By Irene Abenakyo

Global estimates published by WHO indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in there. Gender based violence has been broadly defined as a significant well-recognized threat to public health and human rights It include any act that results in or is likely to result in physical, sexual, or psychological harm or suffering, whether occurring in public or private life. Such acts may include Female infanticide; child sexual abuse; sex trafficking and forced labor; sexual coercion and abuse; neglect; domestic violence; elder abuse; and harmful traditional practices such as early and forced marriage, “honor” killings, and female genital mutilation/cutting.

GBV is wide spread in Uganda and it affects all people irrespective of their social, economic and political status. It occurs in families, communities, workplaces and institutions. According to the Uganda Police Force’s annual crime report, gender-based violence cases that were reported and investigated increased by 4% (from 38,651 to 40,258 cases) between 2015 and 2016. The 2016 Uganda Demographic and Health Survey further revealed that up to 22% of women aged 15 to 49 in the country had experienced some form of sexual violence. The report also revealed that annually, 13% of women aged 15 to 49 report experiencing sexual violence. These statistics leave a number of questions relating to realization of rights. If the state can broadly write about these violations, one wonders what has been put in place to protect women and girls from such abuse.

The Center for Health, Human Rights and Development (CEHURD) in collaboration with the International Law Development Organization (IDLO) implemented a DREAMS Innovation Challenge project titled; Integrating Legal Empowerment and social accountability for Quality HIV Health services for AGYW in the district of Mukono and Gomba.(LE-SA+). One of the achievements of this project was to uncover the GBV cases within districts. We realized a number of challenges in accessing justice for survivors of gender based violence. First, during the initial stages of the project, communities had lost hope in the judicial law and order sector actors for their continued corruption and perhaps insufficient knowledge in what to do in case such case are received. CEHURD worked tirelessly to revive this hope and indeed at the end of the project in October 2018, many had seen light in the sense of accessing justice.

• The most troubling question though is whether government’s failure to provide shelter for such survivors of violence is in itself a violation of rights.
  NFM (pseudo acronyms) a 16 year old was defiled on her way home by a boda boda cyclist, she endured the pain and sought medical attention- the beauty is that the health service provider who attended to her had been trained by CEHURD- he did his best and forwarded her to police- investigations took on and the case is pending before Court.
• NBJ (pseudo name) a 14 year old was defiled by a school, football coach, and who is living with HIV. NBJ sought medical attention and was brought to CEHURD’s attention during one of our community awareness campaigns. CEHURD took over and case is pending before Court of law
• FM (pseudo name) is presumed to have been defiled by her step father when her mother was away and impregnated. She did not have an opportunity to receive PEP neither emergency contraceptives. Her step father did what he could to ensure this girl is aborted. The case is up for police investigations.

The stories are many but that not my point today. My question is, where all these girls and many more go after surviving such violence. CEHURD’s intervention on this subject has proved that once abused, women and girls are left to get back to their communities without receiving any psychosocial support or prepared to get back to the communities. The country lacks such a one stop center that is ideal in the realization of rights of these women and girls.

While there are private institutions like Wakisa ministries, working hand in hand with government, the restrictions are to take on girls who survive violence and become pregnant at such tender ages. CEHURD’s efforts under this project were geared towards ensuring that such girls do not get pregnant and has worked with health institutions to readily avail them with emergency contraceptives and PEP. It thus becomes a great challenge that the government of Uganda has not put in place any of its owned shelters that can cater for each and every survivor

The lack of such a shelter comes with violations of a number of rights. Once the girls are defiled they go through a lot of psychological torture and necessitate rigorous counselling to ensure their right to health and life is not violated. However with lack of a shelter, they face numerous discriminations and stigma including community and self-stigma. Some have opted to run away from their communities while others drop out of schools for the stigma they face. Homes have become a center of abuses yet communities are not prepared to receive such abused girls back. Privacy, nondiscrimination and equality before the law remain in the Constitution as rights but not observed in such scenarios.

In the end, there seems to be no hope for such girls and as a country, we are most likely never going to report a total reduction of teenage pregnancies and hopefully unsafe abortions. .

These and many become pertinent for the government to put in place a shelter, which is accessible to all survivors, which will help the victims/ survivors seek medical help at no cost but also be provided with security from the perpetrators and be reached by police in cases of evidence collection.

By Lilian Aguti

GBV is an umbrella term used to describe any harmful act that is perpetrated against a person’s will on the basis of unequal relations between women and men, as well as through abuse of power. In Uganda sexual and physical violence is widespread and mainly committed against women and girls and it affects all people irrespective of their social, economic and political status.

Global estimates published by WHO indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in there. Gender based violence has been broadly defined as a significant well-recognized threat to public health and human rights. It includes any act that results in or is likely to result in physical, sexual, or psychological harm or suffering, whether occurring in public or private life. Such acts may include Female infanticide; child sexual abuse; sex trafficking and forced labor; sexual coercion and abuse; neglect; domestic violence; elder abuse; and harmful traditional practices such as early and forced marriage, “honor” killings, and female genital mutilation/cutting.

According to the Uganda Police Force’s annual crime report, gender-based violence cases that were reported and investigated increased by 4% (from 38,651 to 40,258 cases) between 2015 and 2016. The 2016 Uganda Demographic and Health Survey further revealed that up to 22% of women aged 15 to 49 in the country had experienced some form of sexual violence. The report also revealed that annually, 13% of women aged 15 to 49 report experiencing sexual violence.

My experience working with the communities, fear is among the contributing factors to committing GBV. Often times, survivors of violence give up to report or follow up on cases due to fear of wrangles, hatred by the family of the perpetuator or even threats of death. In the communities people believe that witchcraft is real and because of this, there is a tendency to fear that they will be bewitched or killed because of following up on cases that end up with imprisonment as a punishment of the perpetrator. At the same time, girls fear to report cases of sexual violence with the assertion that they will be embarrassed, they would rather conceal the information to themselves instead of seeking for support. This is because, in the Ugandan setting, sexuality is considered private and not for public consumption. Through the norm of “Eby’omunju tebitottolwa” literally meaning that what whatever happens in the home should never be a consumption of the public, the young women are culturally taught to conceal any information that is related to their marriage to the extent that even when the husband batters her, she is to keep it to herself.

The fear still goes an extra mile that even the local council members to whom support could be sought from, fear to handle such cases because they feel they will end up losing their positions in the subsequent elections as a result to taking to jail an offender.

All these have been fertile grounds for GBV to prevail in the communities as the perpetrators run away with it and commit similar offences. Much as the fear is at the forefront, we cannot also run away from the fact that there other drivers fueling GBV prevalence in the communities. These include negotiations at the village /community level, poverty, illiteracy levels, weak enforcement of laws on violence, corruption among others. As a result of all these, some parents have been forced to accept bribes from perpetrators which has hindered cases from being forwarded to court. When someone insists that the case be taken forward to court, in some instances the parents of the survivor stand up to say “Is the defiled child yours?”

It is also a common practice for people in the community to tell the parents of the survivor that “At least you get something, agree and negotiate with the perpetrator but if you don’t, then it’s going to be a total loss on your side”. Such comments are usually tagged to the long Court processes and delays at police. As if that is not enough, there is a practice of charging fees at almost every center for one to successfully report a GBV case. For example facilitating the movements to court, to the health facility, to police then later to court and the fees for filling in the police form3. Sometimes the police also need to be facilitated to go and arrest the perpetrator or to visit the crime scene and collect evidence. This facilitation may not be available to most of the survivors so they end up abandoning the cases.

My interaction with the communities also made me know that community members have low confidence in the justice systems. Police has been cited as one such an institution. A number of voices within communities noted the high levels of corruption within the police that sometimes the police are paid off to suppress cases. They connive with parents of the perpetuator to convince the victim’s family that they will not get justice in court but rather they should seek monetary compensation from the perpetrator and sometimes they hide the files and make the cases disappear.

The community members have now developed a belief that perpetuators target poor families of people who cannot proceed anywhere with the cases. Whereas as perpetrators are able to bail themselves out scot free.
Thanks to the Center for Health Human Rights and Development (CEHURD) interventions in the communities of Gomba and Mukono under the Determined Resilient Empowered, AIDS free Mentored and Safe (DREAMS) innovation Challenge project which has and will continue empowering the communities on their human and health rights through the trainings.

CEHURD has also trained Adolescent Girls and Young Women (AGYW) as Community Health Advocates. This continue to empower the communities on their human and health rights. This sensitization trainings have been an eye opener and communities are now able to report cases of violence. The elected local council members have also been trained on their role in handling the GBV cases and there is hope that there is some light at the end of the tunnel.

By ANTHONY WESAKA

The absence of female police officers at majority of the police posts in the districts of Gomba and Mukono, is hampering the fight against sexual violence against women, an official has said.

Ms Noor Nakibuuka Musisi, an official from a Center for Health, Human Rights and Development, explained earlier today that the absence of the female police officers has made some women/girls to fear to report sexual abuses committed against them.

Ms Nakibuuka, named Mamba Police Post in Gomba District and Nkonge Police Post Mukono as some of the posts without female officers attached to them.

Find Full Article HERE

Today the Center for Health, Human Rights and Development (CEHURD), Nnamala Mary and Simon Kakeeto have dragged the Government of Uganda to the Constitutional Court for failing to put in place shelters for women who have been raped or defiled. CEHURD also challenges the unequal punishments that the law provides for sexual offenders as being unjust.

Men charged with rape are liable to suffer a maximum penalty of death whereas the law provides for the offense of ‘defilement’ for persons between the ages of 14-17 and sexual offenders against girls of that category are only given a few years of a jail term. This difference in penalties towards perpetrators who commit the same offense is unjust and offends the principle of equality and non-discrimination before the law. It also has an effect of increasing sexual violence against girls in that particular age group.

According to the Uganda Demographic Health Survey of 2016, 1 in 5 women have suffered sexual violence in Uganda. Uganda Police has also released the Annual Crime Report of 2017 where defilement was rated the 3^rd leading crime in the country with 14,985 cases reported and police recorded 1,335 rape cases. It is important to note that in cases of sexual violence, many women do not report due to fear, stigma and the trauma that is associated with the offences. The police reports are just a tip of the ice bag of the magnitude of the violence that women face on a daily basis in this country.

Click here to Download the Press Release to read more.

By Joy Asasira

There is not a day that goes by that we do not hear of a mother somewhere in Uganda who has lost her life (and that of her baby) while delivering.

In many of the local dialects in Uganda, there is a word to describe this death. To say the least, this has been accepted as, “normal”, but is it? What is unfortunately a common practice, is that when women are faced with complications related to pregnancy or delivery, these women continue to choose high risk options such as delivering at home or with the assistance of traditional birth attendants.

The factors that lead to maternal death are known, these have been explained categorized to include; the socio-economic, cultural and accessibility and actual quality of care of health facilities. These contribute to what have been referred to as the three delays. These delays include; delay of women at home in making the decision to seek care, delay by the women to identify and reach the medical facility and delays at the health facility for the woman before receiving adequate and appropriate treatment.

Whereas the first and second delays are complex to address owing to the need for attitudinal shift, economic empowerment and doing away with deeply rooted cultural practices. The third delay, which is characterised by poorly-equipped facilities that lack among others; health workers, medicines, equipment and blood for transfusion as has been the case in Uganda in the recent past due to rampant blood stock outs. Maybe addressed through systemic and programmatic interventions can improve financing of health care and particularly maternal health care.

As we commemorate the maternal health month, I cannot help but wonder whether the non-affordability of maternal health services among others, is not one of the reasons our women continue to die form preventable maternal mortality causes.

Universal Health Coverage then becomes a possible solution for addressing the high cost of healthcare for maternal healthcare. Simply put, Universal Health Coverage (UHC) refers to the idea of access to health services for all without exposing the user to financial hardship. This is not to say that Universal Health Coverage is a silver bullet, however, it would mean one more step towards accessibility of healthcare, including maternal health services and family planning.

Ensuring affordable, accessible, acceptable and good quality health care for Uganda’s women of reproductive age is inevitable if we are to tackle the persistently high maternal mortality that stands at 336 per 100,000 live births.

The reality is that many Ugandans are just getting by and for every two Ugandans that get out of poverty, three more fall back into poverty. Since reproduction is not a reserve of those with means, those living in poverty also find themselves pregnant and in need of good quality and dignified maternal care.

This means that of the more than two million pregnancies in Uganda annually, many of these happen to women that are living below the poverty line (and these same women probably already have more children than they can care for). Let us not forget about our teenage girls; one in four of these girls have either had sex or been pregnant before their 19th birthday, but can they afford the healthcare that they desperately need?

It is not a surprise that that the media is awash with stories of women giving birth in taxis, at the entrance of hospitals, in corridors and on floors. There is also a new practice of detention of women in health facilities due to failure to clear the medical bills.

It is a fact that the high cost of healthcare is forcing women to make life threatening decisions about how to manage their pregnancies and where to deliver. This high cost must be addressed in order to ensure universal health coverage through a multi-pronged approach that includes investing such as primary healthcare, where we would have issues like malaria in pregnancy addressed.

Secondly, through building upon and strengthening partnerships between the public and private sector, this also includes regulating the operations of the private sector, including the pricing of services.

Thirdly, the creation of innovative financing models such as Uganda’s proposed National Health Insurance Scheme (NHIS). However the proposed NHIS is not without criticism even as its efficacy remains to be seen. Some have pointed out that a scheme that seeks to operate within a health system that is plagued by inequalities, including access to and distribution of health facilities between the rural and urban areas and disparities in staffing levels between facilities of the same level in different parts of the country.

There are lessons to be learned from countries like Rwanda that developed and is currently implementing the Community Based Health Insurance (CBHI) scheme, where a scale of the population based on their income and then worked to subsidize income the contributions for those considered the poorest and vulnerable.
While others considered able, pay a contribution towards their healthcare. It is no wonder that Rwanda was able to achieve Millennium Development Goal 5A, which was to reduce by three quarters between 1990 and 2015, maternal mortality ratio.

Rwanda reduced its maternal mortality ratio by 78% from 1,300/100, 00 live births to 567/100,00 live births in 2005 and 290/100,000 live births in 2015. It is also not surprising that the most significant changes were registered in rural areas where best practices like the women have embraced facility-based birth as opposed to home births.

The cost of health services continues to influence women’s choice of whether to seek health care during pregnancy and also skilled attendance at birth, With the number of women living in abject poverty, the need for government and stakeholder interventions to ensure access to health care without the fear of facing financial hardship becomes a pertinent issue for consideration in order to ensure improved maternal and child health outcomes in Uganda
Address maternal mortality in Uganda by ensuring affordable, accessible, acceptable and good quality health care service delivery.