Activists in Uganda Are Fighting for Better Maternal Health
Sisters Faridah Luyiga and Remmie Wamala were so close they “knew each other’s secrets,” says Luyiga, 34, the younger of the pair. So when they both became pregnant at the same time, they believed it was meant to be.
“She had given birth to her first child much earlier, so I kept asking her for advice,” says Luyiga, adding that her sibling, who was “like a sister and mother,” had always made sure Luyiga went to antenatal visits. “She always mentioned the 16 mothers that die daily in childbirth in Uganda; it was so unfortunate that she became one of the statistics.”
Wamala, 36, had worked passionately for more than five years to prevent maternal deaths as coordinator of the Uganda Parliamentary Forum for Children and had three births that went smoothly. Tragically, she bled to death while delivering her fourth child, who is lucky to be alive today, having acquired cerebral palsy and brain damage during the botched delivery at what is considered one of Uganda’s best private hospitals.
Sadly, these deaths are continuing. According to a recent report, the government insists that the number of women who die from childbirth-related complications at health facilities—excluding the large number who give birth outside these centers, without a proper medic—has dropped by just over 5 percent during the last two years. But activists say there has been “no significant change.”
“If anything, there are reports stating maternal deaths have increased to 17 per day, and some say 19,” says Primah Kwagala, a lawyer at the Center for Health, Human Rights and Development (CEHURD), a local NGO. The organization, along with the families of two women who died delivering their babies, sued the government in 2011, claiming the women’s rights under the constitution had been violated. They argue, among other things in the petition, “the unacceptable higher maternal deaths in Uganda which are due to government’s non-provision of the basic minimum maternal health care and the non-attendance and improper handling by the health workers to expectant mothers are unconstitutional.”
Additionally, they say, “Abortions are still illegal [but] happening, government expenditure has not increased since 2011, [and] more health workers were recruited but many rejected their postings due to lack of resources and health commodities in remote areas of Uganda.”
There were celebrations in late October by campaigners, though, when Uganda’s supreme court, in a landmark ruling, agreed with the petitioners (including Valente Inziku, the widower of Jennifer Anguko, who died along with the couple’s baby; and Rhoda Kukiriza, the mother-in-law of Sylvia Nalubowa, who also died) that the constitutional court erred in not hearing the original case. After an appeal, the supreme court directed that the case go back to the lower court, as it calls for constitutional interpretation.
In 2012, the constitutional court threw out the petition, saying maternal mortality was a matter for the executive arm of government and not for the court, as it was a “political question.”
Activists are now preparing to go back to that court and waiting for it to “determine if indeed non-provision of basic maternal health commodities in public hospitals is a violation of the right to health,” says Kwagala.
The case has dragged on since 2011, but CEHURD is hoping proceedings will resume in early January, according to Kwagala, who adds optimistically that some of Uganda’s new justices are “really progressive.”
“If the court rules that the maternal health status quo is a violation of rights, we’ll demand that government increases financing to health care, that maternal deaths be accounted for, because every life, every woman in Uganda, counts,” she says.
Luyiga says it’s “political will that’s lacking.” With presidential elections looming early next year, candidates have been blasting the government over Uganda’s high rate of maternal deaths. “But they’re not saying what they’re going to do,” she points out.
Wamala’s death, unlike those of so many others, received media coverage “because she was working in parliament,” says her sister, adding that more than 30 members of parliament attended her funeral.
Nalubowa, 40, a mother of six, who bled to death in 2009 at a hospital about 50 miles outside Kampala, allegedly through corruption and negligence, had a very different life.
Her mother-in-law, Kukiriza, sat with her dying daughter-in-law in a government hospital as she told her, “you take care of my kids” after the peasant farmers were unable to pay a $15 bribe to medics to buy drugs, which nurses said the facility lacked.
“I have spent a lot of time going to court, and it’s very painful for me,” said Kukiriza, in her late 60s, who is now looking after Nalubowa’s children and is not celebratory about the court ruling. “I want the government to pay school fees and build a house for them.”
Wamala’s death inspired Luyiga to take up a full-time job with White Ribbon Alliance Uganda as its communications manager. Earlier this year, she handed over a document to U.N. Secretary-General Ban Ki-moon about health concerns of citizens from 20 nations, including maternal mortality, and spoke at the G7 summit in Germany about the cause and her sister.
“I feel I should take forward her work,” Wamala says, adding, “She would be very proud of me.”
“No one understands the true cost of a life like a mother.”