One out of every 49 women die of a maternal complication related to pregnancy or delivery in Uganda. For many years now, government has come under pressure from the opposition politicians, women rights activists, and the entire population due to the continued death of mothers during pregnancy and child birth.
With a lot of attention paid to Malaria over the years and now COVID-19, many a people think maternal health has been ignored, but has it? In this article, I look at what solutions government is putting in place to reduce maternal deaths across the country.
World Health Organization defines maternal death as; the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. https://www.who.int/healthinfo/statistics/indmaternalmortality/en/#:~:text=Maternal%20death%20is%20the%20death,from%20accidental%20or%20incidental%20causes.
The maternal mortality ratio for women aged 15-49 stands at 368 deaths per 100,000 live births in Uganda. This is according to the 2019 Report by Uganda Bureau of statistics, UBOS 2019 report. https://www.ubos.org/wp-content/uploads/2019/03/Womens-Day-Brochure-2019.pdf
In its 2019 report, UNICEF shows that in rural areas, 46% of women made at least 4 antenatal care (ANC) visits compared to 57% in urban areas. Coverage of skilled attendance at birth is 53% in rural areas, compared to 89% in urban areas. Also, 9% of newborns in rural areas receive postnatal care (PNC) within 2 days after birth, compared to 21 percent in urban areas.
What is government doing?
Government has been criticized by members of parliament, civil society organizations and members of the public for not doing enough to save mothers. However, the ministry of health says they have been running several campaigns to save mothers and their babies.
The ministry has, over the years, also run campaigns encouraging mothers to test for HIV/AIDs and attend antenatal, to avoid transmitting the virus to their babies. But, is all this enough?
In July this year, the Permanent Secretary Ministry of Health Dr. Diana Atwiine https://en.wikipedia.org/wiki/Diana_Atwine launched a campaign to teach midwives how to handle mothers and their new born babies. The campaign is focused mainly on Mulago Specialized Women and Neonatal Hospital Kawempe, which delivers 100-130 babies every day, the highest number delivered at a given facility in one day on the continent.
Dr. Atwiine says she saw need for this campaign because she is a woman, mother and professional who has seen what mothers go through during delivery. She also says the campaign is meant to galvanize support from the general public.
“We started this, to tackle systematically beginning with where the burden is, Kawempe. Because Kawempe delivers 100-130 babies per day. And I think on the continent, it could be the largest maternity hospital that delivers such a number. So we wanted to start where the problem is big and move down strategically to smaller entities” she says.
According to Dr. Atwiine, while the campaign is being run at Kawempe, all other government hospitals and some private health facilities have been allowed to take part, since many mothers have also lost their lives in these big private hospitals.
The ministry is also partnering with corporate companies like Telecoms and Banks to help especially with the funding. Additionally, the ministry has signed a joint MOU with cultural leaders to share statistical information with their subjects since they trust them. The ministry shares statistics of maternal health, HIV, Malaria, teenage pregnancies among other health issues that affect their subjects.
Dr. Atwiine recalls an official meeting set with the Kyabazinga in Busoga Kingdom who in turn invited memeber of the Lukiiko to tackle to tackle this issue and ensure that his subjects are well informed about such health-related matters. The ministry also met with the Omukama (King) of Tooro, to request him to speak to the youth on how to protect themselves from early pregnancies and see medical help where necessary.
What has the campaign achieved so far?
Previously, Dr. Atwiine says Kawempe has been receiving many unnecessary referrals from health facility that have the capacity to deliver babies. But she had noticed that ever since the campaign was launched, the number of referrals have reduced as the midwives from these hospitals have been trained to help mothers.
“The biggest problem at Kawempe, is that mothers are referred late, yet the referring entities have everything, theaters, Doctors, but the midwives are the ones referring. But ever since we started this campaign in Kawempe, we have seen that unnecessary referrals have drastically reduced. This week I was amazed to go and find the labour ward with some empty beds” Dr. Atwiine says.
The ministry of health has also used this campaign to offer support to the midwives by sharpening their skills. The technical team is moving to Regional referral hospitals, training and mentoring midwives in handling mothers and their children.
“We have started the mentorship program and we are looking at the skill gap. At the time of our reviews, we not that midwives lacked either confidence to make a decision or the doctor, so we get people to share, and support them. We are not only doing this in Kampala, but also rolling it out to lower facilities to support our staff there, to sharpen their skills so that they are better and know what is current” she added.
The ministry of health says that with the increase in numbers of teenage pregnancies, the numbers of mothers dying due to child birth complications is also likely to increase. The PS says the girls hide their pregnancies and end up not attending antenatal, which puts them and their babies at risk.
A new survey will be carried out next year by the health ministry to ascertain the actual number of maternal deaths recorded everyday across the country. The last survey was carried out in 2016 and this happens every years. While more women continue to die, government through ministry of health is making all strides to bring the problem to an end.
A reduction in maternal deaths would go a long way to restore hope in many women who still fear to go to hospitals for antenatal and to deliver their babies. Also, a reduction in the number of teenage pregnancies is seen as one of the best ways to put an end to the deaths as many of these, hide and end up dying while delivering babies on their own or with village midwives.
Is this enough?
This week, the media fraternity lost one of its own, Sheilaha Nakabuye, during child birth related complications in Mbarara. Sheilah was the NBS Bureau Chief for South Western Region and a tremendous News Reporter. Her death opened many wounds, forcing several media personalities to speak out, and society, to criticize the media for not doing enough to hold government accountable for such continued death.
Media practitioners, just like other Ugandans have done their part in holding government accountable. Several stories have been run in dailies and by online media, TV and Radio stations, but there is only much, we can also do. Enough noise has been made and I love to believe that government has heard it all, that is why campaigns like that Dr. Diana is involved in, have started bearing fruit.
Antenatal should not stop at the mother being checked for blood pressure and other things, but also educate mothers on how to handle the new born babies, what to eat and what to avoid. I pray more noise is made about deaths like that of Sheilah and we continue holding government accountable, so that more solutions are offered. No mother, should die in child birth due to negligence.
May Nakabuye’s soul rest in eternal peace.