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.