How COVID-19 has affected women in Uganda

I met Jennifer Ajiambo on her hospital bed at Bishop Caesar Asili Hospital in Luwero district in central Uganda with metals on her right arm. 

Ajiambo had spent four weeks in the hospital recovering from surgery to re-attach the arm, which her husband had severed with a panga.
 
Ajiambo considers the incident, which happened nine weeks after Uganda was put under lockdown in relation to COVID-19, as the epitome of the 16 years of the violence, abuse and neglect that her husband had subjected her and their six children to.

A resident of Kamila village in Luwero district, Ajiambo narrated that she was used to her husband drinking a lot, regularly becoming aggressive, verbally insulting her and refusing to provide for the family. 

Sometimes, the family would go up to three days without a meal if Ajiambo, who used to dig in people's plantations for money or food, did not provide. 

Fed up of the mistreatment, one time in the past, Ajiambo left the husband and sought shelter at the home of one of the people in whose plantations she worked. However, he pleaded with her to return home, promising to change. 

But less than a week after she returned home, he resumed his abusive behaviour. Whenever he would get money, he would disappear from home for some time and only return when he had run out of money. 

She had reported her issues several times to the local leaders, but they did not have a solution apart from talking to the husband. The local leaders later referred Ajiambo to the Police, but she failed to go there because it was far and she did not have money for transport. 

So, she decided to stay and take care of her children, aged between one and 12. Ajiambo, who is originally from Kenya, does not have any relatives in Uganda from whom to seek help and she has no way of contacting her family members in Kenya.

She says she had found a way of living with the husband, but his behaviour became extreme during the lockdown. From the beginning of the lockdown, the husband became increasingly difficult and quarrelsome. In addition, he would beat her and the children up for no reason. 

On the fateful day, he first returned home with a kilogramme of maize flour for the day's meal, but without sauce to accompany it. Thereafter, he went out drinking. Ajiambo went to pick her wages from the people she had worked for so that she could supplement their meal. 

After she got the money, Ajiambo first went to church to give in her tithe. As she returned home, she found her daughter on the way who told her their father had sent her to tell Ajiambo to return home.

When Ajiambo and the girl returned home, the husband started quarrelling and accusing Ajiambo of adultery. It was around 6:00pm and as Ajiambo tried to prepare tea for their baby in the outside cooking shed, he ordered all of them to stop whatever they were doing and enter the house.
 
Before long, he wanted to get intimate with Ajiambo, who declined his advances. She tried to explain to him that it was not right for them to get intimate in their one-room house with the children still awake.

He started beating her and accusing her of adultery. He then picked up a hoe, threatening to cut her. Ajiambo and the children started shouting for help as her son struggled to remove the hoe from their father. He then picked up a panga and started running after Ajiambo and the children. 

When the husband caught up with Ajiambo, he first hacked her on the abdomen and then the head. As he raised the panga high to cut her on the head, she tried to shield her head with her hand and the panga caught her arm.

By that time, members of the community, who had gathered, called the Police, who took Ajiambo to Bishop Caesar Asili Hospital and then referred the issue to the Luwero district probation and social welfare office. Meanwhile, the husband went into hiding, leaving their children at large.

The probation office mobilized well-wishers to pay for Ajiambo's treatment. In the meantime, the children were taken to a child care institution. Since they had not been attending school, they have since been introduced to start-up classes.
 
As she narrated her story, Ajiambo said her treatment and maintenance costs were being paid by well-wishers. She did not have any plan of what to do and where to go upon discharge, and she was only hoping that well-wishers would come through for her.

Increased cases of domestic violence have been reported in Uganda since the country put in place interventions, to prevent the spread of the COVID-19, which is a global endemic. 

The country first promoted social distancing, wearing of face masks, frequent washing of hands and use of sanitizer. After the confirmation of the first case of COVID-19 on March 21, the Government responded by closing schools, places of worship and banning social gatherings.
 
Uganda was then put under lockdown on March 31 which involved a ban on public transport and restrictions on movement, with people told to stay at home, save for some key workers like medics and those selling food stuffs. People had to seek permission from the resident district commissioners to move. 

In addition, a 6:00pm curfew was instituted. By the end of July, the Ministry of Health statistics showed that the country had recorded 1,154 cases of COVID-19 and three deaths.

Although Uganda has been opening up in phases since June 22, the impact of COVID-19 and its responses are expected to be long-lasting and keep on changing, explained Prof. Lawrence Mugisha, an associate professor in veterinary medicine, animal resources and bio-security at Makerere University.

Mugisha explained that every sector of the country has been affected and there has been a huge impact on people's livelihoods. When it comes to women, the impact has been far reaching, and below is a discussion of the impact of COVID-19 and related interventions on the lives of women in relation to key aspects of women's lives. 

Gender-based violence

Violence in the homes has been increasing since Uganda went under lockdown. Within one month of the lockdown, the Uganda Police Force recorded more than 3,000 cases of domestic violence and six deaths. 

For example, in Luwero district where Ajiambo's incident happened, Joyce Namigadde, the senior district probation and social welfare officer, disclosed that cases of domestic violence being handled by her office have more than doubled during this season.

Speaking at a recent seminar organized by the Knowledge Management and Evidence Response Unit at Makerere University School of Public Health, Dr. Richard Idro, the president of the Uganda Medical Association, explained that the increasing cases of violence are due to the fact that many people, especially men, have been disempowered by loss of income.
 
Subsequently, they are stuck at home where they are unable to provide and are frustrated, which has made them violent. In addition, the lockdown led to the confinement of abusers and perpetuators in households with their victims (who are majorly women). 

Namigadde explained that information recorded at her office shows that issues that lead to acts of violence include failure to provide, partners finding out secrets about each other such as spouses being involved in multiple relationships, disagreeing on how to discipline children and dealing with step children.

She explained that out of every 10 cases she has handled during this season, six involve failure to provide. 

The impact of domestic violence has been exacerbated by the restrictions in movement and curfews as victims cannot move out of the homes to seek help.

Sexual and reproductive health services
  
Women's access to sexual and reproductive health services, such as family planning and maternal health services, was hindered due to restrictions in movement. 

For example, according to Prof. Fred Ssewamala, the director and founder of the International Center for Child Health and Development, poor vulnerable women in one of their studies, the "Kyaterekera Project," in Masaka district report that their access to reproductive health services, including protection in form of PrEP, birth control and condoms has greatly reduced. 

Even after the opening up of movement for women who sought such services, many feared to go to health centres because of the measures put in place to test for key signs of COVID-19, such as taking one's body temperature. More so, some women who were using contraceptives in secrecy, could not continue to do so when their spouses were around. 

According to Diana Kabahuma Muhwezi, the communications co-ordinator at Reproductive Health Uganda, there was a 5% reduction in the number of people accessing family planning services between March and April. 

In addition, family planning commodities continue to be stocked-out in at least 12% of the health facilities. Kabahuma is worried that this will lead to unplanned pregnancies and other complications like unsafe pregnancies.

Maternal and child mortality

Kabahuma also disclosed that between March and April, antenatal care attendance reduced by 7%; health facility delivery reduced by 20%, while immunisation reduced by 20%. Due to failure to seek treatment at health facilities, several pregnant women suffered complications some of which led to loss of life for both mother and babies. 

The health ministry reported that between March and April, with the ban on public transport, at least seven pregnant women died while attempting to walk to the nearest health facility. Others died due to complications related to blood shortage. 

As Kabahuma explains, blood transfusion is a key requirement in the provision of comprehensive emergency obstetric care as it is used to treat pregnant women with anaemia and complications of child birth such as postpartum haemorrhage. 

However, according to the Uganda Blood Transfusion Services, there has been a severe blood shortage since the closure of schools and other such institutions, which were the major donors of blood, explained Anne Lumbasi, a senior programme officer at CEHURD, who is currently spearheading a blood donation drive.

Loss of income  

Closure of schools also meant that increased work for women in caring and homeschooling children, which also badly impacted on their working from home.

In addition, according to the Economic Policy Research Centre, the closure of businesses had a severe effect on jobs dominated by women. More women (85.6%) than men (84.5%) are employed in the informal sector which has experienced closure of businesses. 

In addition, a breakdown by sector reveals that tourism and hospitality sector, where a majority of employees are women (6.6 % as compared 1.1 % among men) has been affected relatively more than other sectors. The most notable case is that of hotels that laid off staff during the lockdown. 

Responding to challenges

Namigadde explained that they have responded to the issues by

- Counselling the affected women 

- Sensitising them about the law and where to seek help

- Refer cases to the Police and organisations that deal with women's issues such as FIDA

- Help to look for resources and mobilize other people to help those with problems

- Resettle children in child care homes

- Help to link affected people to services

- Give them community-based solutions, for example, encourage people to engage in agriculture

On that note, Namigadde urged women who experience problems to seek help from local leaders, the Police or trusted members of the community. 

On the other hand, Idro urged the Government and stakeholders to respond to emerging issues related to COVID -19. 

He said: "Right now we are dealing with the short term issues, but the mid and long term effects are going to be enormous. Therefore, there is a need to plan for them."