Spotlight on Ugandan Pregnant Women

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.

 These statistics are so high because of several issues:

• 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.

 What is being done to improve this situation?

§         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).

§         The Ugandan Ministry of Health has implemented pilot projects that use the drug, Misoprostol to reduce maternal deaths.

§         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.

 

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