For a woman who live in the urban center; has education, a job and a gainfully employed spouse - living on two incomes guarantees the 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 for them is a risk each and every hour.
The two situations depict the dichotomy of our horrifying society characterized by the disparities in the distribution of the fundamental determinants of women’s health. In Uganda any woman who is at the child bearing age is indiscriminately 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 health care has not won a major fiscal consideration when compared to other sectors like the Military or Statehouse.
The United Nations Development Program, 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 6000 woman die every year from childbirth.
Despite the numerous policies that are in place to reduce maternal mortality, nothing seems to be working. For instance the National Safe Motherhood Programs was put in place to recruit and reinforce skills of Traditional Birth Attendants to support save motherhood (Ssengooba et al., 2003).
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 amidst poverty for girl child and the UPE/USE policies have all not prevented early pregnancies leading to maternal deaths.
There are a myriad of other programs and policies, including DISH that was sponsored by USAID for six years. All these efforts, including the elaborate Healthcare structures in place, have failed. What could be the problem?
Politicians blame incompetency of healthcare professionals, including Obstetric surgeons for these deaths. The professionals on their part accuse the government for understaffing and under funding programs and projects 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 evidences, their health promotion strategies could have salvage mothers from the merciless grip of death.
A study by Ugandan scholars, Mbonye et al., (2007) and 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 centers had the highest protective effect on pregnant women (80%). This was followed by availability of functional laboratory, theatre, electricity and clean water, all of which lack in majority of the health centers. In fact, the study also established that 97.2% of healthcare facilities expected to offer Emergency Obstetric Care (Emoc) where not doing so.
So, what is seemingly true is also that Ugandan mothers die in the 102 hospitals; 671 HCIVs and 878 HCIIIs than when they do not seek medical help at all since only documented death are often reported in studies.
These deaths are attributable to nosocomial infections since there is no water for sanitation and electricity to sterilize emergency care equipment; haemorrhage and obstructed deliveries. Further, despite all the available policy frameworks and programs, they are ineffective because they are largely corrupted and alienate the woman from preventive care, creating greater health disparity and unequal access between private and public services.
The poor mothers in the rural setting who need these services the most, and who are most disadvantaged, bear the brunt of our insensitivity. I contend that promoting of maternal health is an ideal upon which all other functions of the state must be adjusted and we should not waver on that obligation.
END
No comments:
Post a Comment