Source: The New Vision
When Sarah Nangobi discovered she was pregnant, she was excited and terrified - excited because this was her first child; and terrified because she did not know what to expect.

"I didn't know how I was going to carry the pregnancy to term and what would happen at the time of delivery," says the mother of four,

who is living with a physical disability.

Nangobi was also worried about how she would get to the nearest and only health facility, which is 2km away, for antenatal clinics.

Though despondent, Nangobi resolved she was not going to wallow in self-pity. She would wake up early in the morning and do her domestic chores before crawling to the health facility.

She never missed any antenatal clinics as she did not want to endanger her life. When she was due, a health worker at the facility was not comfortable to handle her although she never said it openly. Due to the disability, the midwife feared she would get complications.

Fortunately, she managed to carry the pregnancy to term without any complications. "One Wednesday morning as I did my laundry, I noticed a strange discharge from my private parts.

Little did I know the birth waters had broken. I informed my sister, who immediately started running around looking for transport to take me to the hospital," Nangobi says.

Unfortunately, the nearest health facility where she was scheduled to give birth did not have an ambulance, yet back home, the family did not have any means to get her to the hospital. The nearest ambulance was at Iganga Hospital, several miles away.

In such a condition, Nangobi could not sit on a boda boda, so her sister negotiated for a wheelbarrow, which a neighbour provided, and two gentlemen pushed her as her sister carried the bag containing her maternity essentials.

As the labour progressed, Nangobi says she prayed to God to give her time to reach the hospital. She knew delivering on the roadside would require them to hire a car to cover the remaining distance to hospital yet they did not have the money.
Nangobi says it took them an hour to get to hospital and luckily, the midwives were still on duty. However, the facility neither had a wheelchair nor a stretcher to push her to the labour ward. She was lifted from the wheelbarrow to the labour ward.

"Without sympathy, the midwife told me to get onto the delivery bed, but I could not, as it was too high. She scoffed at me, asking why, with such a kind of disability, I even bothered to become pregnant," she adds.

On realising I could not get myself onto the bed and there was no one to lift me, the midwife placed a black plastic bag on the floor and told me to lie on it. With the help of a nursing sister, she examined me. "I had already dilated, so she asked me to push. I gave birth on the floor.

After that experience, Nangobi says she shunned hospitals and resorted to traditional birth attendants, whom she says, are receptive and besides, they live within the community." Nangobi appeals to the Government to set up disability friendly health facilities to enable people with disabilities access them.

Health facilities not well equipped

Government health facilities do not have special facilities for people with disability. The referral hospitals and health centres New Vision visited did not have special facilities such as beds to cater for mothers with disabilities.

In addition, many of the facilities are difficult to access as they do not have ramps or elevators, where people with disabilities can be moved or wheeled.

Like Nangobi, women with disabilities face challenges when it comes to accessing reproductive health services. Some members of society portray women with disabilities as sexually infertile and incapable of being mothers.

What are the numbers?

Uganda Bureau of Statistics has no national statistics of people with disabilities or the number of disabled women who are in their reproductive age.

However, according to the last population census reports, about 10% of the national population make up the total number of people with disabilities.

The representative for the people with disabilities in the northern region, William Norkrach, says representatives for people with disabilities have proposed to Uganda Bureau of Statistics to bring out clear statistics on people with disabilities and the categories of disabilities.
He notes that while there has been a worldwide decline in maternal mortality rates, mothers in developing countries, like Uganda, especially the disabled, continue to face challenges in receiving effective reproductive healthcare.

According to Uganda Health and Demographic Survey, Uganda's maternal mortality ratio dropped to 310 deaths per 100,000 live births in 2010, from 435 deaths in 2006, translating to 4,300 maternal deaths every year, down from 6,000.

Ministry of Health responds

Ministry of Health's public relations offi cer Rukia Nakamatte, says "Currently we don't have specialized delivery beds for disabled women in any health facility.

However, according to the hospital equipment policy, the ministry requires that at least 20% of the beds procured should consider mothers with disabilities," she clarifi es.

Nakamatte says disability-friendly beds have not been procured for health centres because the policy was only passed last year.

Previously, patients with hearing impairment seeking medical services have been facing challenges due to lack of communication.

Nakamatte, however, says the ministry has trained midwives in sign language to enable them communicate to deaf mothers.

Representatives speak out

Safi a Nalule, the Woman Member of Parliament for Persons with Disabilities, says Uganda approved the UN Convention on the Rights of People with Disabilities.

The treaty obliges the Government to provide the highest attainable standards of health for people with disabilities. Nalule says as representatives for people with disabilities in Parliament, they have raised several issues affecting disabled people.

Parliament has enacted laws against discriminating people with disabilities; however, the laws are yet to be implemented.

She observes that Uganda has some of the best policies on disability, but the health sector still remains blind to the needs of people with disabilities because many of the guiding principles are still lacking.

Regarding reproductive health, she clarifies that, Government promised to purchase adjustable delivery beds for disabled expectant mothers, which is yet to be effected.

However, Norkrach, says the beds will be acquired in the next fi nancial year. "There have been delays in acquiring these beds since it is a gradual process where change cannot take place over night."

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