Why expectant mothers in Mbale shun health facilities

Expectant mothers in Mbale District continue to give birth at home assisted by senior women in their communities.

These home deliveries are deeply embedded in cultural traditions in the district even though they come with serious health risks for both mothers and newborns, fuelling high maternal and infant mortality rates.

According to Mbale District health report, an estimated five to eight mothers die monthly before, during, or after childbirth at home because of preventable complications such as excessive bleeding, obstructed labour, and infections. 

Ms Stella Abigail Kisolo, the assistant District Health Officer for Maternal and Child Health in Mbale District, attributed the problem to a combination of cultural beliefs, economic hardships, and gaps in healthcare accessibility.

“Many women still believe that childbirth is a natural process that does not require hospital intervention unless complications arise,” she said.

She added, “Others are influenced by traditional birth attendants, who have served their communities for generations. The challenge is that these attendants lack the medical knowledge to handle emergencies.”

Many mothers say distance to the nearest health facility makes it difficult to deliver in hospitals.

"I live in a remote village, and the nearest health centre is 15 kilometres away," Ms Aisha Wabwire, a mother from Bungokho-mutoto Cell, said.

She added, "When labour starts suddenly, there is no way to reach the hospital in time. That’s why I gave birth at home with the help of my neighbour.”

Ms Harriet Nabulo, a resident of Busano Cell in Busano Sub-county, said there is an ambulance at Busano Health Centre III but when they call, they are asked to fuel it.

Ms Doreen Nakintu from Busiu Cell in Busiu Town Council said the leaders tell them that deliveries in government hospitals are free yet it’s not true.

Another primary concern for expectant mothers is the attitude of midwives, with reports of verbal abuse and mistreatment.

"They insult us, shout at us, and make us feel unwelcome," Ms Justine Nabirye from Busoba Cell in Busoba Sub-county, said.

Ms Esther Namitala, from Nabweya Cell in Busoba Sub-county, said doctors and midwives have turned childbirth into a business.

"They don’t even give mothers a chance to try delivering naturally. The moment you arrive, they tell you that you need a C-section, even when you feel strong enough to push. They do it because it’s expensive and know we have no choice," she said.

She added, “I have seen women struggle to recover from surgery, and I didn’t want to go through that. That’s why I chose to deliver at home instead.”

Health risks of home delivery.

Mr James Wamanga, LC1 Chairperson of Bungokho Cell said many mothers are risking their lives because they lack access to proper healthcare.

“We need more health centres, reliable ambulance services, and better-trained midwives who treat mothers with care and respect," he said.

Another local leader, Sarah Watsemwa, LC1 of Bukyiende, added, "If women avoid hospitals, the system is failing them. We need to listen to their concerns and act."

Umukuuka III of Bamasaaba Cultural Institution, His Highness Jude Mike Mudoma, the cultural leader of Inzu ya Masaba, has urged pregnant mothers in his community to give birth in health facilities rather than at home.

"As your Umukuuka, I am deeply concerned about the rising number of maternal deaths due to unsafe home deliveries," he said.

He said many mothers rely on traditional herbs and delay seeking professional care, which puts their lives and their babies at risk.

"I urge all expectant mothers to please go to the nearest health facility when your time comes. Skilled healthcare workers can help ensure a safe delivery for both mother and child," he said.

Dr. Jonathan Wangisi, the District Health Officer (DHO) of Mbale, emphasised the importance of accessible healthcare for expectant mothers in the district.

"As a district, we have ambulances that have proven life-saving. These ambulances have not only helped transport mothers to health facilities, saving countless lives, but they have also contributed to improving the regions maternal and child health indicators," he said.

Dr Wangisi highlighted that many newborns die from birth asphyxia, infections, and other preventable conditions if not delivered in a health facility.

“The first hours after birth are very critical. Without proper medical attention, babies who struggle to breathe or need resuscitation do not survive,” he said.

According to Dr. Geoff Lloyd, Chair of Trustees and Head of Community Health & Hospital Committees at PONT, maternal and infant mortality in the region remain high due to unsafe home births.

Way forward to solve this issue.

PONT (Partnerships Overseas Networking Trust) is a UK-based charity that works to improve healthcare, education, and livelihoods in Uganda, particularly in the Mbale and Eastern region at large.

“When a woman gives birth at home, there is no immediate response to complications like excessive bleeding, obstructed labour, or infections,” he said. 

Dr. Lloyd highlights that PONT has trained over 1,200 health workers, provided access to healthcare for 500,000 people, and donated tricycle ambulances to help transport women to health centres.

“These ambulances have helped mothers reach hospitals in time, significantly reducing maternal deaths,” he said, adding they are working to strengthen local healthcare systems by providing training, medical equipment, and ambulance services, including bicycle and tricycle ambulances, to improve maternal and child health outcomes.

Mr Hosea Kigayi Kimono, LCV Chairperson of Manafwa District, said improving access to maternal care should be a priority of the government. “Every mother deserves a safe delivery. Let us work together to make sure no woman has to risk her life giving birth at home.”

BACKGROUND

Uganda has made significant strides in reducing maternal mortality over the years. According to the Uganda Demographic and Health Surveys, the Maternal Mortality Ratio (MMR) declined from 500 deaths per 100,000 live births in 1996 to 189 per 100,000 live births in 2022.