I recently met a group of men standing along the road with anxious faces. A few metres away from them were several mothers standing in a circle in a bush.
Inside the circle was a woman screaming in pain and half-naked. One of the men, holding a bloodstained hand-woven stretcher, narrated how she had bled a lot trying to deliver at home.
That crowd was an ambulance group locally referred to as ‘ingobyi’ that was carrying her past a paying private clinic to a free public hospital. They had stopped because her painful scream suggested the baby was coming.
There are many women in Uganda who struggle to get emergency maternity care and have to travel long distances to find free care from public health facilities. Most Ugandan women live in villages and are highly-fertile, poor and least informed about pregnancy-related dangers.
It makes matters more painful when such mothers who could have spent all to access free care are referred back to private health facilities because they are the most prepared, with relatively better quality basic and emergency services.
Private facilities form a big share of maternity and newborn health care providers in Uganda. The 2011 Health Systems Assessment in Uganda shows that 93 per cent of health centre IVs, which are the most geographically accessible health facilities in rural areas, are owned by private for-profit institutions.
Government hospitals are only 50 per cent of all hospitals in the country and majority are in urban centres. Free maternity services, therefore, are available to the few that can geographically access them; paid maternity services are for the few that can pay.
Lack of basic and emergency obstetric care is the leading cause of maternal and newborn deaths. The Millennium Development Goal report of 2014 shows that in 2013 alone, an estimated 289,000 women died globally during pregnancy, childbirth, or within 42 days of termination of the pregnancy.
They died from causes related to – or aggravated by – pregnancy or its management. Sub-Saharan Africa, where Uganda is situated, contributed 62 per cent and Southern Asia 24 per cent.
The 2013 report of state of world’s mothers puts Uganda as one of the toughest places for mothers and the findings of the Uganda Demographic and Health Survey show that maternal mortality ratio was the only indicator that failed to improve but, instead, worsened from 435 deaths (2006) to 438 deaths (2011) in every 100,000 live births.
Some studies show that 16 mothers and 106 newborns die daily due to preventable reasons leaving many other surviving mothers with physical and psychosocial disabilities.
We won’t reduce maternal deaths in time and to levels we want unless we take the HIV/Aids model of care. ARVs, which reduce viral HIV load and promote immunity resilience, are equally costly but are given universally for free in all health facilities.
The local and international community can raise resources and leverage partnerships to offer free maternal health services in both public and private institutions in Uganda. We need to provide additional resources to private practitioners so that their facilities can offer free basic and emergency and newborn care and child care up to one year at no cost.
We have to target this category because it is common knowledge that this is the most dangerous period to mothers and the children below five years. This strategy will promote utilization of safe motherhood services by all minimizing risks associated with maternal and newborn deaths
We can ride on existing frameworks such as the UN maternal, newborn and child health initiatives, Uganda’s 2007 Roadmap for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity, and the 2013 plan to improve reproductive, maternal, newborn and child health that have arguably not translated into improved access to health services.
We can then promote effective referral services, and ensure adequate provision of drugs and essential equipment. More mothers die attempting to fulfill their biological obligation to perpetuate humanity. It is, therefore, not surprising that maternal health millennium targets are the only ones off-track.
Let us not stop at monitoring pregnancy, provision of maternity and newborn emergency care; let us also make every pregnancy wanted through effective family planning programming.
We have to build on social values and norms that prevail on alcoholic male partners so that they become responsible husbands and parents.
The 2016-2021 political leadership should guarantee that more women have freedom from societal and gender-based injustices so that they can make informed choices, including whether to marry or not, the number of children to have and how to space them.
The author is a social critique.