Inside Kapelebyong’s struggle to reduce maternal deaths
"Across the district, we have observed an increase in mothers seeking services after miscarriages and abortions, with about ten cases reported monthly over the last two months. We do our best to care for them,” Eudu says.
Lydia Atiko, a midewife at Kapelebyong Health Centre IV attending to some patients at the martenity ward on Monday. (Photos by Delux Emmy Alomu)
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In March of this year, Sarah Apio, a 32-year-old mother in Onganyakonye village, Kapelebyong sub-County in Kapelebyong district suffered a miscarriage while six months pregnant.
“It started feeling unwell. I felt like I was suffering from flu or malaria at around 7:00pm, but I took it for granted. At around 10:00pm, it worsened and before I knew it, I was bleeding. I was scared. I had informed my husband that I needed to see a doctor, but he was reluctant. When he saw blood, however, he immediately grabbed his bicycle and rode took me to Kapelebyong Health Centre IV, which was the nearest to our home. The health centre is about 2km away from our home,” she says.
With blood flowing down her legs, Apio was admitted to Kapelebyong Health Centre IV, where midwives gave her first aid. The health centre is the biggest health facility in the district.
The Kapelebyong HC IV Maternity ward 
“At the health centre, I was given pain relievers. The midwives also told my husband to buy the drugs that they needed to stop the heavy bleeding and he did. After that, they gave me two injections, but the bleeding continued. With time, it subsided and I underwent the manual vacuum aspiration (MVA) procedure. Under this procedure, an MVA kit is used to remove any retained products of conception or placental tissue from the uterus,” Apio explains.
Although she, did not know the exact cause of the miscarriage, she says she had suffered severe malaria and a urinary tract infection, just days to the unfortunate incident.
Dr. James Eudu, the district health officer, says as part of the effort to strengthen maternal health care, the health centre has been equipped to handle such emergencies that befall mothers.
He says many mothers in the district suffer miscarriages, abortions and postpartum hemorrhage, which can easily result in death if not handled well.
Dr Eudu says many mothers are resorting to herbal concoctions to treat maternal health conditions, especially after childbirth, miscarriages or abortion yet if not professionally handled, such conditions can be life-threatening.
“If the miscarriage or abortion is not handled well, bacteria can enter the uterus, leading to endometritis or a severe infection. If untreated, this can rapidly escalate into sepsis, which is a medical emergency. Leaving an infection or retained tissue untreated increases the risk of scarring inside the uterus, which can negatively impact future fertility,” Dr Eudu says.
“For all your reproductive health problems, please see a qualified health worker,” Dr Eudu says.
With sensitization, Dr Eudu says the number of those seeking services at health centres has increased.
“Many mothers are giving birth in health centres. Even those with incomplete abortions and miscarriages come. Some are brought in unconscious. Across the district, we have observed an increase in mothers seeking services after miscarriages and abortions, with about ten cases reported monthly over the last two months. We do our best to care for them,” Eudu says.
Lydia Atiko, a senior midwife at Kapelebyong Health Centre IV, says the facility has a special space dedicated to different forms of maternal care, depending on the urgency. The facility has an operating theatre and a 25-bed maternity ward.
She says every month, they register approximately between 150-190 normal deliveries and over 50 C-sections.
“It is here where we offer these mothers essential medical services such as antenatal care, delivery, C-section emergency care, counseling, family planning and preventive care. For those that come for post-miscarriage care, they are given pain killers before undergoing the MVA procedure where any retained products of conception, clots or placental tissue are removed from the mother’s uterus,” she says.
Atiko encourages women not to die in hiding, but seek care.
She, however, says the health centre is also over-stretched.
Established in 1954 as a dispensary, the health centre serves a population of 143,000, including residents from neighbouring districts of Abim, Otuke, and Napak. Currently, it has only four enrolled midwives, significantly below the recommended eight, who are responsible for providing services such as antenatal care, deliveries, immunizations, post-abortion care, among others. Unfortunately, with one midwife soon going on maternity leave, the facility will be left with just three midwives to cover all these essential services.
Dr Eudu, noted that the entire district needs 55 enrolled midwives, but they have 18.
Out of the three delivery beds available in the labor suite, the midwives are limited to using just one bed designed for uterine evacuation, rather than the recommended three.
“There are times when we have about three mothers in need of post-miscarriage/abortion services, but currently, two others have to wait until one finishes treatment. We do not have enough beds,” a medic explained.
Francis Edison Echodu, Deputy Prime Minister of the Iteso Cultural Union, encourages women and girls to seek medical support if they experience any complications during pregnancy.
“Reliance on traditional remedies was common in the past due to a lack of health facilities. But now we have health facilities. Do not die in silence,” he says.
Dr. Simon Peter Kayondo, an obstetrics and gynaecology expert in Kampala, says although the country has made gains in reducing maternal deaths, Uganda is not yet out of the woods.
“Uganda has been able to reduce maternal deaths, but some factors still frustrate these gains. Many teenage mothers get pregnant without planning. Whereas some die in the process of giving birth, others die or suffer complications in the process of aborting. Because it is illegal in Uganda, the girls resort to unsafe methods such as herbs and sharp objects. There are many underground quacks who carry out these abortions through crude means. We need sensitization,” he says.
Kayondo further calls for a scale-up in treatment.
“The care that these girls need afterwards should be available to all at least from Health Centre III onwards, regardless of the circumstances of their abortion, as the law in Uganda only allows abortion in specific situations to protect a woman's life.”
National rate
Uganda’s maternal mortality rate has fluctuated over recent years. The Uganda Health and Demographic Survey reported 209 deaths per 100,000 live births in 2020, rising to 216 in 2021. The rate fell to 184 in 2022 and further to 170 in 2023.
Institutional maternal mortality dropped to 69 per 100,000 live births in 2024/25. Leading causes of maternal deaths remain postpartum haemorrhage, high blood pressure, unsafe abortions, and infections.
Globally, sub-Saharan Africa accounts for 70% of maternal deaths, with an estimated 260,000 women dying during childbirth in 2023. Uganda’s maternal mortality rate in East Africa stands at 69 deaths per 100,000 live births, compared to 149 in Kenya.