HEPS News - Features

Findings by the Northern Uganda Coalition for Health Advocacy (NUCHA) have revealed shocking details of the substandard quality of maternal and reproductive health services being offered to women in Lira district.
NUCHA, a HEPS-Uganda-coordinated coalition of health civil society organisations (CSOs) and development partners in the northern region, have found in a new survey that key reproductive health services – including family planning, antenatal, delivery, neonatal and post-partum care – do not meet either the minimum standard or the women’s expectations. NUCHA’s August 2009 survey report suggests that substandard services may be a major reason behind women’s unwillingness to access the life-saving services from health centres, resulting in many unwanted pregnancies, illegal abortions, maternal and infant deaths, and poor quality of life for mothers and other women of reproductive age.

Pregnancy and childbirth-related complications are among the leading cause of death and disability in women of reproductive age not only in Lira district and the rest of post-war northern Uganda, but also in the country as a whole. The district has a high maternal mortality rate (MMR) of 700 deaths per 100,000 live births, far above the national average of 435, according to the district health office and the Uganda Bureau of Statistics.
The World Health Organisation (WHO) estimates that over 70% of maternal deaths could be prevented if expectant mothers received proper care during pregnancy and delivery, and if women who do not want children used effective contraception.
It is estimated that almost one in every five maternal deaths is due to unsafe abortion. Uptake of family planning services in Lira stands at a paltry 25%, predisposing most women of reproductive age to unwanted pregnancies and their attendant need for abortion, which is usually carried out under unsafe conditions.
Maternal health services in Uganda – and more so in Lira and other post-war northern region – suffer from a high drop-out rate. The Ministry of Health recommends at least four antenatal care (ANC) visits in the course of a woman’s pregnancy. In Lira and the rest of the country, almost all expectant mothers make their first visit. However, numbers progressively diminish over subsequent visits. In Lira, the proportion of expectant mothers who make the fourth ANC visit in Lira is only 54%.
This trend continues to the next stage, where only about 42% of expectant in Uganda deliver in health facilities under professional supervision. In Lira, this figure is even much lower, at just 26%. The majority of women (58% at the national level, and 74% in Lira) deliver at home or in the community under poor hygiene and without skilled care, predisposing them to death or severe complications.
Despite the various interventions by government and the civil society to encourage women to access reproductive health services, NUCHA’s study has established that these efforts are yet to result into substantial access because, among other reasons, services provided at health centres continue to be of “unacceptable” quality.
According to the study’s findings, “nearly half of the wards (43%) did not have adequate beds and mattresses; more than half (57%) did not have privacy (cabins); 29% of facilities visited did not have water storage facilities; and 29% did not have a lighting system for the night.
“About 29% facilities did not have any security for mothers coming to deliver late in the night. Observations revealed that some maternity rooms are too small, some have only beds without mattresses, and some health centres are forced to handle deliveries in ‘emergency delivery rooms’ when actually they do not have requisite facilities.”
The report carries testimonies from women alleging various kinds of abuses at the hands of health workers, who they accuse of late-coming, perennial absenteeism, rudeness and extortion.
For instance, a woman in Amach subcounty reported that health workers at a HC IV declined to attend to her when she went there for delivery without her husband. She was assisted to deliver by an elderly woman, presumed to be a traditional birth attendant, near the health centre.
Maternal health services are supposed to be free at government health centres but women reported paying all kinds of fees (both legal and illegal), including Ushs 300-500 on each ANC visit; Ushs 500 for a card; and Ushs 2,000 for each laboratory STI test. They pay for contraceptives, mama kits, delivery, and other services.
Other barriers to access to services were identified as chronic stock-outs of medicines and commodities, limited family planning options and severe side-effects of available options, misconceptions and negative attitudes, lack of male involvement, unacceptable rules and schedules, and long distances to health to health centres, among others.