Reduce maternal mortality and morbidity; Adopt best practices in safe motherhood during and post COVD-19

Finalise and pass the National Health Insurance Scheme Bill into law that recognises the unique maternal functions of women by ensuring their ability to access affordable quality maternal health care services from both public and private health facilities.

Esther Dhafa, Programme Officer – Campaigns, Partnerships and Networks Programme, CEHURD

 

Every year, Uganda commemorates the Safe Motherhood day 17th October.The Center for Health Human Rights and Development (CEHURD) joined the country to commemorate this day by calling upon the Government of Uganda to actualise the declarations in the landmark case, Constitutional petition No. 16/2011. This can happen through enhancing and promoting best practices of safe motherhood during and post COVID-19 TO reduce maternal mortality and morbidity. By doing this, we can realise the “Every Woman Every Child” Global Health Strategy Commitments (EWEC) His Excellency the President of the Republic of Uganda made on 15th May 2016 . 

Uganda’s EWEC commitments include among others; ensuring that comprehensive Emergency Obstetric and Newborn Care (EmONC) services in hospitals increase from 70 per cent to 100 per cent and in health centers from 17 per cent to 50 per cent. It also includes ensuring that basic EmONC services are available in all health centers; ensuring that skilled providers are available in hard to reach/hard to serve areas; and reducing the unmet need for family planning from 40% to 20%; increasing focused Antenatal Care 4th visit from 42 per cent to 75 per cent, with special emphasis on prevention of mother-to-child transmission (PMTCT) and treatment of HIV to ensure elimination.

Small steps towards safe motherhood

We do commend the government for the great efforts in reducing the high rates of maternal mortality from 438/100,000 live births in 2011 to an estimated 336/100,000 live births in 2016 (per the Uganda Demographic Health Survey 2016). However, we also note the little progress being made as a country in addressing health related issues that continue to kill women in Uganda  helplessly during childbirth.  As a best practice therefore, maternal health care services should be available, accessible, acceptable and of good quality in order to enhance safe motherhood. 

Over the years and for this specific year,  CEHURD continues to work tirelessly to ensure that women and girls are able to access affordable maternal health care services. This has been done  through a number of approaches including strategic litigation, research, evidence based advocacy and  collective voicing to amplify the need for better health care and service packages countrywide. With these approaches, coupled with government efforts and adoption of best safe motherhood practices, Uganda will be able to reduce  maternal deaths caused due to preventable health causes. These causes include haemorrhage (blood loss), unsafe abortion, hypertension, embolism, sepsis, and other direct causes like complications of anaesthesia and  caesarian sections, and postnatal depression suicide.

As we continue to commemorate Safe Motherhood, CEHURD remembers all the mothers that have died while giving birth. Unfortunately, an estimate of 6,000 women die annually in Uganda as a result of pregnancy related complications making it about 16 women dying per day (UDHS 2016). This means that today 16 women have died, tomorrow 16 will die and 16 more will die the following day which is very unacceptable. With such scary statistics therefore, Government’s obligation to promote safe motherhood becomes important, to ensure that no woman, or baby dies or is harmed by pregnancy or childbirth. This begins with the assurance of basic safety living for all expectant  girls or women in our society. 

Landmark judgment for maternal health

The Justices of the Supreme Court of Uganda in CEHURD, Prof Ben Twinomugisha, Rhoda Kukiriza, and Inziku Valente Vs Attorney General (Constitution Petition/\ 16/2011) finally made a nine-year long journey of collective voicing and persistence worthwhile. The justices set a precedent on maternal health care in Uganda to the joy of various civil society organisations under the Coalition to Stop Maternal Mortality in Uganda (CSMMU), development partners, grassroot women and well-wishers who were have been pushing for better maternal health care. Court declared among others that the Government’s omission to adequately provide basic maternal health care services and emergency obstetric care in public health facilities violates the rights to health, life, rights of women, subjects women to inhuman and degrading treatment. The Court also stated that this is inconsistent with and in contravention of Articles 8A, 22, 33, 39 and 45 read together with objectives XIV and XX of the National Objectives and Directive Principles of state policy of the Constitution. 

Rhoda Kukiriza and CEHURD staff celebrate the positive judgment on Petition 16. CEHURD PHOTO/Jacqueline Twemanye

This suit was filed in 2011 seeking to challenge the 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, and right to life and freedom from cruel, inhuman and degrading treatment. It’s 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 childbirth when they needed caesarian sections but failed to access the commodities and human resources required to obtain the same.

Call to action

We thus call upon the Government of Uganda to fulfill its statutory obligation by;

  • Providing basic maternal health care services to  women in Uganda which include among others prenatal care services, skilled medical officers in health facilities, and provision of Emergency Obstetric Care and postpartum care. 
  • Investing in family planning, antenatal care, safe delivery, newborn care & Post-natal care, and Emergency obstetric care which are the key pillars of Safe Motherhood. 
  • Prioritizing basic maternity care, primary health care and equity for all women to enable them fully enjoy and fulfil their natural maternal functions which is a fundamental human right (Art 33 of the Constitution).
  • Finalise and pass the National Health Insurance Scheme Bill into law that recognises the unique maternal functions of women by ensuring their ability to access affordable quality maternal health care services from both public and private health facilities.

Lastly, informed and effective advocacy is the starting point for bringing about change. We thus call upon all stakeholders to join us in sensitizing the women including the youth and adolescents about safe motherhood and their right to receive and impart accurate sexual reproductive health information and empower them to make informed decisions to be able to keep and stay healthy since a healthy population is able to efficiently contribute to sustainable development. Safe motherhood values the girl child and implies the availability, acceptability, and easy access to health care for women’s prenatal, birth, postpartum, family planning and gynecological needs. 

Let us adopt a multisectoral approach to SRHR and Safe motherhood, for better health and healthy lives.

EVERY WOMAN DESERVES TO BE AND FEEL SAFE AS A MOTHER OR MOTHER TO BE.

JUDGEMENT: Supreme Court orders the Constitutional Court to hear Maternal Health Cases

The judgment struck down a 2012 ruling by the Constitutional Court that it had no mandate to hear a case regarding the alleged violation of health rights and the rights of women.

The case had been filed by families of two pregnant women who died in childbirth and the Center for Health Human Rights and Development (CEHURD) against the Attorney General in 2011 (Constitutional Petition No. 16 of 2011), arguing that non-provision of maternal health services in Uganda violated the Constitution.

The Attorney General argued on preliminary objection that issues relating to health rights were “political questions”—matter that the Judiciary had no authority to address. Constitutional Court agreed with the State’s objection and dismissed the case.

The Supreme Court’s ruling struck down the Constitutional Court’s judgment, and means the original case can now be heard on its merits.

“With great respect to the Constitutional Court, I think they misunderstood what was required of the court. I do not think the court was required to determine, formulate or implement the health policies of government. In my view, the court is required to determine whether the government has provided or taken all practical measures to ensure the basic medical services to the population. In this case it is maternal services in issue” Bart M Katureebe, Chief Justice

 

 

Supreme Court to deliver Judgment on Maternal Health Rights in Uganda

The Supreme Court of the Republic of Uganda is on Friday 30th October, 2015 at 9.30a.m expected to deliver Judgment on whether maternal health rights are justifiable in Uganda.

In a case filed by the Center for health, Human Rights and Development (CEHURD), Mr. Inziku Valenti, and Ms. Rhoda Kukiriza against the government of Uganda, the petitioners sought remedies for non-provision of basic maternal health commodities in public health facilities in Uganda that led to death of their loved ones.

CEHURD and its co-petitioners argued that the public are affected by the non-provision of basic maternal health commodities in government health facilities, and that the imprudent and unethical behavior of health workers towards expectant mothers was unconstitutional and an abuse of poor women’s rights to access health services.

The petitioners relied on evidence that;

  1. The death of a one Sylvia Nalubowa (daughter of Ms. Rhoda Kukiriza) in Mityana hospital due to non-availability of the basic maternal health kits in the district hospital and the unethical behavior of the health workers towards her violated her constitutional right to life and health.
  2. The death of Anguko Jennifer (wife to Mr. Inziku Valente) in a regional referral hospital in Arua also due to non-provision of the basic maternal health commodities and the reluctance of the health workers towards this expectant mother leading to her death was an infringement of her rights to life and health guaranteed under the constitution of Uganda.
  3. Non provision of the basic maternal health commodities to expectant mothers (evidence gathered from community health facilities) and the failure on the part of health workers to exercise the requisite health care leads to death of children hence an infringement of their rights guaranteed under the Articles 22, 33 and 34 of the constitution.

The constitutional Court absconded from hearing the merits of the case on a preliminary objection raised by the attorney General’s Lawyer that the Court did not have the authority to handle matters of that gravity. The court was of the opinion that the issues the petitioners had put to court were of a political nature that necessitated the intervention of the Executive to allocate resources to the health sector and none of courts business to intervene.

As a matter of fact and law, CEHURD, Ms. Rhoda Kukiriza and Mr. Izinku proceeded to appeal that decision to the Supreme Court on the basis that the Constitutional Court erred in law in refusing to listen to the merits of the case. It is this decision that Court will be making Judgment on Friday 30th October, 2015 at the Supreme Court of Uganda.

The Judgment is particularly important because the Ugandan Constitution does not provide for a right to health and in addition makes no commitments or priorities for health financing for primary health care for Ugandans from a legal perspective.

High-Court

Utilizing social media to realize maternal health rights – the #selfie4her campaign

Social media has tremendously grown to sensitize people on their rights. A number of communities have engaged on different social media platforms including but not limited to Twitter, Facebook, Whatsapp, and Instagram, and in one way or another there have been massive campaigns geared towards realization of rights.

With text, photos and info graphics, users of the different social media platforms have developed techniques to target not only the rights holders but also the duty bearers. This they do either by tagging the duty bearers themselves onto the different posts or ensuring that the initiated campaigns are popularized with clear explanations on how to get involved.

Once a campaign takes shape, there is community attraction and support for the same and this on many occasions leads to the much desired change. A number of publicly known successful campaigns have started in social media; take for example the case of a maid that mistreated a child in Uganda, whose video clip went viral on social media. What started as a simple post in social media turned out to be the centre of debate across the country for some good time. To-date, a mere mention of the “maid from hell” – like she was tagged – anyone can give you the whole chronology of the case.

Center for Health Human Rights and Development has for a long time focused efforts towards the realization, protection and preservation of human rights, key among which are maternal health related rights. In a bid to realize these, and given its experience in advocacy, CEHURD initiated a new media campaign, the #selfie4her campaign, to amplify citizen voices in the fight to end preventable maternal mortality. This campaign was launched in March 2015 during an east African media fellowship organized by CEHURD, that brought together journalists from the East African region to discuss sexual reproductive health rights issues.

This social media campaign set out to advocate for maternal health rights with reflection that it would in the end lead to an influence of the national budget to at least have 15% of it diverted to the health sector given that it greatly contributes to maternal deaths in the country.

The campaign has since gone viral with different people posting selfies for a woman’s cause. It is one of the simplest campaigns you could think of and it is very easy to follow;

  1. Take a picture of yourself and post it on any social media platform
  2. Or, take a picture of yourself and a mother
  3. Or post a picture of a health facility that could be bad or ideal

With either of the above, one posts a picture with a message aimed at improving lives of women.

CEHURD has not stopped at posting and inviting people to post but its methodology is quite distinctive. We have gone ahead to speak about the same on different TV and radio stations. This has created more attention to and recognition of the same. We have also linked the campaign to other key heath related issues like the planned exportation of health workers to Trinidad and Tobago and health budget advocacy. We hope that you can also join the campaign, and remember the #selfie4her is your hash tag.

By Nakibuuka Noor Musisi and Vivian Nakaliika

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.

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