U.S health initiative cuts maternal deaths by third

The first year of the Saving Mothers Giving Life initiative meant to reduce maternal mortality saw deaths from childbirth cut by a third, according to a report released January 9.

Saving Mothers’ first annual report, Making Pregnancy and Childbirth Safe in Uganda and Zambia details outcomes from the first year of the five-year initiative which began in June 2012.

It demonstrates that there is a 30 per cent decrease in maternal mortality in the target districts of Kabarole, Kibaale, Kamwenge, and Kyenjojo in Uganda and 35 percent in four of Zambia’s districts.

This initiative is led by the U.S Global Health Initiative (GHI), in partnership with Merck for Mothers, the American College of Obstetricians and Gynaecologists, Every Mother Counts, Project C.U.R.E. and the Government of Norway.

The U.S. committed $75m to this partnership.

“Uganda has not only seen a 30 percent reduction in maternal mortality in the four districts participating in the program, but has also registered a 28 percent increase in the number of women who received prevention of mother-to-child transmission of HIV/Aids services, said Dr Jane Ruth Aceng, Director General of the Ministry of Health during the report launch in Washington, D.C.

A gynecologist attends to a pregnant woman at Mulago Referral Hospital

She also said the districts increased the number of facilities providing basic emergency obstetric and newborn care and trained and hired 147 new doctors, nurses, and midwives.

With greater access to obstetric care, deaths from haemorrhage and obstructed labour were also reduced.

Health workers were trained to address childbirth-related complications affecting newborns, and saw an 11 percent reduction in institutional prenatal mortality.

Additionally, the districts also saw a 27 percent increase in the number of infants who received HIV prophylaxis and increase in the number of women giving birth in health facilities.

USAID administrator Dr Rajiv Shah said that in Uganda alone, 30,000 transportation vouchers provided by Saving Mothers, were redeemed and used.

Zambia and Uganda are the first two countries to operationalise the initiative because of their high ratios of maternal mortality. Uganda continues to struggle with high numbers of women who die during pregnancy and from complications of childbirth.

It is estimated 438 women out of every 100,000 die in pregnancy or childbirth every year – ranking Uganda 141 out of 172 high burden countries globally.

Uganda loses 1500 women to unsafe abortions annually

The president of the Association of Gynaecologists and Obstetrician of Uganda (AOGU), Dr Charles Kiggundu has revealed that over 1500 women especially the youth die annually due to complications of unsafe abortion. Unsafe abortion refers to the termination of pregnancy in an environment that does not observe acceptable standards done by unskilled providers.

In Uganda, of the two million pregnancies that occur annually there are 400,000 unsafe abortions majority of which are self induced using methods such as smoking cow dung, drinking laundry detergent, bleach or gasoline, insertion of a catheter, clothes hanger, stick and cassava into the vagina and taking oral hormonal drugs.

 “Out of every 100preganant women, 20 will get abortions and eight of these will need emergency post abortion care but might not access it because of the stigma society and health workers attach to abortion,” Dr Kiggundu said during a lawyers meeting on the use of a human rights approach to unpack the legal and policy framework on abortion on Monday.

He added that 90,000 of these women develop complications such as haemorrhage that need emergency obstetric care and this is available in only 15 per cent of the health facilities. 

A lady at Hoima Hospital being led to theatre for surgery after developing fistula

Unsafe abortion accounts for 26 percent of Uganda’s maternal mortality burden which is currently at 438 deaths per 100,000 live births. Among the factors fuelling the high rates of the unsafe abortion in Uganda are the restrictive and unaddressed misconceptions about laws concerning abortion.

Unpacking the abortion laws;

According to Moses Mulumba, the Executive Director of the Centre for Health, Human Rights and Development (CEHURD), abortion is permitted in Uganda under some circumstances but the relevant laws and policies are unclear and are often interpreted inconsistently, making it difficult for both women and the medical community to understand their options.

Currently, the Penal Code Act is the substantive law on abortion and under its Sections 140 to 142; it is an offense for a person to procure the miscarriage of woman or to attempt to procure the miscarriage of a woman. Under Section 143, it is also an offense for a woman to procure her own miscarriage.

“Because abortion is an offence under this law, it is being carried out secretively in un safe dark places, using unsafe instruments so that the giver and receiver of the service is not penalized. This has worsened the situation,” the acting assistant commissioner for reproductive health services in the health ministry, Dr Collins Tusingwire, said. 

A teenage mother in Apac district looks adorably at her suckling infant. The rate of unsafe abortion is highest among the country's youths

In 1995, the Constitution introduced improvements to the law on abortion in article 22 (2) which provides that “no person has the right to terminate the life of an unborn child except as may be authorized by law.”

“The Constitution envisages that a law may be enacted authorizing the termination of the life of an unborn child in the circumstances which should be specified in that law. However, since 1995 there is no law that has been enacted to give effect to article 22(2) of the Constitution,” Denis Kibirige, a senior state attorney said.

This disclarity, according to Dr Kiggundu has limited women’s access to safe surgical and medical abortion procedures such as dilation and curettage.

Moreover, policies on abortion remain unknown.

In the meantime however, Uganda is using the 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health Rights for skilled medical personnel to carry out an abortion.

According to these guidelines, pregnancy termination is permissible in cases of foetal anomaly, rape and incest or if the woman has HIV. The challenge however, is that these guidelines are not clearly detailed in legislation.  

Kibirige argued that Sections 141 to 143, 212 of the Penal Code could be amended to remove the general criminalization on procuring a miscarriage in order to realize safe medical abortions.

He also proposed that a new law may be promoted and introduced in Parliament to specifically address the circumstances under which the life of an unborn child may be terminated in accordance with article 22(2) of the Constitution