On 1 August 10, 2009, Sylvia Nalubowa died in labour complications after she was denied care because she could not afford a maternity kit. More than a year later, a similar fate befell Jennifer Anguko after her uterus ruptured following more than 12 hours of labour without help from health workers. She is reported to have been the fourth woman to die at the same hospital that day.
The deaths of these women formed the basis for a strategic litigation case brought before the Constitution Court by the Centre for Human Rights and Development (CEHURD). In Constitutional Petition No.16 of 2011, they argued that the Government of Uganda violated the women’s right to life by failing to provide them with basic maternity care.
Last month, in a precedent setting judgment, the Court agreed with CEHURD on all the grounds of the petition and declarations sought therein.
The Constitutional Court, among others, recognised the right to maternal healthcare services and emergency obstetric care and held government accountable for their deaths by a declaration that “the families of the mothers who have died due to the negligence of government’s health workers and government’s non-provision of maternal healthcare package be compensated because of the rights violations”.
Although the petitioners were awarded damages, no amount of money can ever make up for the death of a loved one.
The decision, however, provides a measure of comfort in holding the government accountable.
Provision of adequate maternal healthcare in Uganda has been a subject of policy debate, public discourse, as well as a promise upon which politicians, have built their campaigns. This case is a recognition that the blood of all the women who have died and will continue to die during childbirth is on government’s hands. It is a win, but it is not in the least bit comforting.
Despite constitutional guarantees and commitments to regional and international treaties to protect women, Uganda’s maternal mortality rate is one of the highest in the world estimated at 343 deaths for every 100,000 live births. The deaths of these Ugandan women is neither accidental nor inevitable. It is a result of deliberate policies and choices by those in power such as the low budget allocations to the health sector, which as the case highlights, are “too inadequate to fund the Uganda National Minimum Health Care Package,” a lack of political will to address the gaps in sexual, reproductive health and rights and the dearth of commitment to find concrete solutions for women.
Maternal mortality is a gender equality issue representative of the inequality between men and women in the enjoyment of the right to the highest standard of care. The Covid-19 pandemic has exacerbated these risks.
Media has been awash with stories of women delivering by the roadside, women dying on the way to hospital due to the ban on public transport or as a result of the laxity of government officials to provide necessary permits to allow movement to hospitals.
According to an investigation by Open Democracy, human rights lawyers have warned that African governments, Uganda inclusive, could face more lawsuits due to maternal mortality from Covid-19 restrictions.
While it remains to be seen if government will fulfil its obligations as mandated by the court, the case is a reminder that the government policies and decisions on maternal healthcare are not just ideas, they are applied to women and those bodies bleed-to death.
It also puts the government on notice that Ugandans have a springboard to hold it accountable when it refuses or neglect to hold up it’s end of the social contract.
Ms Fionah Komusana is a feminist lawyer
and writer. @komusana