Why health literacy is important in improving maternal health

There is a common belief that pregnancy and child birth is a test of endurance and maternal deaths are just a sad occurrence that in one way or another could not have been avoided; and any woman who evades the traditional birthing practices and delivers by caesarian, is weak and cannot endure pain and suffering that women were born to endure by virtue of them being women. This mentality has resulted into very dangerous practices in which women delay seeking assistance during labor and by the time they realize they are obstructed, it’s too late and they cannot access emergency obstetric care in the nearby health facilities thus end up losing their lives. This coupled with other delays such as distance from the home to the nearby health facility, the health facility’s capacity to manage obstetric complications and the failure to utilize health facilities because mothers do not understand the relevance of the treatments or do not ever seek such services because of ignorance of their existence; all contribute to the high maternal mortality rate in Uganda.

Although maternal mortality in Uganda has declined from 527 deaths per 100,000 live births in 1995, to 438 deaths per 100,000 live births in 2011, this still falls way below the MDG target of 131 deaths per 100,000 live births by 2015. This translates into an annual decline rate of 5.1% and an average of 18 women dying every day. It remains evident that many mothers are still dying as a result of pregnancy related complications and as shown in the Reproductive maternal, Newborn and child health Sharpened plan for Uganda; November 2013 which highlighted the highest maternal mortality to be in Eastern, Western, North and the Karamoja regions and lowest in Central the central region.

Although there has been strong commitment from the Ministry of health and government at large to address preventable causes of maternal morbidity and mortality, there is still generally low turn up for health services in rural areas as expectant mothers prefer receiving care from traditional birth attendants other than health facilities and often mix conventional medicine with local herbs.

Many women choose not to go to health facilities because they do not understand why they are being subjected to tests or why certain medication is important in saving their lives and that of the baby. This is so because most women in rural areas are illiterate and therefore rely on ancient family practices, rumors, myths and misconceptions associated to pregnancy and child birth. Even where women endeavor to visit health facilities for antenatal care, health providers ignore communicating certain information that is important in advising them accordingly on the dangers of prolonged labor and what signs to look out for in order to identify complications that may in one way or another cause obstruction in delivery of the baby which may endanger the mother’s life.

We as Ugandans must keep our mothers, wives, sisters and daughters alive by doing what we can to reduce preventable maternal deaths from happening. Many of us think about saving the child’s life and not the mother’s, but there is a link between child mortality and maternal mortality and it’s indelible. Research and practice have shown that infants whose mothers die within the first 6 weeks of their lives are most likely to die before reaching the age of 2 than infants whose mothers survive child birth. This shows that a child’s survival is dependent on the survival of the mother.

We can therefore only improve access to and delivery of maternal health services in rural areas through Health literacy amongst health providers, women and girls of reproductive age, men, cultural and religious heads etc. There is need for appropriate interventions to address the existing barriers between rural mothers and the formal health care system, this should include health literacy for both men and women in rural communities and health providers on a human rights based approach to service delivery such that we reduce mother’s seeking care in more traditional or homeopathic environments.

In this century, with drugs and commodities to save lives, no woman should have to die due to lack of reproductive health choices or worse still, have to give her life to give life. We can all make it happen for all the women in our lives.

By Florence Nabweteme.

Luuka District Hospital finally gets Maternity Ward

Giving birth, though painful, is supposed to be a joyful process, a process of pride that reflects the dignity of a woman and puts her aside as the mother of all humanity. But this is not always the case as mothers have across the country been forced into giving birth under terrible and inhumane conditions that degrade all the dignity that women are naturally entitled to given their life giving role in society. Such has been the plight of women in Luuka District who have been subjected to giving birth under trees and in dingy squalid and dirty rooms when it rains because there has been no semblance a premise in the form of a maternity ward where women can be taken to give birth.

It all started in 2012 when fire gutted the maternity ward at Kiyunga Health Center leaving the health facility without a maternity ward. This left the facility bereft of options of how to handle the cases of pregnant mothers that came to the hospital and what followed is a harrowing tale of just how far the challenges of the decentralized system of health system management in Uganda can become synonymous with decentralisation of health rights violations. Luuka District it should be noted is one of the newer districts in Uganda and its facilities haven’t been upgraded to reflect its District status so Kiyunga Health Center is operationally a District hospital for Luuka District without the capacity to serve as a district Hospital. Therefore when the maternity ward was burnt down leaving the district without a maternity ward it became a case of stealing from the church mouse.

Concerned by the on-going human rights violations at the health facility, CEHURD took special interest in the matter and led a fact finding mission to establish the state of affairs at the facility which confirmed the worst of our fears that indeed mothers were giving birth under trees, on verandas and in dingy rooms because the maternity ward had been burnt. Unfortunately the Luuka District Local Government which is mandated with administration of health facilities and provision of medical services at that level did nothing to rectify this situation because apparently protecting the dignity of mothers giving birth in the district is not one of the financial priorities of the District.

CEHURD begun a process of engagement of the district authorities to prioritise the renovation and restoration of the maternity ward at the hospital to the extent of issuing a notice of intention against the district authorities to sue for the continuing violations of the rights of women in the district. Despite the slow reaction to the needs of the women in Luuka District, CEHURD is pleased to confirm that our efforts have paid off and following a resolution by the District Local Council Meeting held in December 2014, funds have been specifically committed to the reconstruction of the maternity ward at Kiyunga Health Center in Luuka District.

In a recent meeting with the Chief Administrative Officer Luuka District, the Chairman LC3 Kiyunga, the District Secretary for Health and CEHURD representatives, the CAO confirmed that the District has committed funds for the reconstruction of the Maternity Ward and showed CEHURD representatives a copy of a Memorandum of Understanding entered between the district and the UPDF Engineering Brigade for the reconstruction of the ward. We appreciate the Luuka District Local government for finally seeing sense in the situation and avoiding litigation to prioritise the rights of mothers in the district. CEHURD will continue to monitor the developments for the expeditious reconstruction of the ward to immediately rectify the on-going violations of the maternal health rights at the health facility.

By James Zeere