By Fatiha Nkoobe

Maternal health remains central to humanity world over since it is among the key indicators of the health of the population in all countries across the globe. It is therefore true to say that the death of mothers due to pregnancy-related causes must be a key focus of the health system of any country if good health indicators are to be realized.
Uganda has a high maternal death rate. Around 7000 women die each year, as many as 20 mothers every day due to pregnancy and birth-related complications. Access to skilled birth attendance reduces the risk of maternal death and other child-birth related complications by up to 87 per cent, according to the 2014 State of the World’s Midwifery Report.

In Uganda, access to this essential care is constrained by a human resources gap in midwifery, and retrogressive policing around sexual reproductive health. With only 73 per cent of pregnant women receiving skilled attention the country is grappling with a huge number of women who die while giving birth to 336 deaths per 100, 000 live births as put forward by the 2016 Demographic and Health Survey (UDHS) as opposed to the 70/100,000 target by WHO. This places Uganda among the top five countries in terms of maternal health deaths in sub-Saharan Africa.

On 11th April 2018, Uganda joined the rest of the world to commemorate the International Day for Maternal Health and Rights under the Theme: “Rights Based Approach to Maternal Health in Uganda: No Woman Should Die Giving Birth.”

Civil Society, led by Center for Health, Human, Rights and Development (CEHURD), and other stakeholders including policy makers marched from the Independence Monument to Parliament where a dialogue with Members of Parliament was held to collectively find sustainable solutions to the alarming maternal mortality rate. “We want to see progressive laws when it comes to maternal health and SRHR in the country because that is when we shall be able to reduce on maternal mortality,” Mr. Jjuuko Dennis – Programme Officer at CEHURD, while UWOPA chairperson Hon. Monica Amoding backed by other women legislators pointed at the weak health system as the driving force behind high maternal mortality. They however pledged to support the ministry in designing new policies to reduce the death of mothers and women.

Civil Society used dialogue to petition Parliament in demand for the implementation of the resolution that was passed by the house on December 15, 2011 urging Government to institute measures to address Maternal Mortality in Uganda. Ms. Prima Kwagala from CEHURD highlighted a number of pending resolutions that were made by Parliament yet no action has ever been taken. Among these included tasking government through the Ministry of Health to strictly enforce maternal health audits and take actions to the established causes, together with developing a policy of compensation to the families of all women who die as a result of maternal related cases through government facilities

Different stakeholders committed to raising awareness to legislators about the state of maternal health, the preventable contributors of maternal mortality and the legal and policy environment for the same to stimulate action for addressing preventable maternal mortality in Uganda.

The Center for Health, Human Rights and Development (CEHURD) has today the 8th April 2018 joined other Civil Society Organisations working with People with Disabilities as well as the Uganda Medical Association to condemn a Judgment by the High Court of Uganda which declared the practice of torturing mental health patients for hours in Secluded rooms at Butabika National referral hospital a legal practice.

 

The Center for Health Human Rights and Development (CEHURD) www.cehurd.org is looking for a Country Programme Coordinator who will be contracted for a period of two (2) years beginning on 1st May, 2018 and will be stationed at CEHURD offices located at Plot 4008, Justice Road, Canaan Sites, Gayaza – Nakwero.

CEHURD with financial and technical support from the AIDS and Rights Alliance for Southern Africa (ARASA) http://www.arasa.info/, will be implementing the HIV, TB and Human Rights Training and Advocacy Programme for two (2) years, April 2018 – March 2020. The overall objective of the programme is to support the strengthening of a human rights based response to HIV and TB in an effort to ensure the creation of an enabling environment where HIV/TB related stigma and discrimination is eradicated and people living with and at higher risk of HIV have access to affordable quality health care services.

PLEASE follow this link for the Job Description and how to apply.

By Avako Specioza

The tobacco industry has for a long time affected innocent lives world over through several ways including; advertising and encouraging direct smoking of cigarettes, secondhand smoke exposure, smoking of other combustible tobacco products , smokeless tobacco and electronic nicotine delivery systems (ENDS) among others. Cigarettes were manufactured as far back as the 17th century in America and in Uganda, British American tobacco introduced tobacco growing in the 1920s. During this time the industry grew and became a force to be reckoned with. Tobacco came to be known as one of Uganda’s leading cash crops and the industry recruited many people to cigarette smoking which has to date had exponential adverse effects on public health of the nation.

The scope of the burden of disease and death that tobacco smoking imposes on the public’s health is extensive. Tobacco smoking has serious ramifications on public health as it is one of the leading causes of death in the world. Tobacco smoking kills more people annually than AIDS, Malaria and tuberculosis combined. Tobacco has passed the test of being the most toxic legal product which kills its users when used according to prescription. The World Health Organization has stated that tobacco kills up to half of its users because it contains more than 7000 chemicals, of which at least 250 are known to be harmful and at least 69 are known to cause cancer.

The WHO report on Global Tobacco Epidemic 2008, confirms that the global tobacco epidemic is one of the greatest public health threats of modern times as smoking causes so many deleterious health effects. Some of these health effects include; diminished health status, susceptibility to acute illnesses and respiratory symptoms, death, coronary heart disease, cancers of any organ of the body, chronic obstructive pulmonary disease or COPD, pre-mature births, among others.

The tobacco companies use a business model that is focused on maintaining or increasing new users of their products, even if this means targeting adolescents. This is achieved by marketing products that promote adolescents perception that increase the probability of experimentation and continued use. Over the years, the tobacco industry has created distinct lifestyle images associated with different brands, and their marketing strategies include package design, product placement, advertising, promotional activities and pricing.

Uganda has taken a great leap in tobacco control interventions through ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and consequently the enactment of the Tobacco Control Act of 2016. This Act provides for control interventions including; large pictorial health warning of not less than 65%, restrictions of the tobacco industry’s advertisement of its products, smoke free policies in public places, 50 meters smoke free space from residential or business areas, restrictions on tax incentives given to the tobacco industry, restricting minors from purchasing tobacco products among others.

With all its insidious acts and plans, the tobacco industry strives to maintain customers, encourage those that have quit resuming smoking and recruiting others especially the youth. This therefore makes the implementation of the tobacco law more apparent than before. Furthermore this calls for concerted efforts of the government departments, civil society, the police and all members of the public to ensure implementation of the tobacco law, a smoke free environment and support to patients who are addicted to quit smoking. Effort should therefore be directed to ensure that commercial interests of the tobacco industry do not override public health.

By Denis Jjuuko

Sexual Reproductive Health and Rights (SRHR) continue to be among the most controversial and contentious topics in Uganda’s cultural, religious and policy environment. This is because of the competing approaches in the policy debates that range from religious and cultural perspectives, to legal approaches. However, a combination of factors such as: limited access to a wide range of family planning services by those in need; access to sexuality education has led to an increasing number of unwanted pregnancies, among teenagers for instance, which stands at 25%. A significant number of these end in induced abortion, posing a serious public health, human rights and social equity dilemma that affects millions of women in sub – Saharan Africa, including Uganda, albeit the ambiguous regulations on abortion.

Uganda’s dwindling maternal health record is partly evident in her highest rates of unsafe abortion in Eastern Africa. The estimated rate of 54 abortions per 1,000 women of reproductive age is far higher than the average of 39 abortions per 1,000 women for East Africa. Unsafe abortion is among the leading causes of maternal morbidity and mortality in Uganda, contributing approximately 26% of the estimated 6,000 maternal deaths every year, and an estimated 40% of admissions for emergency obstetric care. It equally places a huge cost on the public health system; approximately Ushs 7.5 billion (US$13.9million) are spent annually to treat complications. Poor, rural women are at increased risk of unsafe abortion, 68–75% experienced complications, compared with the 17% complication rate for non-poor urban women.

The country’s restrictive abortion laws permit termination of pregnancies only to save the life of a pregnant woman. However, conflicting and restrictive interpretations of the abortion provisions under the 1995 Constitution of Uganda, the Penal Code Act of 1950 and National Reproductive Health Policies have created confusion about the correct legal status of terminating pregnancies. Because the government has not operationalized Article 22(2) of the 1995 constitution of Uganda as a way of clarifying the parameters for legal abortions, healthcare providers are unable to provide safe and legal services, while law enforcement officials and judicial officers do not effectively enforce or implement laws that permit abortion, thus denying women and girls access to safe and legal services. Inadequate regulations have also led quark doctors to freely advertise abortion services without clarity on their degree or level of safety. This environment further risks the lives of young girls and women, due to the complications that arise, thereby making unsafe abortion a public health dilemma. However, this can be averted by creating a progressive SRHR legal and policy environment as a central tenet to preventing and reducing the unacceptably high rates of maternal death in Africa.

It was upon this background that CEHURD convened a socio-cultural dialogue on 6th and 7th March 2018 at Hotel Africana to discuss SRHR in Uganda and find sustainable strategies for addressing the deficit created by a regressive SRHR environment as a critical element for good health and wellbeing of people, quality education that encompasses access to information for living healthy lives, and promoting gender equality.

The dialogue involved examining the status of the SRHR environment in Uganda; tracking progress of achieving Sustainable Development Goals 3, 4; discussing strategies of harnessing the population dividend for holistic development within a progressive SRHR environment; and defining roles, responsibilities and accountability mechanisms of key sectors for a progressive SRHR environment.

The dialogue targeted policy makers, technical people in the different line ministries, civil society organisations, religious and cultural leaders, law enforcement institutions, service providers and academics alike. The dialogue involved use of videos, panel discussions, and questions and answers questions, and participants agreed to a need to reduce on teenage pregnancies as a way of solving the unsafe abortions equation. They also agreed to a need for clear regulations and implored different SRHR stakeholders contribute to a progressive SRHR environment.