19 August 2007

Uganda: 70 Percent Women Abused - Survey

Kampala — NO one who saw Fiona Kyalisiima's picture, in Bukedde with her teeth hanging out, after being battered by her husband would imagine that she would plead for his release.

Last Thursday, Bukedde, a local daily, reported that police officers at Buwama, Wakiso district, were shocked at Kyalisiima's pleas and released Justus Byaruhanga, her husband, from jail a week later.

"The women in my home area sat me down and told me that I shouldn't have denied my husband sex, claiming our child was ill," she told the Police.

Juliet Hatenga, a human rights advocate, says in case a woman is battered, the first place she would turn to for help is the police and local leaders, but the police will ask her why her husband would beat her.

"Did you cook well? what did you do? Then she will be told to sort it out with him because 'that is a domestic issue,'" she says. Hatenga adds that most victims of domestic violence have not had an opportunity to cry out.

She says because of high poverty levels among women, whenever they are battered, they still run to the perpetrator for protection, since the man is the bread winner.

In the Uganda Demographic Health Survey 2006 released by the Uganda Bureau of Statistics last week, seven in 10 women and about 60% of men believe that there are some situations in which a husband is justified when he beats his wife.

However, the majority of women and men (three in five) agree that a woman is justified refusing to have sexual intercourse with her partner or husband for any of these reasons: if she knows her husband has an STD, he has sexual intercourse with other women and she is tired or not in the mood.

Two fifths of the married women say their husbands or partners make decisions concerning their wives healthcare, though in terms of making decisions on household purchases, percentages range from 15% to 35%.

This indicates an absurd trend that some women have more power to make decisions on household purchases than on their own health.

The report states that the more empowered a woman is, the more likely she is to receive antenatal, postnatal and delivery care from a health professional, yet Uganda's reproductive health indices are still wanting, according to data from the survey conducted by the Uganda Bureau of Statistics among over 11,000 respondents.

Studies show that although 60% of maternal deaths occur six weeks after delivery, effective postpartum care still eludes many mothers. The survey revealed that only 23% of mothers receive postpartum care within the critical first two days after delivery.

A total of 74% of women who had a live birth in five years preceding the survey said they received no postpartum care.

According to health experts, this is a worrying trend.

Also more worrying is that although the percentage of mothers giving birth in a health facility is increasing, half of the births (58%) in Uganda are delivered at home.

Dr Henry Kakande, a consultant with Acquire Project, says delivering at home is risky.

He says within six hours after delivery, a woman should be under close monitoring by a skilled health provider, which in most cases is unlikely if one delivers at home.

He warns that if delivery is done at home, one should visit a medical facility within six days after delivery. "The leading cause of death during the first few days after delivery is bleeding," Kakande says. He adds that bleeding occurs within the first 24 hours of child birth.

According to the report, almost all births are attended by a relative or some other person. Only 42% of the deliveries are attended to by a skilled provider and 23% by a traditional healer.

"The quality of antenatal care, especially in rural areas, leaves a lot to be desired. They don't do enough investigation. You know these women are also supposed to get some supplements when they visit health facilities, but some of these are not offered and as a result they keep away," Kakande explains.

But the report, however, has some good news. Although minimal, the percentage of mothers giving birth in health facilities is increasing, with 42% of deliveries done in health facilities compared to 36% 12 years ago.

"The percentage of mothers giving birth in a health facility is increasing. A total of 42% delivered in a healthy institution, compared with 37% in 2000 and 36% in 1995," the report reveals. It mentions the skilled personnel as doctors, nurses/midwives, or a medical assistant/ clinical officer.

According to the report, fertility rates continue to be high in Uganda with little national change in the last 10 years. The report warns that at the current fertility levels, a Ugandan woman will have an average of 6.7 children.

Although there has been a slight decline, it is not significant. But there is a decline in fertility rates among women aged 15-19. The report shows that women aged 15-19 show a decline in fertility, indicating that they are marrying, having sex and their first child at later ages.

The survey results indicate that the total fertility rate for the country is 6.7 births per woman. However, the total fertility rate in urban areas is much lower than in rural areas; 4.4 and 7.1 children, respectively.

Kampala has the lowest fertility at 3.7 births per woman. The report shows that education and wealth have a marked effect on fertility, with uneducated mothers having about three more children on average than women with at least some secondary education.

Ugandan women have an average of 3.5 children by their late twenties and more than six children by their late thirties.

The report generally indicates a remarkable improvement in the state of health.

Child mortality rate has gone down. The mortality rate for children under five years declined from 156 deaths per 1,000 births to 137 deaths.

Vaccination coverage has also improved. However, with 44%, the percentage of children fully immunised against immunisable diseases remains low. There is general awareness on HIV/Aids.

However, according to the report, provision of a full package of antenatal care to mothers is still inadequate. In general, women pregnant with their first birth tend to get more comprehensive antenatal care.

Women in urban areas are much more likely to receive key antenatal care than rural women, with the exception of drugs for worms, which urban and rural women are equally likely to take.

According to the survey, antenatal care is also strongly associated with the woman's level of education. About 15% of women who have attained secondary or higher education, received antenatal care from a doctor compared to only 8% of women who have primary education.

Eight percent of women with no education received no antenatal care compared to only 2% who had secondary education and above.

However, the report reveals that knowledge about contraceptives is now almost universal in the country. Contraceptive use doubled over the last 11 years, but it remains low, with only a quarter of married women using contraceptives.

Two in five married women (41%) have unmet needs for family planning, particularly for birth spacing. Currently 37% of the demand for family planning is being met.

Family planning experts say lack of awareness largely contributes to this trend. "Women, especially in the villages, are not aware of the services and where to access them," Linda Birungi, a service provider with Family Planning Association of Uganda explains.

Birungi adds that the attitude of husbands, especially in the rural areas, affects women's access to family planning.

"Usually, rural women may not have the money to be able to afford the services. Without the husband's support, a woman can't access the family planning services," Birungi says.

She adds that poverty and the distance a mother has to travel to access the facilities also affects their capacity to access family planning services.

The bad news is that chronic under-nutrition among Ugandan children is significant, with 38% of children being stunted.

In addition, seven in 10 children below five are classified as anaemic and 20% have Vitamin A deficiency.

The level of chronic under-nutrition in Ugandan children is significant with 38% being stunted. And seven in 10 children aged 6-59 months are classified as anaemic, with 7% severely anaemic.

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