AN African adage goes; every pregnant woman has one foot in the grave. One hundred years since women protested against unfair treatment in the workplace in the western world, Ugandan women still die from preventable and treatable complications that result from pregnancy and childbirth.
Developed economies have reduced maternal deaths to insignificant levels but poor countries like Uganda are far from that.
Canada, for example, records only 10-12 maternal deaths every year while Uganda loses 16 mothers in childbirth and pregnancy daily. Most of those who die are the poorest of the poor.
Speaking at a media briefing organised by Save The Mothers recently, Prof. Florence Mirembe, an obstetrician/gynaecologist, said although poor women are fertile, they find themselves in a vicious circle of poverty and ill-health.
Dr. Eva Nakabembe from the Association of Obstetricians and Gynaecologists of Uganda (AOGU) says up to 60% of mothers with complications can be saved by basic interventions.
However, basic emergency obstetric care (EmOC), the life-defining interventions for any mother with complications, is very poor in Uganda. According to a survey of over 500 health facilities in 2007 only 2.5% of the facilities can offer this care.
With about 15% of all pregnancies at risk of complications that may necessitate emergency care, there are always shortages of oxytocics (drugs used to prevent excessive bleeding) and antibiotics (help to treat infection after childbirth) in lower health facilities.
The two complications are the major causes of death during and after childbirth.
It is worse with blood transfusion. While only 17% of health four centres can provide blood transfusion, 81% of these have completed theatres. Only 23.9% of pregnant women access emergency care.
Dr Jolly Beyeza, an obstetrician/gynaecologist says health centre threes are ideally charged with provision of basic emergency care while health centre fours provide the enhanced comprehensive interventions.
However, the facilities are handicapped. They lack water and lighting while health centre fours lack functional operating theatres and equipment to enable medical personnel to perform life-saving tasks.
The situation is worsened by poor training. â€œThere are midwives who were trained to use ergometrin (an old type of oxytocic) but now need training to use oxytocin or misoprostol,â€ Beyeza says.
While accessibility to health facilities has increased, many of them are still not completely functional.
Dr. Olive Sentumbwe, the national programme officer population and reproductive health at the WHO says: â€œThe death of a woman is simply a full stop to a long story. Doctors just witness the last breath.â€
Sentumbwe attributes it to poverty levels, bad roads, ability of the facility to provide the needed care plus training of the available staff. Nonetheless, she says, we have made some progress over the years.
â€œWe have moved from 527 to 435 deaths per year (maternal mortality-the number of women deaths because of pregnancy or childbirth measured against every 100000 live births),â€ she says.
Dan Murokora, the president of AOGU: â€œA lot has been done but there is still more to be done. The persistent problem is that reproductive health never gets direct funding. Money comes but you cannot find specific allocations to maternal health.â€
He says there is hope with external funding. UNFPA and UNDP are working on a five-year plan to expand access to maternal health services. The STRIDES project on maternal health and family planning is doing the same.
â€œBut we need to empower the communities to demand the services. At the household level, the Government should reduce the poverty levels,â€ he says.
Deputy Speaker of Parliament Rebecca Kadaga says the Government needs to allocate a special budget for maternal health to reduce maternal deaths. She says the country needs specialised planning to prioritise maternal health at lower levels.
While the Government is a signatory to the Maputo Protocol that mandates all member countries to commit 15% of their national budgets to health, Uganda still staggers at 9%, with maternal health suffering the most.
Dr. Jean Chamberlain, the executive director of Save the Mothers Programme at Uganda Christian University, says the Government fund the six pillars of safe motherhood (family planning, antenatal care, clean and safe delivery and post-natal care, emergency care prevention and treatment of STIs/HIV and prevention and management of abortion).
Mahmoud Fathalla, the former FIGO president, said: â€œWomen are not dying because of the diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.â€
Arenâ€™t womenâ€™s lives worth saving?