with failing to prevent the deaths of expectant mothers was thrown out by the constitutional court on 5 June, but the petition’s supporters plan to appeal.

The constitutional court argued that upholding the petition, which urges the government to boost health services, would have forced judges to wade into a political issue that was outside their jurisdiction.

However, the petitioners said the court relied on outdated international law in making its decision and overlooked its constitutional obligation to protect Uganda’s mothers.

Principal State Attorney Patricia Mutesi, who argued the case for the government, said the petition “was asking the court to do the work of the parliament in reviewing the efficiency of the health sector”.

The petition, which centred around the deaths of two mothers (Sylvia Nalubowa in central Uganda and Jennifer Anguko in the north), got nationwide media coverage when it was filed in March 2011. It said the women’s deaths could have been prevented if the health centres where they died had had “basic indispensable health maternal commodities” and if health workers at the facilities had not neglected the two women.

In throwing out the case, the justices suggested the petitioners seek an order from the high court compelling a public officer, such as a government health worker, to carry out his or her duties, or to request compensation for individual deaths from the government.

On 14 June the petitioners filed a notice informing the Supreme Court and the Attorney General’s office of their plan to appeal against the constitutional court decision; they have 50 days to finalize and file the appeal.

Rights denied?

Moses Mulumba is the executive director of the Centre for Health, Human Rights & Development (CEHURD) – the group that originally pushed the petition forward. He said the court’s decision not to wade into a “political question” was based on antiquated law and failed to address the fact that women were being denied rights guaranteed under Uganda’s constitution.

“I think it was very wrong for the judiciary to rely on very old United States jurisprudence to inform their decisions on clear violations of human rights,” he said. The courts should focus on upholding the constitution, he said, instead of “hiding under old political doctrines.”

In a country where statistics show that 16 women die every day from childbirth complications, the activists generally charged the government with perpetuating a maternal death rate that is “unacceptably high”. Ultimately, they are looking for the government to invest more in the country’s health system, to improve care and make sure critical resources are always available.

Valente Inziku, Anguko’s husband and one of the petitioners, said he watched his wife bleed to death as he tried to get nurses at the hospital to attend to her. “When she started bleeding seriously, the only the thing [the staff] did was they came and they told me… to clean the blood,” he said.

“People are disappointed, but we are not stopping there,” said Sylveria Alwoch, of the Uganda National Health Consumers Organization, one of the groups that supported the petition. “We are encouraging people to always report those cases. They shouldn’t be demotivated… They should still have that courage, that vigilance to speak out and bring out those issues.”

Win or lose, CEHURD’s Mulumba said;

the petition had raised awareness of the country’s ongoing maternal deaths and helped rally people around the cause.


 

Posted on Categories General News Leave a comment

Maternal Deaths Focus Harsh Light on Uganda

ARUA, Jennifer Anguko was slowly bleeding to death right in the maternity ward of a major public hospital. Only a lone midwife was on duty, the hospital later admitted, and no doctor examined her for 12 hours. An obstetrician who investigated the case said Ms. Anguko, the mother of three young children, had arrived in time to be saved.
Her husband, Valente Inziku, a teacher, frantically changed her blood-soaked bedclothes as her life seeped away. “I’m going to leave you,” she told him as he cradled her. He said she pleaded, “Look after our children.”
Half of the 340,000 deaths of women from pregnancy-related causes each year occur in Africa, almost all in anonymity. But Ms. Anguko was a popular elected official seeking treatment in a 400-bed hospital, and a lawsuit over her death may be the first legal test of an African government’s obligation to provide basic maternal care.
It also raises broader questions about the unintended impact of foreign aid on Africa’s struggling public health systems. As the United States and other donors have given African nations billions of dollars to fight AIDS and other infectious diseases, helping millions of people survive, most of the African governments have reduced their own share of domestic spending devoted to health, shifting to other priorities.
For every dollar of foreign aid given to the governments of developing nations for health, the governments decreased their own health spending by 43 cents to $1.14, the University of Washington’s Institute for Health Metrics and Evaluation found in a 2010 study. According to the institute’s updated estimates, Uganda put 57 cents less of its own money toward health for each foreign aid dollar it collected.
Rogers Enyaku, a finance expert in Uganda’s Health Ministry, disputed the assertion, saying the country’s own health spending had increased, “but not that substantially.” Still, the government set off a bitter domestic debate this spring when it confirmed that it had paid more than half a billion dollars for fighter jets and other military hardware — almost triple the amount of its own money dedicated to the entire public health system in the last fiscal year.
Poor people surged into Uganda’s public health system when the government abolished patient fees a decade ago. Increasingly, African countries are adopting similar policies, and experts say that many more people are getting care as a result. But Uganda’s experience illustrates the limits of that care when a system is poorly managed and lacks the resources to deliver decent services, experts say.
At regional hospitals like the one here in Arua, more than half the positions for doctors are vacant, part of a broader shortage that includes midwives and other health workers. A majority of clinics and hospitals reported regularly running out of essential medicines, while only a third of facilities delivering babies are equipped with basics like scissors, cord clamps and disinfectant, according to a 2010 Health Ministry report.
The hospital where Ms. Anguko died handles obstetric emergencies for a region of almost three million people, but it recently had no sutures in stock to sew up women after Caesarean sections. Dr. Emmanuel Odar, the hospital’s sole obstetrician, said that even in childbirth emergencies, families must buy missing supplies themselves, typically at nearby pharmacies. Patients without money must beg or borrow it, Dr. Odar said.
“We are overwhelmed with cases of people looking for free services, and they expect a lot despite supplies not there, human resources lacking and the beds not enough,” he said.
Dr. Olive Sentumbwe-Mugisa, a Ugandan obstetrician and adviser with the World Health Organization, participated in the Health Ministry’s investigations of the deaths of both Ms. Anguko and Sylvia Nalubowa, a second woman named in the lawsuit against the government, and concluded that both women arrived in time to be saved.
“We are in a state of emergency as far as maternal services are concerned,” Dr. Sentumbwe-Mugisa said. “We need to focus on the quality of care in our hospitals and address it in the shortest period of time. That will mean more resources. We cannot run away from that.”
In its lawsuit filed in March, the Center for Health, Human Rights and Development, a Ugandan nonprofit group, contended that the government violated the two women’s right to life by failing to provide them with basic maternal care.

Source: http://www.nytimes.com/2011/07/30/world/africa/30uganda.html?hpw

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