When childbirth becomes a deadly gamble

In Uganda, childbirth can be deadly. With 435 deaths for every 100,000 births, lack of modern family planning methods, a poor health care system and battered infrastructure means every pregnancy is a gamble,writes Evelyn Lirri:-

Ms Margaret Ajok is expecting her sixth child. The 26-year-old resident of Awere Sub-county in Pader District had come for antenatal checkup when I met her at Awere Health Centre. It is her fourth visit since she became pregnant.

A midwife at the health facility said Ms Ajok’s pregnancy has so far progressed well and there is no danger to the child and mother. But Ms Ajok’s experience of childbirth has not been without incident. When she was pregnant with her fourth child, she never attended any antenatal care.

“It was very expensive for me to move from home up to here. I have to walk more than 10 kilometres to access the health facility,” she said. And when it was time for her to have the baby, the journey to the hospital was too long, she decided to give birth at home - only with the help of a traditional birth attendant. It was a still birth.

While Ms Ajok said she had given birth to her other four children at the health facility, the daunting cost and expenses she needed to travel had forced her to deliver at home.

Slight improvement
According to the Uganda Demographic and Health Survey 2006, there has only been a slight improvement in the proportion of mothers who deliver in health facilities from 38 per cent in 2001 to 41 per cent.

“Now I don’t want to take any risk again. I have already saved some money for transport when the time to deliver this baby comes,” she said. A journey from Ms Ajok’s home to the health facility costs Shs5,000 on a boda boda.

But in a country where more than 10 million people live on less than a dollar or Shs2,100 a day, being pregnant can be potentially tragic for women like Ms Ajok who come from rural areas- and where services are scarce or expensive.

Pregnancy and childbirth-related complications are the leading causes of death among women in Uganda, where for every 100,000 women who get pregnant, 435 or 44 per cent die.

Daily deaths
This translates to an average of 16 deaths everyday. Most of these deaths result from complications of unsafe abortion, prolonged or obstructed labour where the woman’s body is too small for the baby to pass through the birth canal, massive bleeding, high blood pressure, malaria and HIV/Aids.

But often the underlying cause of death is the high cost of maternal care. Maternity care, like all other health services in Uganda, is supposed to be free but pregnant women are asked to provide their own delivery items like gloves, razor blades, cotton wool and birth sheets.

Dr Jotham Musinguzi, the African regional director for Partners in Population and Development (PPD), said many of the women are dying from causes easily preventable with basic medical care.

“Maternal mortality is not purely a health issue. If we want to get results, we need to have well functioning facilities in place with health workers. There must be good roads in order to transport women incase of emergencies and generally, there should be real investment in the health sector,” Dr Muzinguzi said.

Without a trained, experienced midwife on hand, women are more likely to die from complications like severe bleeding and obstructed labour. “If you have a skilled health worker with a mother during delivery, it will help her to detect if there is any complication and immediately do something to save the life of the baby and mother,” said Dr Hassan Mohtashami, the deputy representative of the UN Population Fund (UNFPA) in Uganda.

“If a mother needs specialised and sophisticated care by a doctor such as caesarean and blood transfusion, then there should be a centre equipped with these facilities where mothers can be referred,” he added.