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By Noor Nakibuuka

On 10th and 11th July 2023, Africans converged in Nairobi, Kenya to commemorate 20 years of the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (The Maputo Protocol). The protocol was adopted on the 11th of July 2003 in Maputo. It is one specific piece of legislation that advances women’s rights in Africa.

The celebrations come in at a time when most African countries are facing retrogression in advancing women’s rights. Uganda, for example, has had several incidences where access to sexual and reproductive health and rights for girls and women, which is a key pillar in this protocol, is on a descending trajectory. At the same time, other countries like South Sudan have taken bold steps to adopt the protocol given its importance in advancing women’s rights in Africa. South Sudan makes the 44th country out of 55 African countries to adopt the protocol.

As we commemorated the 20 years of Maputo, the Center for Health, Human Rights and Development (CEHURD) had an opportunity to engage in one of the side events that were organized by IPAS Africa Alliance in collaboration with other partners like Akina Mama wa Afrika to specifically focus on Article 14 of this protocol. The article  discusses access to safe abortion as a key human rights issue. From the discussions, it was emphasized that indeed many African countries should look into this instrument to advance women’s rights to access safe abortion, since many still have archaic legislations that restrict the same at domestic level.

While speaking at this side event, Commissioner Njie Sallah of the African Commission on Human and People’s Rights specifically highlighted the importance of this article that, “the article is one that we would all wish to retain, highly guard and utilize it to advance women’s rights. Many African countries do not have such a progressive legislation when it comes to this issue and it’s important that as human rights activists, leaders, pan Africans, government officials, deeply think about the importance of this article”. The Maputo Protocol is one of its kind.

The commemoration also comes at a time when many countries have boldly advanced conversations around access to safe and legal abortion. In Uganda, the Constitution allows Parliament to enact a law regulating termination of pregnancy. However, since its promulgation in 1995, parliament has not taken such a step. This prompted CEHURD to institute a legal case in the Constitutional Court for an interpretation of this particular constitutional provision. The existing Penal Code Act, was enacted over 70 years ago and does not address public health discussions that have since been advanced by the colonialists including Britain to put aside such legislations. The court is yet to issue a ruling in this matter.

Uganda is celebrated for having boldly ratified the Maputo Protocol. While the state entered a reservation on article 14(2)(c) of the same, pertaining to reproductive health and safe abortion, commendable steps have been taken to advance the rights of women. Uganda enacted various pieces of legislation that place women at the forefront of decision making. Beyond the Constitution that stipulates equality, non-discrimination, the maternal role that women play in society, and the leadership of women, among others, the Domestic Violence Act, 2010, Equal Opportunities Commission Act 2007, the Penal Code Act cap 120, the Public Finance Management Act, 2015, et cetera, have provisions that advance gender equality and women’s rights.

At the 20th anniversary of Maputo, it is worthy to note that this protocol is special. Of all the regional and international human rights instruments that Uganda and other African countries have ratified, the Maputo Protocol is one of a kind and a lot of attention is paid to it. Implementation of the Maputo Protocol has been the core agenda under the Solidarity for African Women’s Rights (SOAWR) to which CEHURD is a member together with 62 other Civil Society Organisations working across 32 African countries to protect and advance women’s rights. SOAWR has ensured that each of the African member countries works towards the implementation of the protocol and reports back to the committee even when governments have fallen short of this reporting.

CEHURD celebrates SOAWR, for having taken this bold step. We will continue to work to ensure that women’s rights are recognized, protected, respected and fulfilled.

The writer is a Lawyer and Deputy Executive Director – Programmes at Center for Health, Human Rights and Development (CEHURD). 

Empowering Health Service Providers in Uganda: CEHURD’s Impact on Sexual and Reproductive Healthcare Transformation

CEHURD’s strategic litigation approach has been instrumental in strengthening health systems. By utilizing health workers as witnesses in strategic cases, CEHURD has shed light on systemic issues and advocated for policy reforms. Through these efforts, we have successfully influenced positive changes in the healthcare infrastructure, resource allocation, and access to essential medicines and supplies.

By Ms. Ajalo Ruth 

CEHURD is a non-governmental, not-for-profit indigenous research and advocacy organisation established to pioneer advocacy for the justiciability of the right to health in Uganda and East Africa, and with a regional and global impact. CEHURD works towards ensuring that the vulnerable communities in Uganda access health systems and that social justice and human rights in health systems are realized. One of the goals of the organization is to create an enabling legal environment and justice system that promotes, respects, and guarantees the right to health.

The provision of quality sexual and reproductive healthcare services in Uganda has long been a challenge, especially in under-served communities.  CEHURD has over the years taken a deliberate effort in transforming healthcare through legal and policy awareness on sexual and reproductive health and rights thus empowering health service providers with the right information to deliver quality health care. This has been realized through a multi-faceted approach that includes trainings, legal support, and strategic litigation.

CEHURD recognizes the critical role health service providers play in ensuring women and girls do not die due to preventable causes. It has nurtured and sustained relations with medical health service providers associations to create exchange learning platforms where health care service providers are equipped with up-to-date knowledge and skills to deliver effective healthcare services and advocate for better health care systems.

Health service providers have been trained on the Harm Reduction and Life Indication Models. The Harm Reduction Model refers to a range of public health policies and practices designed to lessen the negative social and/or physical consequences associated with various behaviors both legal and illegal, while the Life Indication Model addresses a lacuna that often arises when the state permits abortive procedures under certain exceptions, such as to save the life of the mother. These trainings ensure that health workers are equipped with the necessary information and tools to provide appropriate and compassionate care, reducing harm and improving health outcomes for patients and to keep within the confines of the legal framework in Uganda.

The trainings of health service providers have also paved the way for the development of various knowledge products with information guiding them on how to effectively offer SRHR information and services. There has also been ongoing litigation of cases which are advocating for a progressive legal and policy environment around SRHR to support health workers to operate and offer SRHR services legally.

Given the known controversies around abortion related health care services, CEHURD established the Legal Support Network (LSN). This is a network of lawyers that plays the crucial role of providing free legal services to health service providers who are caught up in the criminal justice system. In addition to representing health workers in legal proceedings relating to Sexual and Reproductive Health and Rights (SRHR) services, the LSN also aims at building a body of legal practitioners knowledgeable on the law and practice on SRHR in Uganda. Further, the LSN has been a big player in the various health service provider trainings as well as ensuring that the said professionals operate within the law.

More so, CEHURD’s strategic litigation approach has been instrumental in strengthening health systems. By utilizing health workers as witnesses in strategic cases, CEHURD has shed light on systemic issues and advocated for policy reforms. Through these efforts, we have successfully influenced positive changes in the healthcare infrastructure, resource allocation, and access to essential medicines and supplies.

CEHURD’s engagement with health workers has yielded remarkable success stories. Health workers involved in CEHURD’s initiatives have demonstrated improved knowledge of laws and policies surrounding SRHR. Their commitment and dedication have been recognized, with accolades such as “Midwife of the Year, 2022” awarded to deserving individuals with whom we have worked. These success stories serve as inspirations, showcasing the positive impact of CEHURD’s empowerment programs on health workers’ professional growth and patient care.

While our work with various health service providers  has achieved notable progress, challenges persist; limited resources, the restrictive legal environment on SRHR, cultural barriers, and social stigmas pose ongoing obstacles to effective healthcare delivery. Additionally, health workers still face risks and legal challenges in providing care related to contested issues such as safe abortion care. CEHURD continues to address these challenges through collaborative efforts and advocacy for policy reforms.

Nonetheless, we continue to invest resources in capacity building for health workers, ensuring they receive ongoing trainings to stay afloat given the slippery Ugandan environment within which they operate vis a vis the evolving healthcare context like digital service provision. It calls for strengthened partnerships with stakeholders to advocate for progressive policies, particularly in sensitive areas like abortion. Additionally, CEHURD emphasizes the importance of expanding legal support networks to protect health workers’ rights and foster a supportive environment within the criminal justice system.

The writer is a Lawyer and a Programme Officer in the Strategic Litigation Programme at CEHURD.

A World Of Equal Chances

By John Vianny Ayebare

In his book, Animal Farm, written many years ago, George Orwell tells us about Moses the tame raven who had made it a mission to convince other animals that there was a better world somewhere in what he called Sugar candy Mountain. Moses said that in that world, it was always holidays, and sugar and cake grew on hedges. Anybody visualizing such a world would imagine a world where everyone’s rights are respected, a world where life flourishes and good health reigns supreme.

Every 11th of July, the world remembers the World Population Day which was established by the United Nations in honor of the 11th of July 1987 when the world population hit the five billion mark. What has happened in terms of population growth since then has been extraordinary. Within just 36 years, the number of people gracing this little planet has increased by more than half to an estimated eight billion.

On one hand, this increase in population should signify increased opportunities and a well-developed support system where we all feel treasured and respected, on the other hand, it gives us an opportunity to reflect on the population issues such as family planning, gender equality, violence against others especially the vulnerable, discrimination, access to sexual reproductive services, among others.

The United Nations Population Fund (UNFPA) notes that women contribute 49.7 percent of the total world population, yet it is also evident that despite their special role in this very aspect, they still face uncertainty about their own lives while giving birth. It was revealed early this year that every two minutes, a woman dies during pregnancy or childbirth. Imagine the shame you must accept to the effect that by the time you finish reading this article, at least 3 women will have died. In Uganda, the situation is no different. About 5,500 women die every year while trying to play their natural role of bringing life on earth. This translates to one woman dying every one and a half hours.

The Constitution of Uganda is to the effect that it is the responsibility of the government to direct the health policy in the country. This position is also reiterated in a number of international instruments. For Example, Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women goes further to oblige states to ensure that women access appropriate services in connection with pregnancy, confinement and the postnatal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation. Uganda ratified this covenant without any reservations.

While the government has taken great strides to improve the conditions of women and girls through affirmative actions in representation, and education, there is a lot more to be done if we are to achieve the sustainable development goal of ensuring healthy lives and promoting well-being for all, which aims at reducing maternal mortality ratio to less than 70 per 100,000 live births. The following should therefore be done to salvage the situation.

  • Strengthen the Village Health Teams to increase their capacities in monitoring the health needs of pregnant women in their jurisdictions.
  • Men should be encouraged to welcome family planning methods especially those which are male centered, and to support women in accessing family planning services.
  • Establish progressive budgetary commitments at both national and local levels to meet maternal needs and avert the likely dangers of refusal to attend to pregnant women because of their financial incapability. The Abuja Declaration made 22 years ago where African states committed to spending at least 15% of their budgets to the health sector should be respected.
  • Strengthen Public Private Partnerships to ensure ease of access for both antenatal and postnatal care.
  • Provide strict policy guidelines on stocking contraceptives and sexual reproductive services in all health centers to avoid stock outs.

Women should be empowered to make informed choices through unfettered access to sexual reproductive health services while removing barriers such as cultural beliefs, discrimination, violence, and lack of information as far as sexual reproductive services are concerned. This way, we will start looking at a world of 8 billion people as that in Sugar candy Mountain where dignity, happiness and respect for all matter.

The writer is an Intern at the Center for Health, Human Rights and Development – CEHURD.

An African Child Deserves a Chance to Reach their Full Potential

” The International Day of the African Child is a time to reflect on the challenges facing children in Africa. One of the most pressing challenges is teenage pregnancy, a serious problem in Africa. Uganda has one of the highest rates of teenage pregnancies in sub-Saharan Africa, estimated at about 25%.


By Clifton Irahuka – Health service provider

Ms. X, a 16 year-old walked into a facility for the first time and was later confirmed to be 4-months pregnant. She came in with neither companion nor sure of who owns the pregnancy. Her family had rejected her and she dropped out of school. Her friends advised her to use some herbs to end the pregnancy. She followed the advise of peers but was later  worried after noticing vaginal bleeding, but had no idea on what to do next, which help to seek and where to seek it.

The tears she’s been shedding since she saw the blood were triggered by her recall of how others bullied her on one day when she stained her dress at school. At the time, she had no access to menstrual pads and neither could parents provide. She was in a dilemma. This prompted her to sleep around with older men to earn some money for her survival. Her cry for them to at least use condoms fell on rock-filled ears because they are men, had the money and thus her decision and choice didn’t matter.

The scenario of Ms X is a true reflection of an African girl born in a poor, less literate and rural family who like many others, is burdened with high fertility rate, risky sexual behaviors, peer pressure into early sex, forced into early marriages, lacks education, lacks family support, with a low socio-economic status and low use of contraceptives. Many of them find themselves in such scenarios but with no help. That is the African child!

On June 16 every year, the world marks the International Day of the African Child. This day commemorates the Soweto Uprising, which took place in South Africa in 1976. On that day, thousands of black students protested against the apartheid government. The protests were met with violence, and hundreds of students were killed.

The International Day of the African Child is a time to reflect on the challenges facing children in Africa. One of the most pressing challenges is teenage pregnancy, a serious problem in Africa. Uganda has one of the highest rates of teenage pregnancies in sub-Saharan Africa, estimated at about 25%.

According to UNFPA, one in five girls in Africa will become pregnant before the age of 18. This has a number of negative consequences for girls, including but not limited to increased risk of maternal deaths, reduced educational opportunities, increased poverty and increased risk of sexual violence.

Some of the factors that contribute to teenage pregnancy in Uganda include:

  • Limited access to sexual and reproductive health services: Many girls like Ms X in Uganda do not have access to sexual and reproductive health services, such as contraception information and services. This makes it difficult for them to prevent pregnancy, and can also put them at risk of unsafe abortion.
  • Early marriage: According to the Uganda Demographic and Health Survey (UDHS, 2016), 19% of girls aged 15-19 are married or with a partner. Many girls lack family support, are under peer pressure to engage in early sex and the outcome is unplanned teenage pregnancy.
  • Limited access to education: Girls who do not attend school are more likely to become pregnant as teenagers. 22% of girls who had never attended school were pregnant or had given birth, compared to 12% of girls who had completed secondary school (UDHS, 2016).
  • Poverty is another major factor in teenage pregnancy. Girls like Ms X from poor families are more likely to drop out of school as well as experience sexual violence, which puts them at increased risk of becoming pregnant. They experience power imbalance with cross generational men denying them a choice of contraception further engaging is high risk sexual behaviours.
  • Gender inequality and cultural beliefs also contribute to teenage pregnancies significantly.

On the International Day of the African Child, we must recommit to ending teenage pregnancy in Uganda and some specific things that can be done to achieve that include:

  • Provide access to contraception which is one of the most effective ways to prevent teenage pregnancy. Governments and NGOs can work to increase access to information and use of contraception by making it more acceptable, affordable, and available.
  • Provide sexuality education: this is essential for teaching young people about their bodies and how to prevent pregnancy. Governments and schools can work to provide  sexuality education that includes information about contraception, sexually transmitted infections, and healthy relationships. This could be age appropriate information
  • Address the root causes of teenage pregnancy: Teenage pregnancy is often a symptom of other problems, such as poverty, gender inequality, and lack of education. The duo can work to address these root causes by investing in education, providing economic and entrepreneurial skills and opportunities, and promoting gender equality.

By taking these steps, we can help to reduce the number of teenage pregnancies in Africa and give all children the chance to reach their full potential.

The writer is a Midwife and Sexual Reproductive Health and Rights Advocate.

Investing in women’s Health is not a mere humanitarian call, it is a human right and development issue

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation.

By Fatia Kiyange

Every year, on the 28th of May, the world marks International Day of Action for Women’s Health. The day symbolises the importance of giving attention to the health of women and girls. It reminds nations that women’s rights are human rights. Reflecting on the World Health Organization’s definition of health, women’s and girl’s health means that women and girls are in a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Women play an indispensable role in the health of their families and consequently their communities. Because of this, investing in their health is an investment in population health with positive implications for the country’s overall development.

Women’s health, especially in lower-income countries is influenced by many factors. These range from social, cultural and economic to gender, biological factors and place where they live. These come with a myriad of barriers which make it difficult for women and girls to access health care services at the time and in a place where they need them. This constitutes an injustice and a violation of the right to good health and well-being for women and girls, consequently affecting their physical, psychological, mental and spiritual state.

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners. Uganda’s maternal mortality ratio is still high at 336 per 100,000 live deliveries, and this translates into 18 deaths per day. This is way above the target of reducing maternal mortality to less than 70/100,000 births under Sustainable Development Goals. Important to note is that 28% of maternal deaths are among young women aged between 15 to 24 years. Early and unwanted teenage pregnancies are still high with a prevalence of 25%, one of the highest in East and Central Africa and with a national target of reducing it to 15% in the National Development Plan III 2020/21-2024-25. Our child marriage rate also remains very high at 43%. Despite the high total fertility rate of 5.4 contributing to the high population growth rate of 3%, the country has a high unmet need for contraception and other family planning services of 23.8% with a national target of reducing this to 10%. The HIV prevalence among women (7.6%) is higher than the national rate of 6.2%. Sexual and gender-based violence has remained high with spousal violence reaching 56% and sexual violence at 26%. A total of 12,715 cases of defilement (among children 0 -17 years) were reported in 2022 according to the Police crime report for the same year with 653 of these happening among children aged 0 – 8 years.

There are also health conditions women and girls suffer because of their biological make up. These range from reproductive cancers like breast cancer, cervical cancer, to menopause, pregnancy and menstrual cycle challenges. Urinary track infections and sexually transmitted diseases present more in women with undesirable effects.

It is now common knowledge that the Covid-19 pandemic and some of the response measures exacerbated indicators for sexual reproductive health, especially among young people and heightened the need for specific health services, such as mental health. However, emphasis for post-Covid recovery have been placed more on stimulating economic recovery programs. Attention towards access to quality health care for the most vulnerable members of our society could be given more attention to realise full recovery from the multifaceted impact of Covid-19.

All nations are working to realize the 17 SDGs by 2030 and committed to prioritise progress for those who are furthest behind by pledging to “Leave No One Behind”. Uganda among the first countries to develop a national development plan in line with SDGs for which Universal Health Coverage (UHC) under SDG 3 on good health and well-being is central. UHC means that all people have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliation) without the risk of financial hardship when paying for them. Given their economic challenges, women and girls especially those in the remotest areas are more likely to experience catastrophic expenditures on health which push them further down into poverty. A common and practical example is the reality of women and girls having to bear the cost of sanitary pads or their equivalent every month for the larger part of their lifetime.

As a country, we must reflect deeply on the underlying causes of these persistent reproductive health challenges of women and girls and set out to address them in the most honest and transparent way. Only then will we be able to realise Uganda’s Vision 2040 which identifies human capital development as fundamental for development. Human capital development contributes to the National Development Plan (NDP) III’s goal of increased household incomes and quality of life through increased productivity, inclusiveness, and well-being of the population. The Goal of the Human Capital Development Programme (HCDP) is to improve the productivity of labour for increased competitiveness and better quality of life for all. The challenges women and girls face in accessing health care services have to be addressed in order to realise this goal. We also have to reverse the population growth rate and structure which is largely constituted by a dependant young population.

Uganda has several policy and legal frameworks, which if well implemented can lead to improvement of indicators for the reproductive health of women and girls and consequently the health of families and communities. Examples of these are: Uganda Family Planning – FP2030 Commitments; the National Family Planning Costed Implementation Plan II; the National Sexuality Education Framework; 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School settings in Uganda; 2018 Uganda National Parenting Guideline and the second National strategy to end child marriage and teenage pregnancy 2022/2023 – 2026/2027, among others. For full implementation of these frameworks to be realised, financial resources must be allocated.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation. The projected reduction in budget allocation to the health sub-programme in 2023/232 will work against the realisation of the country’s goal of the Human Capital Development Programme (HCDP) of improving the productivity of labour for increased competitiveness and better quality of life for all.

The Writer is the Executive Director at the Center for Health Human Rights and Development (CEHURD).