11 June 2011

Uganda: Activists Take Maternal Deaths Fight to Court

Clad in black T-shirts with words such as: "Government stop the deaths of mothers now!" activists a few weeks ago arrived in their numbers at the Constitutional Court to the start of a historic legal action against the country's high maternal deaths.

Ms Zulaika Nankya was one of them. A mother of three children, the 32 year-old resident of Kawempe--a suburb near Kampala city -- joined the activists with the death of her fourth child during childbirth still fresh in her mind.

It was a complicated delivery gone wrong that led to the child's death in June 2010 at Mulago--the country's largest hospital. "I am lucky to still be alive. Many women have died during childbirth and for a moment, I thought I would be like the many women I have seen dying. I have come here to support my fellow women," she said.

While Ms Nankya is indeed fortunate to have been present at this historic event, not many women in Uganda have had the same chance. And as activists poured into the Constitutional Court to secure a legal instrument, they had one message: Force government to tackle the high maternal and child deaths.

16 deaths daily

Uganda's maternal mortality figures remain unacceptably high that for every 100,000 live births, there are at least 435 deaths. This translates to 6000 deaths annually or 16 deaths daily. Equally high is the under-five and infant mortality rates which stand at 137 and 78 per 1,000 live births respectively.

Activists say these deaths can be prevented if government tackles the shortage of doctors, midwives, the high cost of delivery and the long treks that women have to make to reach health facilities among other essential requirements. "We are at the Constitutional Court because these unnecessary deaths of pregnant women and expectant mothers must end," said Ms Lillian Mworeko of the International Community of Women Living with HIV/Aids East Africa--one of the many civil society groups behind the petition.

Describing the death of women in child birth as a crisis, Ms Mworeko said it was essential for government to increase funding for critical areas such as essential medicines, health worker salaries and recruitment of more health workers, all of which impact on the outcomes of women and children's health.

The constitutional petition arose out of a case filed by a civil society group, Centre for Health Human Rights and Development together with three individuals; Prof. Ben Twinomugisha, a lecturer at Makerere University and two health activists, Ms Rodah Kukkiriza and Mr Valente Inziku in which they dragged the Attorney General to the Court.

The group accuse government of, among others things failing to provide basic indispensable maternal facilities in government health services leading to high maternal deaths. Key among their demands, the activists want the court to declare that maternal death is a violation of the right to life as guaranteed under Article 22 of the Constitution and that it is a violation of the right to health when some health workers and the government fail to take the required essential care during pre and post natal periods.

Basing their arguments on two maternal deaths that occurred in Mityana and Arua, the petitioners also claim that the imprudent and unethical behaviour of health workers towards expectant mothers is inconsistent with the Constitution.

According to the activists, Ms Sylvia Nalubowa died in Mityana Hospital on August 10, 2009 from the complications of obstructed labour. She was carrying twins, one of whom was delivered. The second child died with her.

In a another incident, they say Ms Jennifer Anguko died in Arua regional referral hospital on December 10, 2010 when her uterus finally ruptured after 15 hours of obstructed labour. A councillor within the district, it is said that she was the fourth woman to die at the hospital that day.


The petitioners now want court to compel government to compensate families of mothers who have died due to negligence of health workers and none provision of basic maternal health care packages. However, the government in its defence suggests that the disciplinary committees of nurses and mid wives council and the medical and dental practitioners should address the issue involving unethical behaviours among medical workers.

Ms Robinah Kaitiritimba, the executive director of the Uganda National Health Consumers Organisation which has been running advocacy campaigns on improving maternal health, said the non-provision of basic minimum maternal care packages due to underfunding of the health sector, resulting in lack of emergency obstetric care and other health care services is a major challenge for many women especially in rural areas.

Health experts say three quarters of all maternal mortalities result from direct obstetric complications obstructed labour, haemorrhage and infections.

They say if these services were made available to women, maternal deaths would significantly reduce and Uganda would be able to meet its targets of reducing maternal and child deaths by 2015.

Although government abolished user fee in public health facilities in 2001, pregnant women often bear the cost of their maternity care especially with the provision of delivery items such as gloves, birth sheets, razor blades, and cotton wool. But Ms Kaitiritimba said the provision of such items should be solely the responsibility of government.

"Government just needs to put in place the right investment. Mothers have been neglected and yet most of these deaths can be prevented," she added.

According to her, government has the obligation to provide basic health services and opportunities necessary to enhance the welfare of women to enable them realise their full potential.

The government concedes it hasn't done as much as it should have in trying to reduce maternal deaths. With MDG targets on maternal and child health still far from being achieved, the government hopes it can address this challenge through a new accelerated framework.

The framework outlines key areas it say will be priority to achieve the MDG goal including access to Emergency Obstetric Care, ensuring skilled attendance at birth to be able to detect and manage any complications and making available effective antenatal care to prevent, detect and treat problems such as malaria, anaemia and HIV/Aids--all of which are contributing causes of maternal deaths. Mr Leonard Okello, the country director for the International HIV/Aids Alliance is hopeful the court will rule in their favour--an optimism shared by Ms Nankya.

"If we cannot have mothers surviving childbirth, who will be the future of Uganda's next generation? I'm hopeful the court will find our petition significant enough to change the lives of women," she said.

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