World Health Organization

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infi rmity according to the World Health Organisation. Reproductive health thus implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

This however has not been the case in Uganda, as poor reproductive health and gender-based violence have overwhelmed Ugandan women for years.

Dr. Joaquim Saweka, WHO Country Representative says gender-based violence is so much a public health issue.

Defi lement, rape, and physical violence heighten the likelihood of infection, and also distortion of the child’s genitalia in case of defi lement. These cause severe physical, emotional, and psychological trauma.

He says gender-based violence is a growing trend especially defi lement which has increased from 15, 000 cases reported in 2006 and 2007 to over 20, 000 cases at present.

Although the numbers of health workers has improved, it is still inadequate for delivery of the minimum health care package and so the health workers are overworked.

The capacity of training is insuffi cient to meet the human resource needs for maternal and new-born health.

Maternal Health Activities

WHO thus partners with the Ministry of Health, providing support on policy, capacity building, provision of equipment, medicines, etc. to better the lives of women.

WHO in the same vain contributed to the development and completion of a Road Map for accelerating the reduction of Maternal and Neonatal Mortality.

A Soroti project was started by WHO close to ten years ago. It was a pilot intervention meant to build the capacity of Soroti hospital, health centre threes and fours. “We set up the referral system, built capacity training of the medical personnel about handling maternal cases,” explains Dr. Saweka.

When you improve the quality of services, the community will see a need to come to the health centres, he argues.

Maternal mortality in Soroti thus came down from 800 maternal deaths to less than 193 in less than four years. Soroti’s success story has inspired many interventions.

“In the programs we are having, improving capacity for health facilities to receive mothers, promote women groups for peer education and mobilisation and sensitization are at the forefront of our programs.”

Also Male Action Groups are important as a lot of decisions are made by them; so men’s participation in reproductive health dialogues is now the way to go.

We work to promote youth-friendly services, so that young people with specifi c needs let’s say STDs feel free to come over for medical help. The population in Uganda is mainly youthful; with 51% below 15 years and 20% aged 15- 24 years.

The way to go

We look at the three components that are central in maternal health. For instance, the role of communities in maternal and newborn health cannot be overemphasized.

The decision making power of women to utilize health services during pregnancy, childbirth, and the postpartum period is limited in many ways. Decisions are mainly dictated by their husbands and relatives.

Sometimes there is evidence that delivery cannot happen normally. If people are educated and sensitised, they should take the step to rush the woman to a health facility.

Many women and girls also suffer various health problems related to sexual and gender based violence.

Those in the health sector need to be able to help the survivors physically and psychologically; there is a need to create a onestop centre to cater for those needs plus a form of referral network for reporting and accessing justice.

According to Dr. Saweka, even regarding maternal health, the issue of gender equality comes into play. “Once you have an educated woman, the rate of dependence on men will be reduced signifi cantly.

Uneducated women endure domestic violence because they have got nowhere else to go. They are dependants.”

However, an educated woman with a job is selfreliant. The marriage or relationship will be based on love and equality and not dependence.

“We need to sensitise the society as well to be open about equality, and this will be achieved through education,” he reasons.

We have to see a woman as part of the global society as everything affects her as well. Both communicable and non-communicable diseases sometimes affect her more. For example a pregnant woman is more susceptible to malaria than other people.

Looking at maternal deaths, he suggests a life cycle approach. If a baby girl doesn’t have the adequate nutrition, she will not develop well enough to host a baby in her womb and give birth normally.

Also avoiding some traditional practices such as FGM in young girls will help us stop the damage they create.

According to the Health Sector Roadmap, to address the gaps highlighted under human resources, there is need to build the capacity of training institutions and service providers for maternal and newborn health issues. Providers need to be equipped with advanced / newer knowledge and skills.

Seeing that over 26% of maternal deaths are due to abortion gone wrong; there is need to put in place measures to prevent unwanted pregnancies and reduce the need for recourse to abortion through expanded and improved reproductive health services as well as managing the complications arising from abortion.

Family planning is a cost effective means to lower maternal mortality rates because it reduces the risk of exposure to pregnancy and death ; reducing the incidence of abortion by averting unwanted and unplanned pregnancies; and by averting pregnancies that occur too early, too late or too frequently during a woman’s reproductive cycle, and those that are inadequately spaced.

Remember it is only pregnant women who face the risk of maternal death.