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Maternal health is a human right – activists

By Vicky Wandawa

The Population Secretariat (POPSEC) has started campaigning for maternal health as a human right. The project, launched on Thursday at Hotel Africana, Kampala, changes strategy from merely advocating for maternal health to creating massive awareness that it is a human right.

Dr. Betty Kyadondo, the Head of Family Health Department at POPSEC said they hope this will empower all women with knowledge regarding their rights to health. This will exert pressure on the government to respond accordingly.

According to the Uganda Demographic and Health Survey 2011, 438 mothers out of every 100,000 live births, die while giving birth. The figure has risen three points from 435 deaths in 2006.

Presenting a report by POPSEC, Kyadondo called it developing the capacity of duty bearers, the government, to meet their obligations and encourage rights’ holders, the community, to claim their rights.

“A woman in the village does not know that health is her right,” she said. “Once they do, and start demanding for them, then the government will shift priority. When the community gets empowered, then the voice will be even stronger.”

States are obliged, under international human rights law, to respect, protect and fulfill the human rights related to pregnancy and child birth, for example, ensuring women’s access to a wide range of sexual reproductive information and health services, including family planning, antenatal care, skilled delivery and post natal care.

Through the Partners in Population and Development Africa Region, POPSEC was commissioned by the World Bank to implement the project. Dr. Jotham Musinguzi, the Regional Director of Partners in Population and Development Africa Region, noted that mothers were dying from preventable and treatable diseases, and such approaches are needed to scale the numbers down.

The chief guest, Hon Gabriel Aridru Ajedra, the MP of Arua Municipality, also minister designate for investment, described the intervention as unique


350,000 abortions in Uganda are induced – experts

Article by Catherine Mwesigwa Kizza ( New Vision)

Infanticide, child abandonment and abuse — the Ugandan media is full of the stories. The missing story though is that the abused and murdered children are most probably survivors of induced abortion.

“There are over two million conceptions in Uganda every year. 200,000 to 300,000 of these miscarry or abort spontaneously but 350,000 abortions in Uganda are induced,” said Dr. Charles Kiggundu an obstetrician and gynecologist at a breakfast meeting convened by the Center for Reproductive Rights and Centre for Human Rights and Development in Kampala Wednesday, to discuss the laws and policies on abortion in Uganda.

“90,000 of the induced abortions end up with severe complications but only a half of them access post abortion services,” he added.

“Only half of the women with complications seek medical care. A few survive but many others die,” he added.

Joy Asaasira of CEHURD said of the 20 women in Uganda who die due to pregnancy and childbirth-related complications every day, four to five of these are due to induced abortion.

Dr. Kiggundu says these are needless deaths. The policy environment allows women to receive healthcare for post- abortion complications, however, studies have shown that when they seek care, it takes about 44 hours for them to get attention compared to 35 to 45 minutes other women spend in hospital before getting a service.

“Health workers do not want to treat women with abortion complications because they do not want to be seen to be accomplices to the termination of pregnancy,” he said.

He also pointed out that phrases on hospital documents like “Police notify” worry health workers and are a deterrent to provision of care for women.

‘Health workers do not want to get involved with police. They want to do their work unencumbered,” he said.

Women induce abortions due to unwanted pregnancies due to wrong timing of pregnancy or economic and social hardships.

“Some men tell their wives to abort because ‘they stopped having children’ and yet did nothing about it,” Dr. Kiggundu said.

Those who survive death end up with chronic pain, anemia, and infertility among other complications.

He said safe abortion services were available but hidden to the poor.

“You must be connected and well-oiled to access the services. Some women fly to South Africa to terminate pregnancies and return,” he revealed.

The consequences for the majority who go to quacks or unskilled medical workers working undercover are dire.

“We recover forks, pens, knitting needles, bed springs, sticks, herbs from women who run to us with botched abortions. Some of these things kill the woman before they even kill the foetus,” he said.

Treatment for those who survive death is expensive. According to CEHURD, sh17.6bn is spent on treating abortion complications.

Not only can this money be saved and spent on worthwhile health causes but women’s lives can be saved as well.

According to Dr. Kiggundu, the Ministry of Health’s comprehensive abortion care includes sexuality education to promote safe sex practices, family planning use including access to emergency contraception, reducing fertility, providing safe abortion services and quality post-abortion care.

Government is also training nurses and giving them skills to perform manual evacuation procedures to attend to women with incomplete abortions.

“There are still many gaps,” said Dr. Kiggundu. “Uganda still produces health workers for export and retains only a few.”

He revealed that only 30% of the vacancies for skilled health personnel required to provide safe motherhood are filled.

It is no wonder that despite government commitments, advocacy efforts, plans and policies to reduce maternal deaths in the country, there has been no progress in this indicator in the past five years.

New data from the Uganda Demographic Health Survey report of 2011 show that the maternal mortality ratio increased from 435 deaths per 100,000 live births in 2006 to 438 deaths, though other international studies show a decline to 310 deaths per 100,000 live births.

“26% of these deaths are due to unsafe abortion,” said Elisa Slattery the Regional Director, Africa Program Center for Reproductive Rights.

Once addressed, reduction in unsafe abortion contributes to reduction in maternal death.

Slattery said studies on the law on abortion in Uganda have found that “abortion is permitted where a mother has severe illnesses threatening her health like cardiac disease, renal disease, eclampsia.”

The Centre for Reproductive Rights study also found that healthcare providers are not required under the Uganda law to consult one or more providers to get their consent before terminating pregnancy as has been previously believed.

The organization is calling on government to broaden access of information among healthcare professionals and the public as a means of stopping the tragedy.


Functional health delivery system is the right answer, not legislation

I would like to respond to the story titled, ‘Kabale considers a by-law to force pregnant women into hospital’ in the Daily Monitor of July 27. The story said the by-law will compel pregnant mothers to deliver in a health facility and penalise those who deliver under the care of a traditional birth attendants.

Experience from around the world suggests that about 15 per cent of all pregnant women will develop obstetric complications and that not all these complications can be predicted. Delivery under the care of a skilled health care provider – midwife, doctor, or nurse with midwifery skills – is the safest method for saving the lives of mothers and their newborn.

Countries with the highest skilled attended deliveries such as Sweden and Malaysia are also the nations with the lowest maternal and newborn deaths. Every year, 350,000 women worldwide die during pregnancy, or during labour, almost 1,000 a day. Of these deaths, 99 per cent occur in developing countries such as Uganda.

Every year, up to 2 million newborns die within the first 24 hours of life. Uganda looses 45,000 newborns annually; many more suffer birth trauma that impairs their development and future productivity.

In recognition of the critical role of skilled care in reducing maternal and newborn mortality and morbidity; Uganda has committed itself to increasing skilled attended deliveries from 53 per cent to 90 per cent by 2015.

I would like to commend the local leadership in Kabale District for recognising the importance of skilled healthcare and their intentions to encourage mothers to deliver in a health facility instead of under a traditional birth attendant. However, enforcing skilled attended delivery through a by-law is not the answer.

A survey conducted by White Ribbon Alliance for Safe Motherhood in six districts in Uganda (Assessment of Maternal Health Services in Six Districts in Uganda, 2010) showed that health facilities in Kabale had only 2 per cent of the required midwives and only one doctor. None of the health centre IVs could provide blood transfusion services or caesarian sections. Many facilities lacked essential supplies, transport for referral of obstetric emergencies at HC4 and 3.

I would like to request the decision makers in Kabale District to examine the current healthcare delivery system and make it attractive to the clients by providing an attractive healthcare delivery package to women. That means adequate supplies, equipment, provision of emergency obstetric at HC 3 and 4, adequate midwives. Conduct community awareness raising about the benefits of skilled attended births in addition to addressing social-cultural factors that limit a woman’s ability to access her maternity care services.

The government should play its role of ensuring adequate financial and human resources towards meeting its national and international commitments on Millennium Development Goal 5 and support local governments to deliver quality services to its citizens. Uganda committed itself to giving the health sector 15 per cent of its annual budget.

Robina Biteyi,


Kabale considers law to force pregnant women into hospitals

 By Robert Muhereza

Kabale District is working on a by-law to compel pregnant women to give birth at health facilities and penalise those who deliver aided by traditional birth attendants (TBAs).

District speaker Pastoli Twinomuhangi said on Wednesday that he is ready to present the draft by-law for the council’s consideration. This follows a recent survey in Rukiga, one of the four counties in Kabale District, where it was found that nearly one in every two expectant women that TBAs help to give birth, die.

“An ordinance is already being drafted to compel mothers in labour to deliver at the established government health centers in order to save their lives and that of the babies,” Mr Twinomuhangi said.

However, according to District Health Officer Patrick Tusiime, the number of women delivered by TBAs has reduced due to intensified mobilisation through media and community meetings.

Half of pregnant women in the district now deliver at health facilities, up from 12 per cent five years ago, the doctor said.

However, Ms Allen Busingye, a businesswoman in Kabale town, said some of them prefer the services of TBAs because they offer “motherly care unlike in the health centres where we are attended to by young and abusive nurses.

“The young nurses are rude to the mothers in labour pains,” she said.

The government outlawed the traditional birth attendants, but they continue to thrive especially in rural areas where public health services are either lacking or unaffordable.

The District Deputy Resident District Commissioner, Mr Nickson Kabuye, said his office is investigating reports that some health workers in the district on government payroll extort money from women seeking antenatal care, forcing them to turn to TBAs. The culprits, he said, will soon be exposed.

TBA head responds
The head of TBAs in the district, Mr Charity Mugisha, said an accusation pinning them on causing maternal deaths is baseless because reports of women dying in labour at hospitals are a common place hence not of their (TBAs) own making.

“Traditional Birth Attendants are complementing the government efforts in assisting pregnant mothers to have safe deliveries,” he said.

District vice chairperson Mary Bebwajuba noted that a shortage of qualified staff coupled with lack of ambulances are the reasons behind the delay of referrals, leading to many deaths of expectant women in the area due to delayed birth.



By Iryn

A lot of people keep asking me why I want to stay childless and of course, usually I just retort- ‘why not?’ but I’d like to tell everyone who cares to know that while death is inevitable; I don’t want to beg it to come to my doorstep and becoming pregnant lately will do just that. I have enough things bringing me closer to my Maker without having to add child bearing to the list; our life expectancy is at a mere 45years and I should be experiencing a midlife crisis anytime now, then there are those high risk transport things called boda bodas ridden by special men that try to see how far they can tease and coax death and get away with it every time I jump on one, and because of the high unemployment rate which stands at about 78% among youth, I just might die of starvation, desperation or depression- whichever gets me first.

But let me just walk you through the odds women have to go through in Uganda to give that life that so many people demand of them

On average, an estimated 16 pregnant women die every day in Uganda- that’s a lot of pregnant women if you ask me especially given that these deaths are preventable. I read and hear so many stories of women dying in the ward because of complications giving birth and my resolve not to get pregnant just becomes stronger and stronger.

There is the story of Jennifer Anguko who bled to death in a government hospital in October 2010, while waiting to deliver her child as her husband begged health workers for attention. Another lady recently is reported to have lost one of her twins while giving birth in IHK, a respected private hospital in Kampala and when asked what caused the death, the doctors actually dint know so it’s not just a public institutions problem.

I was also shocked to learn that for every woman or girl who dies as a result of pregnancy-related causes, between 20 and 30 more who survive will develop short- and long-term disabilities, such as obstetric fistula, a ruptured uterus, or pelvic inflammatory disease.

But more saddening is the fact that with Uganda’s fertility rate at 6.9%, and with your average Ugandan woman getting married at 18yrs, the number of women getting pregnant is not about to reduce.

Lately also, there have been more women that have pregnancy complications and need caesarian help to produce their child but there are only 200 surgeons out of the 2,105 registered doctors in the country. This means there is only one surgeon for every 400,000 Ugandans. And this morning I was reading an article in the New Vision about how unqualified doctors are operating on patients, case in point being the ongoing case against one Dr. Ssali of the Fertility hospital in Bukoto who admitted the doctor he allowed to operate on a female patient that passed away did not have a practicing certificate in Uganda.

Government hasn’t really done anything to change these statistics; in fact our health care system is falling apart if you ask me. CEHURD, an NGO, brought a petition against government complaining that it violated the women’s rights by neglecting to put essential medical commodities in place for them when they are pregnant and the Constitutional Court threw the case out holding that it could not interfere with the Executive’s mandate- I know, real jokers!

And so tell me reader, why in God’s name with all those odds against pregnant women, would I want to conceive on a whim of faith that at the end of those 9 months, I’ll be sitting on a hospital holding a bouncing baby girl?

I prefer to meet my death in another way, thank you