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.

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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.

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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.

A crossroad of ideas reflective of cultural and religious morals, beliefs and values affects young people of all social standings without sufficient attention given to scientific evidence that speaks to Sexual Reproductive Health and Rights SRHR issues. Teenage pregnancies have increased according to the 2016 Uganda Demographic and Health Survey, the school dropout rate especially in the hard to reach areas is still outrageous, sexually transmitted infections are still on the rise with 500 HIV infections happening among young people every week according to UNAIDS. Unsafe abortions also happen in a setting that still remains open to quack doctors operating in an unregulated environment due to the stay and disownment of different SRHR policy guidelines and service standards.

While they are at the center of SRHR decisions and service provision, cultural and religious leaders still remain a critical constituency that has not been tapped into by advocates for a progressive SRHR legal and policy environment in Uganda. They are a significant constituency because policies cannot be declared right with engaging them through consultations. However, this is a constituency that remains out of reach of scientific evidence that gives a clear and true picture of Uganda’s laughable SRHR record in comparison with other East African countries.

It is at this time that advocates must recognize that the influence of cultural and religious institutions cannot be go unnoticed, and they hold the key to ensuring that young people’s SRHR is realized. The role of religious and cultural institutions in child and human development is seen in church programs like Sunday school, youth camps/guild, and missions, the Kisakaate of the Nabagereka of Buganda and the girl-power conference of Pastor Jessica Kayanja for instance. Some of Uganda’s communication platforms are equally owned and operated by the religious and cultural institutions.

These include lighthouse television, Top TV and Radio, CBS Radio, Power FM, BBS Telefayina, Radio Sapientia, Radio Maria among others as important channels that we can leverage to enforce our support for the young people. Religious founded institutions through the Catholic Education Secretariat, Church of Uganda Schools, UMEA, and tertiary institutions like Uganda Christian University, Busoga University, Muteesa I Royal University, Ndejje University, and Uganda Martyrs University among others is other avenues in the education arena that are critical. It is therefore to the advantage of young people that this is another avenue the government is considering in the implementation of the recently launched Sexuality Education Framework.

The cultural and religious camps need to embrace access to SRHR information by young people through this avenue. They are equally at the center of health service provision and handle health predicaments of a significant number of people, including the SRH of young people.

The Medical bureaus (Uganda Catholic Medical Bureau, Uganda Protestant Medical Bureau, and Uganda Muslim Medical Bureau) are centers of power in determining the kind of services provided including on SRH. It is therefore important to emphasize these synergies with cultural and religious institutions in ensuring provision and access to a wide range of SRH services that remain out of reach by the young people. This is when Uganda will be able to score high on the different SRHR indicators.

Dennis Jjuuko
Programme Officer – Research, Documentation and Advocacy
Center for Health, Human Rights and Development