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Advocates Reject Constitutional Court’s Ruling that it has no Competence to Address the Crisis of Preventable Maternal Mortality in Uganda: Appeal to Supreme Court Planned

(June 5 2012) Advocates have sharply criticised the ruling by Constitutional Court on whether or not the Court has standing to hear Petition Number 16 of 2011, a landmark case on preventable maternal mortality, the rights of women, the right to health and the right to life.

Justices ruled that the case, Petition Number 16 of 2011, must be dismissed, they believe that they have no competency to hear a case regarding realization and protection of these human rights.

“We are deeply disappointed that Constitutional Court has ruled that it has no standing to address a life and death issue affecting all Ugandans. We feel this is a grave mistake,” said Nakibuuka Noor Musisi of CEHURD and the Coalition to Stop Maternal Mortality. “This ruling means the Court wants the status quo to continue. They are standing in the way of constructive solutions to a crisis.”

“We did not receive the ruling we sought today. However, we are confident that in the near future, the Judiciary will realize its role in addressing the crisis of preventable maternal mortality in this country. We will not be deterred,” said Lillian Mworeko of the International Community of Women Living with HIV/AIDS East Africa. The advocates called for an appeal of the ruling to the Supreme Court. The ruling was in response to a preliminary objection raised by government on 26th October 2011.

The Petition was filed on 3rd March 2011, highlighting the cases of Sylvia Nalubowa and Jennifer Anguko, both of whom died unnecessarily in childbirth. It seeks a declaration that non-provision of essential maternal health commodities and services in government health facilities leading to the death of expectant mothers is an infringement on their rights to life and health.

While this case has delayed, many more preventable maternal deaths continue unchecked—Cecilia Nambozo, Nanteza Irene, Sanyu Kassaga and Sarah Nalukwago and many more. These people died as a result of failed maternal health care system in Uganda.
80% of maternal deaths are caused by severe bleeding, infections, unsafe abortion, high blood pressure and obstructed labor. Lack of access to life-saving HIV treatment is another major contributor to maternal deaths—and results in high rates of mother to child transmission of HIV.

In Uganda, untreated HIV contributes to about one in four maternal deaths—and triple-combination HIV treatment for all pregnant women would substantially reduce maternal mortality (See: Trends in Maternal Mortality, 1990-2008. WHO, UNICEF, UNFPA and the World Bank. 2010). Petition Number 16 of 2011 argues if the government does not provide essential medical commodities and health services to pregnant mothers, it is a violation of the Constitutional rights of Ugandans, including the right to health, and the rights of women.

Feature: Maternal health case puts govt on the spot

As Sylvia Nalubowa cried out in agony and begged the nurses to help her, she pledged to give them part of her kibanja (plot of land), hens and pigs if they could save her life.

Only 38, Nalubowa had developed complications after she managed to give birth to one of her twins normally. With the second baby twin still posited in her uterus, Nalubowa’s mother-in-law, Rhoda Kukkirizza, moved her from the government health centre III in Mityana to Mityana district hospital, hoping Nalubowa would get better services there. She did not. An affidavit to a Constitutional Court petition, challenging government to provide better maternal health services, states that Nalubowa died at the hands of negligent and corrupt medical workers.

She became part of the statistics that are Uganda’s maternal mortality rate or MMR (the number of women that die whilst giving birth). Standing at 435 of 100,000 live births, there is general consensus that Uganda’s MMR remains unacceptably high. In 2009, Nalubowa’s tragic tale put a face to the country’s MMR. Her death shook the administration of Mityana district hospital and the ripples spread throughout the nation. It did not take the civil society long to voice its disgust.

The Centre for Health, Human Rights and Development (CEHURD) did more than voice its disgust. It lodged a constitutional petition, seeking a declaration that government’s failure to provide proper maternal health services to women be deemed a violation of their rights.
Nalubowa’s family, together with that of Jennifer Anguko, another woman who died due to negligence during childbirth in 2010, are among the petitioners seeking justice, not just for their departed relatives, but also for other women who have lost their lives while giving life, as well as others likely to become statistics in Uganda’s grim MMR.

Filed on March 3, 2011, the case kicked off with a very high momentum and attracted ample interest from the media and Ugandans at large. It was supported by affidavits from the families of Nalubowa and Anguko, and from human rights experts like Professor Ben Twinomugisha (Dean, faculty of Law at Makerere University). In their submissions to court, the petitioners argued that the right to health was a human right the government had failed to respect and protect.

The state, however, denied violating women’s right to health, contending that the petition was speculative and without merit. But the petitioners insisted that the maternal deaths were due to government failure to provide basics like razor blades, plastic sheets and other consumables, let alone medicines and medical personnel to attend to pregnant women.

In response, the state reasoned that the government’s meagre resources have to cater for various competing interests that also affect other human rights. And, health aside, the state said the petition raised political rather than legal questions, and objected to court hearing it. The petitioners now await the court’s decision on whether or not it will hear the case.

“We just want court to tell us whether the death of over 16 women due to child birth-related complications is not a violation of human rights. Why is the judiciary dragging its feet?” says David Kabanda, a lawyer for the petitioners.

A letter signed by Deputy Chief Justice Mpagi Bahigeine not only expresses regret at the delay in delivering the ruling, but also promises that everything possible is being done to ensure disposal of the case.

But the petitioners are not convinced. “We do not want regrets,” Kabanda says. “We want a ruling. The judiciary should tell us if they do not have the mandate to decide the case so that we seek other avenues.”

He adds that if the Constitutional Court has expediently disposed of other cases — like the one that challenged the Inspector General of Government’s mandate to prosecute cases of corruption, a case also filed in 2011 — it should be in position to quickly decide on the pertinent issue of women’s lives.

“We understand that there is backlog and the judiciary is understaffed, but priority should go to the rights of pregnant women. Pregnancy will not wait. Every day, 16 women die due to pregnancy-related complications,” Kabanda says.

Judiciary only hope
Uganda’s Constitution has a comprehensive bill of rights, but its rich provisions on human rights have not necessarily translated into respect for human rights in the country. In addition, Uganda is signatory to international human rights instruments such as the Convention on the Elimination of all forms of Discrimination against Women, the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of a Child, and the regional African Charter on Human and People’s rights.

All these protect the rights of women and children, and the right to health. On December 15, 2011, Parliament passed a resolution, which, if executed, would come in handy in addressing the issue of maternal mortality. The resolution urges government to expedite the reformation of the midwives’ training curriculum and to recruit a minimum of 2,000 well-trained and well-motivated midwives and other medical personnel.

It further says government should report periodically to Parliament on progress on maternal health. Uganda, as a member of the World Health Organisation’s Safe Motherhood programme, is expected to spend $1.40 per capita on maternal health. It, however, currently spends only $0.50, a mere 36 percent of the required minimum per capita.

The reality is that at the entrance of any government hospital in Uganda, a woman going to give birth is required to present a plastic sheet, razorblade, cotton wool, gauze and other consumables before she can receive any medical attention. Bribes to medical personnel are the norm, and experiences like Nalubowa’s read like a familiar folktale told over and over again. But can a court ruling turn around the tragic scenario where 5,840 women die in child birth each year? Time will tell.


Ugandan Government To Be Held Accountable For Maternal Deaths In Landmark Constitutional Petition 16

After a frustrating year of slow progress, a landmark lawsuit that seeks to hold the Ugandan government accountable for the high number of preventable maternal deaths in the country may finally see a resolution, RH Reality Check reports.

In August 2009, 40-year-old Sylvia Nalubowa died in labor in a hospital in Mityana, Uganda, after medical workers asked for bribes and then failed to treat her when the mother of seven refused, the Guardian reports.

Her death incited protests in the African country that sees 16 women die each day in childbirth.

Activists and community members took to the streets to challenge the rampant corruption, lack of trained staff and skimpy health budget that have plagued Uganda in recent years and which, activists say, has resulted in the unnecessary deaths of women like Nalubowa, Independent Online reports.

Then in December 2010, Jennifer Anguko, a popular elected official, bled to death in the maternity ward of a major public hospital in Arua when her uterus ruptured after 15 hours of obstructed labor.

According to the New York Times, Anguko was bleeding for 12 hours in the hospital before she was finally seen by a doctor. By the time she went into surgery an hour later, it was too late and the mother of three died on the operating table.

Last March, Ugandan human rights groups led by the Center for Health, Human Rights and Development joined the families of Nalubowa and Anguko to file a petition against the government of Uganda.
The landmark petition argues that by not providing essential medical commodities and health services to pregnant women, the Ugandan government has violated the constitutional rights of Ugandans — including the right to health, the right to life and the rights of women.

“Maternal health [in Uganda] has been overlooked,” Primah Kwagala, a lawyer for the Centre for Health, Human Rights and Development told RH Reality Check. “People do not know that they have a right to good health service provision. They think it is a privilege.”

According to a 2010 Ugandan Health Ministry report, a majority of clinics and hospitals in the country reported regularly running out of essential medicines, while only a third of facilities delivering babies are equipped with basics like scissors and disinfectant. Many hospitals also do not get regular electricity and light, the Guardian reports.

Though the petition initially garnered plenty of global media attention and was gaining ground thanks to the support of international activists, an objection raised during the petition’s hearing slowed proceedings down, Key Correspondents reports.

Finally, after months of stagnation, a letter was released to the petitioners last week by Deputy Chief Justice Alice Mpagi Bahigeine, RH Reality Check reports.

“The delay in delivering the ruling is very much regretted,” Bahigeine wrote. “However, it has been brought to the attention of the Hon. Justice responsible and everything possible to ensure speedy disposal of the matter.”

The world is now watching to see if the Ugandan government will take responsibility for the unnecessary deaths of thousands of mothers that die every year.


Uganda: Pregnancy and Childbirth Mean Playing Russian Roulette With Women’s Lives

by Jessica Mack

Sylvia Nalubowa’s surviving twin is two-and-a-half; Jennifer Anguko’s baby turned one this past winter. Both of their mothers died giving birth to them – they are orphans of maternal mortality, an epidemic that continues to plague Uganda as it does the rest of the developing world. But these babies are also children of history.

Their mothers have become the face of a landmark case in Uganda that seeks, for the first time, to assign blame to the government for the deaths of women in childbirth. Last March, Ugandan human rights groups joined families of the deceased to file Constitutional Petition 16, alleging that the Ugandan Government failed to protect the women’s constitutional rights to life and health by allowing them to die in ill-equipped and poorly managed public hospitals, or failing to provide them with basic maternal care.

“We are seeking a declaration that maternal deaths happening due to avoidable causes is a violation of the right to health,” said Primah Kwagala, a lawyer for the Centre for Health, Human Rights and Development (CEHURD), a lead petitioner of the case. “The government should own up and increase funding towards maternal Health, and fulfill the Abuja Declaration to give at least 15% of the annual budget to the Health Sector.”

One of the key complaints in the petition is the Government spends just one-quarter on maternal health of what it pledged to spend, per capita.

Each woman died of negligence, essentially, as do 1 in 35 Ugandan women during pregnancy or childbirth. From ill-equipped health workers untrained for obstetric emergencies to inaccessible clinics, birth control stock-outs, and unsafe abortions gone very wrong, women in Uganda are forced to play Russian Roulette with a failing health system.

The petition was filed in March and heard in October, garnering impressive and global attention from advocates and media around the world. It seemed a rare breakthrough in an endless news cycle that treats maternal deaths as sad, but inevitable.

“Maternal health has been overlooked, as people seem to look at it as the daily status quo. People do not know that they have a right to good health service provision; they think it is a privilege,” said Kwagala.

An objection was raised during the petitions hearing which derailed promising momentum, and which must first be ruled upon before the actual petition hearing can move forward. Since then, five months have elapsed and the global media has long since packed up.

This petition was unique from other cases like it worldwide, which have sought retribution for the violation of women’s rights. Other cases before it have centered on unusually cruel and exceptional circumstances – for instance a 17-year old Peruvian woman denied the abortion of her anencephalic fetus, being forced to deliver and breastfeed until it died. Rather, this petition focuses on the mundanity of the status quo, seeking to “make it famous” as an acute abuse of human rights. Given the scale of maternal mortality in the country, the outcome of this petition could potentially put the government on the hook for crimes against humanity.

“Governments have an obligation to take action to prevent maternal deaths, which represent a gross violation of women’s basic human rights,” said Jill Sheffield, President of Women Deliver. “Where human rights have been violated, individuals and organizations must turn to the courts at the national, regional, and UN levels. Health systems that deliver for girls and women, deliver for everyone.”

Women Deliver and the Ugandan group Partners in Population and Development co-hosted a regional consultation on maternal health in the capital city late last month, drawing African maternal health experts from across the continent. The petition didn’t come up explicitly, but experts spouted the same important, but now redundant, points they have for years: women deserve more, and when they get more, we all win.

Maternal health seems to be a chronic back-seat issue, barring a few hopeful moments in history. One of those was 2010, when the Women Deliver conference drew 3,000 maternal health advocates to hear Melinda Gates announce $1.5 billion in new funds for the issue. Soon after, global maternal health data estimates confirmed that progress was underway; the G8 made maternal health its pet issue, and the UN Secretary-General launched a major initiative, the Global Strategy for Women’s and Children’s Health.

That was two years ago. It is too soon to comment on progress, but in many ways outward excitement for this issue has drained. In recent months, it isn’t maternal deaths, but rather the wanted ghost of war criminal Joseph Kony which has catapulted Uganda into the news once again. Love it or hate it, the KONY2012 campaign generated a magnetic force field of global attention toward Uganda. Deft Ugandan advocates parlayed that to leverage new commitments to Nodding Syndrome, a disease overlooked for years. The country’s rising HIV prevalence, has also garnered new focus. Surely this is an opportunity for maternal health advocates to claim their stake once and for all.

“The Government of Uganda talks a good game about its commitment to maternal and reproductive health, but it needs to do more than talk,” says Elisa Slattery, Africa Regional Director for the Center for Reproductive Rights. “It must put money and resources behind efforts that save the lives and health of women.”

What exactly should those efforts look like? That should be up to Ugandan health professional and advocates. Kwagala easily rattles off a list: “recruit more midwives, increase the pay of health workers to motivate them. Amend the constitution to include the right to health. Provide redress measures to patients whose rights have been violated & respect citizen’s rights.” There are other crucial issues to address, like ensuring access to birth control and considering expansions to the country’s abortion law. A recent government estimate suggests it is the cause of 26 percent of maternal deaths in the country.

An even more pragmatic first step might be addressing electricity cuts. “How honestly do you expect a health worker to perform C – Sections on a mother who is suffering obstructed labour if there is no electricity to sterilize instruments, or even light to see if it is in the night,” asks Kwagala. Last week, CEHURD filed a complaint against a major power company, alleging indiscriminate load shedding (rolling blackouts to save money) at hospitals undermined patients right to health.

It’s not for lack of ideas to save them, whether creative or practical, that Ugandan women are dying, but for lack of action. And when it comes to maternal mortality, Uganda is in a unique position: it has neither the best nor the worst death rates in the continent. It was commended by the UN in 2010 for “making progress,” having reduced deaths by 36 percent from 1990 to 2008. Maternal mortality remains a problem of considerable magnitude, but there are potentially enough resources to actually address it.

Last week, CEHURD and their co-petitioners got a break. After constant follow-up and months of waiting, they received a letter from Deputy Chief Justice Alice Mpagi Bahigeine:

“The delay in delivering the ruling is very much regretted. However, it has been brought to the attention of the Hon. Justice responsible and everything possible to ensure speedy disposal of the matter.”

This acknowledgement signals that the government knows the world is watching, and perhaps really is committed to prioritizing this issue. The outcome is still in question, so it is too early to say that the paradigm has shifted but instead we should recognize that it is, indeed, shifting, and we can still do our part to catalyze that.


Ababaka beeyamye okuyamba abakyala abazaala

ABABAKA ba Palamenti okuva mu mawanga ag’enjawulo batadde essira ku ngeri gye
bagenda okuyambamu bamaama abafiira mu ssanya n’abaana abafa nga bawere.

Omukozi mu kitongole kya Center for Health, Human Rights Development (CEHURD),
Muky. Noor Nakibuuka, yagambye nti Gavumenti esaanye okwongera ensimbi z’eteeka mu
buzibu bwa bamaama abafa nga bazaala ssaako okutaasa abaana abafa nga bawere.

Zino ze zimu ku nsonga ezigenda okuteekebwako essira mu kukendeeza
omuwendo gw’abakyala abafa nga bazaala n’abaana abafa wakati w’obuwere
n’emyezi ebbiri. Bino byayogeddwa mu lukiiko lw’abaamawulire olwakubiddwa e
Bukoto wiiki ewedde nga batema empenda z’okumalawo ekizibu kino ekyeyongera buli bbanga.