Although Uganda is closing the gaps in several basic child-health measures such as infant and neonatal mortality rates, maternal health indicators seem to be progressing at an annoyingly slow rate.
The country is among the six African countries contributing 50 per cent of maternal mortality on the continent. Others are Nigeria, Democratic Republic of Congo, Ethiopia, Tanzania and Kenya.
Results from the recently- released health sector performance report for the financial period 2010/11-2014/15 indicate only a slight improvement in maternal mortality ratio. Accordingly, it fell from 438 deaths per 100,000 women in 2011 to 360. Despite this progress, the country is still off the target for millennium development goal five which requires that the figure be 109 by end of this year.
With the newly launched sustainable development goals (SDGs), this figure is supposed to drop further to 70 by end of 2030.
“Ugandan women are dying needlessly because of delay in emergency transport, inappropriate and unavailable emergency obstetric care and unintended pregnancies which result into unsafe abortions,” said Dr Olive Sentumbwe-Mugisa, the family health and population advisor at the World Health Organisation (WHO).
She made these remarks at the annual Helen Kanzira memorial lecture organized by the University of Pretoria and Makerere University’s School of Law held at Imperial Royale hotel last week. This was under the theme: ‘Exploring Uganda’s performance on the MDGs in the area of maternal health: achievements and challenges.’
Sentumbwe, who gave the keynote address, said it is not just a question of how many women are dying, but also who these women are.
“It is the poor and marginalized women who continue to die of such preventable causes,” she added.
Maternal mortality is one of the important indicators used for the measurement of maternal health. However, in Uganda, maternal health is inhibited by social determinants such as early marriages and teenage pregnancies, where 24 of every 1,000 girls below 18 years has ever been pregnant or procured an abortion.
Other contributing factors to the high maternal mortality ratio include unsafe abortions, hemorrhage, hypertensive disorders, sepsis and obstructed labor. Moses Mulumba, the executive director for the Center for Health Human Rights and Development (CEHURD) blamed the limp in improving maternal health on its commercialization.
“We are seeing many clinics and centers coming up and claiming to be providing maternal health services. Maternal health has now been transferred to the market place and only those with financial means may survive death. How about the poor women; should we let them die because they cannot afford? This is the time to invoke the law to revitalize Uganda’s collapsed health system,” Mulumba shared.
Other challenges highlighted include inadequate implementation of the minimum health care package, inadequate financing of maternal health services and a high fertility rate (about six children per woman).
As a means of redress, Prof Ben Twinomugisha of Makerere’s law school called for enactment of law that would permit legal procurement of an abortion as has been done in Ghana, Swaziland and Ethiopia. Currently, only Section 224 of the Penal Code Act stipulates conditions under which an abortion may be procured legally such as in cases of rape and defilement. However, about 1,200 girls and women die from unsafe abortion annually in Uganda.
Twinomugisha also called for people to vote leaders who will ensure proper prioritization of resources to ensure they do not hemorrhage in frivolities.
“We have two choices; to either lament or go on with more women dying in child birth while new districts are being created or to elect leaders who will prioritize important issues,” he said. Dr Sentumbwe urged for the creation of a maternal death audit where each death is recorded and investigated, regular independent performance reviews by various stakeholders and establishment of transparency and accountability mechanisms for finances and human resource.
Helen Kanzira was an alumnus of the pioneer class of the Masters in Human Rights and Democratization in Africa at the University of Pretoria. She passed away in October 2007 due to complications arising from giving birth to a baby girl.
She was a wife to Ernest Kalibala, a lecturer of law at Makerere University and vice president of Uganda Law Society (ULS). In his address, Kalibala urged stakeholders to implement and monitor programmes to ensure that no woman dies giving birth.
“I have two girls and one day they will carry pregnancies. But when the day for them to give birth comes, shall we be discussing statistics or rather celebrating life? The time to [rectify] maternal health was yesterday, is today and tomorrow,” he said.