Uneasy progress for women’s health

As a women’s health and rights advocate, I could not hide my excitement when I learnt that the maternal mortality ratio had declined from 336/100,000 live births in 2016 to 189/100,000 live births. This refreshing news emerged during the recent dissemination of preliminary data from the 7th edition of the Uganda Demographic Health Survey (UDHS).

Since I started my activism for women’s health over a decade ago, Uganda has had a persistently high maternal mortality ratio (MMR), one of the highest in the region. At that time, the MMR stood at 438/1000,000 live births. 

Maternal mortality has been one of the highest killers of women of reproductive age in Uganda, it was satirically described by the late Dr Charles Kiggundu, a renowned obstetrician-gynecologist who succumbed to Covid-19 in 2020, marking a huge loss to the fight to address preventable maternal deaths in Uganda and the region.

By the time of his death, there is no day that the good doctor spoke about women’s health without wondering why in this day and age, 17 women die from preventable pregnancy-related causes. He vividly likened this toll to a full passenger service vehicle (taxi) filled with women being involved in a road accident daily, with no survivors. He mused further that, if these were men dying at this alarming rate, heaven and earth would have been moved to find a solution – he was a man after all, and must have known firsthand the value attached to the lives of men compared to those of their female counterparts. 

But I digress. Without further information, I cannot authoritatively state which ones of the big five causes of preventable maternal mortality have been effectively addressed resulting in this remarkable improvement in maternal health in Uganda. They include sepsis, high blood pressure, unsafe abortion, hemorrhage, and other indirect causes.

What is certain, though, is that the Ministry of Health and other key stakeholders including development partners and civil society organisations have worked tirelessly to address this issue.  However, could we have gone further, and are there some missed opportunities that have gone un-harnessed? 

One of the most affected demographics that experience preventable maternal death are adolescent girls. One in four girls in Uganda aged between 15 and 19 is either pregnant or has already had a child. Therefore, a celebration of the remarkable decline in pregnancy-related deaths, should also be accompanied by an analysis of other closely related indicators including that of teenage pregnancies.

Given the high teenage pregnancy rates in Uganda, one of the strategies that the state and all stakeholders should have adapted is to ensure access of age-appropriate sexuality education and adolescent and youth sexual reproductive health services and information. Unfortunately attempts to implement the Comprehensive Sexuality Education (CSE) Framework have stalled since 2018 when the framework was finalised by the Ministry of Education and Sports. To date, Uganda has also not recommitted to the Eastern and Southern Africa Ministerial Statement on CSE.

This is due to a number of reasons, however. One that has become more glaring is the role of fundamentalism in causing legal, policy and practice roll backs in the field of youth and adolescent sexual health in Uganda. The fuelling of moral panic around programmes aimed at educating young people about their sexual and reproductive health, is an attempt to introduce non culturally and socially acceptable information among young people who are the main target for this education. 

These groups also conduct webinars for parents and educators and have set up WhatsApp groups where they actively campaign against sexuality education programmes. Interestingly, unlike the scientifically backed programmes by Uncief, UNFPA, WHO and our own keyline ministries that are backed by science generated by technical staff that are highly skilled in these fields, these groups have only personal conviction and unsubstantiable credentials to inform their opinion.

It is critical that a holistic approach is adapted to address preventable pregnancy-related deaths and this cannot be achieved if one of the most at risk demographics, the adolescents, are not catered for. We urgently need to roll out the Sexuality Education Framework and other key interventions like the curriculums for out of school youth, development of robust evidence-based sexual reproductive health information and services. 

If we really care about the lives of women in Uganda, we should empower them at the earliest possible opportunity, and this empowerment should be sustained throughout their lives. 

Ms Asasira is a women’s health and rights advocate.