UGANDA: Promoting Maternal Health Should Be Our Priority

Source: All Africa
For a woman who lives in the urban centre, has education, a job and a gainfully employed spouse- living on two incomes guarantees a sense of safety. For the rural woman, who performs unpaid household chores, has no education or any steady income or nutritious meal, and a spousal relation with a man of no means- life is a risk each and every hour.

The two situations depict the dichotomy of our horrifying society characterised by the disparities in the distribution of the fundamental determinants of women's health. In Uganda, any woman of child-bearing age is at serious risk of dying and the risk is worse for the woman of lower socio-economic status. This is absurd for a country where healthcare has not won a major fiscal consideration compared to other sectors like the military or State House.

The United Nations Development Programme, in its Millennium Development Goals report (2011) posited that from 1995 - 2000, maternal mortality in Uganda stagnated at about 505 deaths per 100,000 live births. Uganda Demographic and Health survey indicates that there are 435 maternal deaths per 100,000 live births.

For Uganda to meet its MDG target, maternal mortality rate must be reduced from 505 to 131 deaths per 100,000 live births by 2015. According to government of Uganda's MDG report (2010), 16 women die every day and nearly 6,000 women die every year from childbirth.

Despite the numerous policies that are in place to reduce maternal mortality, nothing seems to be working. The National Population Policy, geared towards reducing fertility and maternal-related morbidity and mortality, was predicated on easing service accessibility, improving quality of care, informed choices, has not worked (Ssengooba et al., 2003).

Increasing age of marriage for girl child and the UPE/USE policies have all not prevented early pregnancies, leading to maternal deaths.

There are a myriad of other programmes and policies. All these efforts, including the elaborate healthcare structures in place, have failed. What could be the problem?

Politicians blame incompetence of healthcare professionals for these deaths. The professionals on their part accuse the government of understaffing and under funding programmes that could be crucial for monitoring the health of mothers when they conceive to the time they deliver.

If Uganda's policies were to be informed by valid scientific evidence, their health promotion strategies could have salvages mothers from death.

A study by Ugandan scholars, Mbonye et al., (2007) titled "Declining maternal mortality ratio in Uganda: Priority Interventions to Achieve the Millennium Development Goals", offers a lot of insight into the key causal factors contributing to the high maternal mortality rate in Uganda.

This study revealed that availability of competent staff and more so midwives in health centres had the highest protective effect on pregnant women (80 per cent). This was followed by availability of functional laboratory, theatre, electricity and clean water, all of which are lacking in most health centres.

The deaths of mothers are attributable to nosocomial infections since there is no water for sanitation and electricity to sterilise emergency care equipment; haemorrhage and obstructed deliveries. Further, despite all the available policy frameworks and programmes, they are ineffective because they alienate the woman from preventive care.

The poor mothers in the rural setting who need these services the most, bear the brunt of our insensitivity. I contend that promoting maternal health is an ideal upon which all other functions of the State must be adjusted and we should not waver on that obligation.

Uganda