Judicial Endorsement Of Maternal Health Rights In Uganda

PRESS STATEMENT

FOR IMMEDIATE RELEASE:

WEDNESDAY 19TH AUGUST 2020

JUDICIAL ENDORSEMENT OF MATERNAL HEALTH RIGHTS IN UGANDA

Kampala – Uganda. Today, Center for Health, Human Rights and Development (CEHURD), Prof. Ben Twinomugisha, Rhoda Kukiriza and Inziku Valente with joy welcome the long awaited judgement from the Constitutional Court of Uganda in the case of CEHURD, Prof. Ben Twinomugisha, Rhoda Kukiriza and Inziku Valente vs. Attorney General [Constitutional Petition No. 16 of 2011]. The Constitutional Court agreed with our submissions and all judges accepted all the grounds of the petition. Through this judgement, the right to maternal health care (and the right to health broadly) has been granted a place in Uganda’s Constitution. The judgment recognizes basic maternal health care services and emergency obstetric care.

This suit, filed in 2011, sought to challenge Government’s omission to adequately provide basic maternal health services and commodities in public health facilities as contravening the right to health, rights of women, right to life and freedom from cruel, inhuman and degrading treatment. The suit is premised on the wrongful deaths of the late Anguko Jennifer who died on 10th December 2010 in Arua Referral Hospital and the late Sylvia Nalubowa who died on 19th August 2010 in Mityana District Hospital. Both women died during child birth when they needed caesarean sections but failed to access the commodities and human resource required to obtain the same.

Today a panel of 5 (five) judges from the Constitutional Court of Uganda including Mr. Justice Alfonse Owiny Dollo DCJ, Mr. Justice Kenneth Kakuru JCC, Mr. Justice F.M.S Egonda Ntende JCC, Mr. Justice Barishaki Cheborion JCC and Mr. Justice Christopher Madrama JCC have upheld the maternal health rights of women and went ahead to declare and order that;

  1. The Government’s omission to adequately provide basic maternal health care services and emergency obstetric care in public health facilities violates the right to health, the rights of women, the right to life and freedom from cruel, inhuman and degrading treatment.
  2. The Government should in the next financial year prioritize and provide sufficient funds in the national budget for maternal health care.
  3. The Ministry of health are directed to ensure that all staff who provide maternal health care services in Uganda are fully trained and all health centers are equipped within the next 2 financial years (2020/2021 and 2021/2022)
  4. The Ministry of Health is directed to compile and submit to Parliament, with a copy to Court a full audit report on the status of Maternal health in Uganda at the end of each of the next 2 financial years (2020/2021 and 2021/2022)
  5.  Rhoda Kukiriza and Inziku Valente are awarded 155,000,000/= each as general and exemplary damages for the psychological torture, loss suffered and violation of rights

In his lead judgement Mr. Justice Barishaki Cheborion JCC found that “I have no doubt that the government has made attempts to address the omissions by putting in place policies, programs as reflected in the respondents submissions however for the right to maternal health to be realised, subsequent implementation of all the above mentioned policies and programs, their extension and evaluation has to be done which to a large extent has not been the case. Adverse effects on maternal health impact negatively on society’s wellbeing”  

He also found that “The deaths of Ms Anguko Jennifer at Arua Regional Referral Hospital and Ms Sylvia Nalubowa at Mityana District Hospital were a result of non-availability of basic maternal health services and negligence of Health Workers. The actions caused utmost pain, degrading and cruel treatment of the deceased for the period they spent in the said hospitals fighting for their lives with no hope of survival until they died. This also caused untold suffering and loss to their families”

He also found that “Women suffer a lot due to shortages or short comings in the delivery of maternal health care services caused by stock-outs of maternal health care packages, drugs, professional negligence. Limited budgetary provisions to the health sector all of which deprive them of opportunity to safely deliver babies. Preventable deaths of pregnant women at Government hospitals deprive Women of the right to enjoy and realize their sexual reproductive rights

We appreciate the judiciary for protecting, promoting and fulfilling the rights of women especially concerning their maternal function, indeed the power of the judicial pen has come to light in this case. Thank You

For more information contact: info@cehurd.org and copy in wasswa@cehurd.org or call 0788-882809.

Instructions For The 7th Annual National Inter-University Constitutional Law Moot Court Competitions 2020

The Center for Health, Human Rights and Development (CEHURD) convenes the Annual National Inter-University Constitutional Law Moot Court Competitions. Since 2014, the moot court competition has seen more than ten (10) law schools in Uganda participate. The moot court competition is geared towards inculcating a better understanding of the Justiciability of the Right to Health and other human rights guaranteed by the Constitution of the Republic of Uganda, 1995 and recognized in several international instruments.
It also aims at aiding law students to improve their public speaking skills and give them an experience of the litigation process in Uganda. The CEHURD moot has built a cohort of young lawyers who appreciate the right to health and its Justiciability within the confines of Uganda’s legal system.

The Plight Of An African Child: Lived Realities Of Girls In Uganda

Rose (not real name), a 15-year -old girl of school going age, is now eight
months pregnant and about to deliver after being allegedly defiled by a
paternal uncle. Being an orphan with no immediate family to turn to, she
struggles daily to find decent shelter and meet her basic needs. While she
stays in the care of a well-wisher, her case was only reported to the Police
when she was five months pregnant. The delay in reporting her case was
caused by the alleged offender who has threatened the life of Rose and
anyone that attempts to provide shelter and seek justice for her.

Rose is a classic example of many girls whose stories have been
normalised in our societies. They barely see the light in the corridors of
courts of justice due to other contributing factors that have resulted into
immense physical and mental traumatic suffering.
Many children and young people are yet to receive justice for the abuses
inflicted upon them due to the failure of the different stakeholders playing
their respective roles in the chain of justice.

A gap in access to information
In 2019, 13,613 defilement cases were reported according to the Police
Annual Crime Report. Center for Health, Human Rights and Development
(CEHURD) has so far recorded 21 cases through their Community Health
Advocates and their toll-free line (0800313131). Many of these have not
received sufficient redress from the Police and the Courts of Law. The few
that have been settled out of court, are usually done so in ways that do not
favour the justice needs of the children affected. As such, access to justice
for children in Uganda remains a dream.

Access to sexual and reproductive health and rights (SRHR) information
continues to be among the most controversial and contentious topics in
Uganda’s legal and policy environment. This is because of the competing
approaches in policy debates and legal approaches that range from religious and cultural perspectives that inform our different backgrounds. A combination of factors such as limited access to a wide range of sexuality
information and education for both in and out of school young people, rape,
defilement and poverty continue to account for the numerous teenage pregnancies and child marriages in Uganda.

The lack of information among adolescent girls and young women such as
Rose shows that many of them are not empowered about their SRHR. It
further demonstrates the violence adolescent girls and young women go
through as a result of sexual violence coupled with the lack of SGBV shelters
from where they can receive psychosocial support.

Three out of 10 teenage girls become pregnant before they reach 20 years
of age and over 300,000 babies born in Uganda are born by adolescents
aged 15-19 years. Teenagers in rural areas are more likely to start child
bearing earlier than those in urban areas; 27 per cent and 19 per respectively. It is important to note that one of the major drivers of teenage
pregnancy is an early sex debut among young people. According to the
Uganda Demographic and Health Survey of 2016, 10 per cent of women
and 17 per cent of men have already had their first sexual encounter by the
age of 15.

Pursuing a child-friendly justice system
The current retrogressive regulations and policies coupled with lack of
sexuality education and other reproductive health and rights information and services have exacerbated the already bad state of young people’s health and well being.

As the world commemorates the Day of the African Child today in memory
of the thousands of black school children who took to the streets on June
16, 1976. They did this to protest the inferior quality of education and to
demand their right to be taught in their language. This is therefore a good
opportunity to not only create awareness about the needs of young people
but also to assess the state of their rights in Africa. It is also a good time to
amplify the need for a continued improvement in their education. The day
draws attention to the lives of African children and encourages people’s spirit of abundance to share something special with a child in Africa.

The Constitution of the Republic of Uganda defines a child as any one
below the age of 18 years. This year’s theme, “Access to a child- friendly
Justice system in Africa
”, reminds us of the restrictions that our current
policies have. It is also an opportunity for duty bearers to help the Ugandan
child enjoy their right to access to friendly justice, sexuality education and
other health information and services. This access would counter the
problems of unplanned pregnancies, pregnancy related complications and
unsafe abortions that account for a sizable contribution to the maternal
mortalities in adolescent girls and young women. The outbreak of the
COVID-19 global pandemic and its rapid spread throughout the world,
Uganda inclusive, came with increased risk for the population, especially
young people.
The pandemic has equally put many health care systems to the test on the
competence of responding and containing the virus while observing human
rights, particularly the rights of young people.
In Uganda, the state’s response to minimise the spread, has been slow to
address sexual and reproductive health, maternal health, access to justice
and other needs of young people. This is further reflected by the supplementary budget allocations being requested by the institutions of
government to respond to the pandemic. Many of these barely have any
consideration for health and human rights.
Just a few weeks into the outbreak, access to services was already
problematic as a number of rights violations were cited. Numerous media
reports about teenage pregnancies, violence against children, defilement,
and rape, among others were and continue to be reported. All this has been
exacerbated by the lock down as imposed by the President of Uganda which
also caused temporary halting of court proceedings. This has further slowed down the speed at which young people can access justice during this time.
Meanwhile, they continue to experience human rights violations.
This comes at a time when the country continues to grapple with poor SRHR
indicators. This means that young people in and out of school continue to
bear the burden of these negative SRHR indicators. This burden includes
teenage pregnancies, problems accessing essential health commodities like
menstrual health products such as sanitary pads, HIV/AIDS and other STIs
medication, among others. Some of the factors that have contributed to this
state of affairs include the lack of information for young people to enable
them make informed health choices, lack of access to services and all these
are exacerbated by the weak policy and legal environment.

Recommendations
To undo this harm and correct the above indicators, the government needs
to take bold steps in establishing progressive laws and policies that are
aimed at eliminating the various injustices that continue to affect Uganda’s
children;

  1. Fast track the passing of the National Policy on Sexual and
    Reproductive Health and implement the recently approved Age Appropriate Sexuality Education National Framework.
  2. Fast track the effective implementation of the National strategy on
    ending child marriage and teenage pregnancies in Uganda of 2015
  3. Develop comprehensive multi-sectoral strategies to avert the
    challenges and injustices that continue to ruin lives of children and young people and harmonise legislation on marriage to provide for 18 years as the minimum legal age for marriage.
  4. Strengthen the enforcement of laws against defilement, rape and
    other forms of child abuse and establish youth friendly spaces at health units.
  5. Facilitate the Courts of Law to hear and determine cases defilement,
    rape and other forms of child abuse to enable children access justice timely.
  6. Finalise and pass the Adolescent Health Policy to update issues of
    adolescent health in national and global development trends and context.
  7. Government establishes provisional shelters at police stations manned by the Child and Family Protection Unit, to avail SGBV survivors temporary accommodation pending medical examination and investigation of cases to avoid frustrations.
  8. That the government ensures that children have access to psycho social support to meet their mental health needs. Train senior women and male teachers on how to provide counselling and deal with the different health needs of young people, including implementation of the Girl Child School Re-entry and Retention Strategy to give any girls who may report to school with pregnancies, an opportunity to continue with their studies.
  9. Repeal all those laws and policies that compromise the protection and
    welfare of the children.

In a nutshell, as we celebrate the Day of the African Child, creating a child-
friendly justice system in Africa, and specifically in Uganda, requires a multi sectoral approach and meaningful collaborations. This collaboration should not only be among the different government line ministries and agencies but also with civil society organisations, parents, teachers and the media.

A version of this article was originally published in the Daily Monitor.

Patient Abandoned For More Than Five Hours After A C-Section At Kibuli Muslim Hospital

By Faith Nabunya

“My wife was left unattended in the postnatal ward for close to five hours until I paid Shs205,000 to have blood brought to Kibuli Musilm Hospital for her diffusion. Without any medical records, they told me to take my wife to either Mulago hospital ICU if I still needed her alive. For the three days I was in Kibuli hospital, I never got anyone to explain the state of my wife even during transfer to Case hospital. I was never given her medical records. It’s only at Case Hospital that I was told that my wife is anaemic due to over bleeding and she had suffered from liver damage. Justice should be served for my wife and it should be a lesson that all women deserve good health care,” Mr Rafaile Omony shares what happened to his now deceased wife.

On July 2nd, 2020, The Center for Health, Human Rights and Development filed a complaint with the Uganda Medical and Dental Practitioners’ Council (UMDPC) against Kibuli Muslim Hospital, challenging the violation of medical professional ethics, and human rights of Mr Omony. Omony’s wife, Scovia Mary Alupo, died on  October 27th, 2018 after undergoing a cesarean section, following which she bled to death.

Uganda suffers a persistently high maternal mortality ratio (MMR) currently at 336 per 100,000 live births which translates into 16 women dying every day during childbirth majorly because of lack of basic maternal health commodities like gloves, syringes, blood, medicines etc, which enable women to give birth safely. This is worsened by low political will to equip and sufficiently fund healthcare facilities, which sees two midwives working in more that 30 expectant mothers at a go. 

“Women die everyday due to severe bleeding while giving birth. Blood is an essential life saving commodity that can’t be replaced and so should be freely given to those who critically need it. Health facilities should be held accountable for any life lost due to failure to pay for blood. This is unacceptable and we need UMDPC to exercise its mandate of general supervision and disciplinary control over medical practice to uphold health and human rights”, Ms Edith Sifuna shares.

Dr. Katumba Ssentongo, the Registrar at UMDPC says that their role as UMDPC is to supervise and exercise discipline action to all dental and medical practice in Uganda. In two (2) weeks time after reviewing the complaint (CEHURD & Omony), Kibuli hospital will be notified through an official letter from the council to get their defence.

Ms Alupo has become one of these tragic statistics and we cannot leave her death unaccounted for. CEHURD has therefore petitioned UMDPC seeking that Kibuli Hospital and the concerned health care workers be investigated and found culpable for the professional misconduct exhibited. CEHURD equally intends to bring these human rights violations to the attention of the courts of judicature, seeking compensation for the family of Ms Alupo. “ We want UMDPC to take action against its members that violate the medical profession ethics fulfilling their mandate of monitoring and regulating the practice of medicine and dentistry as per the Uganda medical and dental practitioners’ Act” Ms Ruth Ajalo, a lawyer representing CEHURD adds.

The writer is a Communications Officer at Center for Health, Human Rights and Development.