Maternal health in Uganda

Maternal Health

Maternal Mortality and Morbidity

The World Health Organization (WHO) defines maternal health as the health of women during pregnancy, childbirth and the postpartum period [3]. According to estimates from UNICEF, Uganda’s maternal mortality ratio, the annual number of deaths of women from pregnancy-related causes per 100,000 live births [4], stands at 435 [5] after allowing for adjustments. Women die as a result of complications during and following pregnancy and childbirth and the major complications include severe bleeding, infections, unsafe abortion and obstructed labor. Uganda is slow in its progress in the fifth goal of improving maternal health in its Millennium Development Goals. With the 2015 target for maternal mortality ratio at 131 per 100,000 births and proportion of births attended by skilled health personnel set at 100% [6], Uganda has a long battle in reaching its intended goals. Moreover, the methodology used and the sample sizes implemented by the Uganda Demographic Health Survey (UDHS) do not allow for precise estimates of maternal mortality [7]. This suggests that the estimates collated are erroneous and it is conceivable that the actual rates could be much higher than those reported. High maternal mortality rates persist in Uganda due to an overall low use of contraceptives, limited capacity of health facilities to manage abortion/miscarriage complications and prevalence of HIV/AIDS among pregnant women. Despite malaria being one of the leading causes of morbidity in pregnant women, prevention and prophylaxis services are not well established. In rural areas, conceiving pregnant women seek the help of traditional birth attendants (TBAs) due to difficulty in accessing formal health services and also high transportation or treatment costs. TBAs are trusted as they embody the cultural and social life of the community. However, the TBAs’ lack of knowledge and training and the use of traditional practices have led to risky medical procedures resulting in high maternal mortalities. Almost all women in developing countries have at least four antenatal care visits, are attended to by a skilled health worker during childbirth and receive postpartum care. In contrast, only 47% of Ugandan women receive antenatal care coverage and only 42% [8] of births are attended by skilled health personnel. Among the poorest 20% of the population, the share of births attended by skill health personnel was 29% in 2005/2006 as compared to 77% among the wealthiest 20% of the population [9]. The case of Jennifer Anguko [10] , a popular elected official who bled slowly to death in the maternity ward in a major hospital, aptly exemplifies the poor state of maternal health care that is provided to women, even in major urban healthcare facilities. Despite the national policy of promoting maternal health through promoting informed choice, service accessibility and improved quality of care through the national Safe Motherhood Programme (SMP), it remains a challenge to the Ugandan government as to how it would achieve its 2015 Millennium Development Goals of reducing maternal mortality rates and 100% births attended to by skilled health personnel. In order to achieve future economic growth, it is vital that the population remains healthy.

Health Care Services

A study was done in 54 districts and 553 health facilities to determine availability of emergency obstetric care and its related maternal deaths. The study found that few of these units had running water; electricity or a functional operating theater. However having these items was shown to have a protective effect on maternal deaths. The availability of midwives had the highest protective effect, reducing the case fatality rate by 80%. It was also found that 97.2% of health facilities were expected to have emergency obstetric care services, but were not doing so. This is the most likely explanation for the high health facility-based maternal death rate of 671/100,000 live births in Uganda. The study conclude that addressing health system issues, particularly among human resources, and increasing access to emergency obstetric care could reduce maternal mortality.

There is not only the issue of lack of resources in healthcare services, there are also cultural barriers in women seeking professional care. A study was conducted in Hoima, Uganda whose aim was to enhance understanding of why, when faced with complications of pregnancy or delivery, women continue to choose high-risk options leading to severe morbidity and mortality. The study found that women considered the use of primary health units and the referral hospital when complication occurred as a last resort. Women reported that a lack of skilled staff, complaints of abuse, neglect, and poor treatment in the hospital and poorly understood reasons for procedures, plus health workers’ views that women are ignorant, also explain the reason many women consider going to a hospital for delivery as a last resort. Ugandan women also adhere to very traditional birthing practices and believe that pregnancy is a test of endurance and maternal death is merely a sad but normal event. This cultural view also hinders the chances of women seeking professional maternal care. In the Kiboga community it is evident that pregnancy and childbirth were one of the major areas where women still command power and status, which they would strive to keep to enhance their status within the household and community.

As found in the previous study, many women do not utilized healthcare services because they do not understand reasons for procedures. Health literacy is also a large issue in among women in Uganda. It not only affects birthing outcomes but also information on reproductive care. Another study found that many Ugandan women rely on myths, rumors, and misconceptions that discourage them from using reproductive health services, particularly family planning. <ref> Belle, Taylor-McGhee. "The Right of Every Woman"], ' ' [ [ GenderWatch ] ] ' ', 2010, Retrieved 3 March 2012