Maternity in Uganda
In Uganda, there is a saying
that goes, “Every pregnant woman has one foot in the grave”. Citizens say this
because according to the statistics:
- Uganda’s maternal mortality ratio is 435 deaths per
100,000 live births
- Uganda loses 16 mothers to pregnancy and
childbirth everyday; that’s 6,000 deaths annually
- 47% of pregnant
Ugandan women go for antenatal check-ups
- 24% of women in
their reproductive age use contraceptives
- The four leading causes of maternal death are:
bleeding, sepsis, obstructed labor, and abortion.
- For every woman every woman who
dies from childbirth and pregnancy, six women survive but with injuries
such as obstetric
fistula and chronic health problems.
The situation has gotten so
bad that the country will not be able to reach two of the MDGs goals
which are to reduce the maternal morality rate by three quarters and reduce the
mortality rate among children under five by two thirds by 2015.
- Women live very long distances from hospitals
and have no access to transportation to take them there.
- Women cannot afford to pay for health-care to
get the adequate medical attention they need while pregnant.
- Some women are afraid/uninformed about
hospitals, medical procedures and their benefits.
- Women and their husbands are not aware of contraceptives
and their benefits and how to use them properly.
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Poor expectant mothers are now being offered an option to
obtain "baby vouchers"
Provided
through the German Development Bank and the Global Partnership on Output Based
Aid (managed trust fund by the World Bank), the “baby voucher” is part of a
three-year Reproductive Health Voucher project that is aimed improving the
management of STIs and providing safe deliveries in the Ugandan districts of
Mbarara, Kiruhura, Isingiro, and Ibanda. This voucher costs sh35, 000 – sh50,
000 and gives the expectant mother access to four antenatal visits, STI and HIV
testing, delivery (includes C-section), screenings for malaria and prophylaxis,
transportation for referral in case of emergency, and post-natal care (up to
six weeks after delivery).
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The Ugandan Ministry of Health has implemented pilot projects that use
the drug, Misoprostol to reduce maternal deaths.
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The Ugandan Ministry of Health has also acknowledged the
need for more trained midwives especially in the rural areas of the country.
The Irony:
§
Most poor women can not afford the sh35, 000-sh50, 000 fee
for the “baby voucher”
§
The drug, Misoprostol that the Ugandan Minister of Health is
suggesting to use because it is “effective and relatively cheap” is, according
to the FDA, very unsafe for pregnant women. The FDA states, “Misoprostol
administration to women who are pregnant can cause abortion, premature birth,
or birth defects. Uterine rupture has been reported when Misoprostol was
administered in pregnant women to induce labor or to induce abortion beyond the
eighth week of pregnancy.”
§
Women still live far away from hospitals and because they
can not afford the health card, they will become part of the statistics
§
Men do not want their wives utilizing contraceptives or
talking about family planning
What SHOULD BE done:
§
There is an urgent need
to train more midwives and place them within rural areas
§
Poor pregnant women
need access to health care; the “baby voucher” is a great idea and has had a
positive effect with the women who are ABLE to obtain the card. Therefore, the
rate for the card should either be reduced or given to these women for free.
When this is done, more women will be able to obtain transportation to the
hospital where they will receive the adequate care they need to have a safe
delivery.
§
Both women and men need
to be educated about contraceptives
and their benefits and how to use them properly.
§
Women need to be
educated about the different forms of delivery possible, such as C-sections.
This type of education will help prevent cases such as an expectant mother who
was already the mother of 12, came into the hospital for a delivery but left
after she was referred for a C-section out of fear of being operated on. When
she came back to the hospital, it was an emergency patient; she ended up losing
one of the twins she was carrying.
