Uganda is a country in East Africa that has been ravaged by war and ethnic cleansing for several decades, leaving the country in a state of political and economic instability. Civil unrest has led to the weakening of health infrastructure and perpetual shortages of medical supplies and trained physicians. Uganda currently has one of the highest maternal mortality rates in the world. For the past 5 years, several organizations, such as UNICEF and USAID, have been working with the Ugandan government to strengthen health care facilities in order to improve emergency obstetric care. Despite these concerted efforts, there has been only a small reduction in maternal deaths. A recent study by G. Kyomuhendo demonstrated that pregnant women in Uganda declined emergency obstetric services resulting in death. Kyomuhendo showed that Ugandan women did not seek care because of 1.) an adherence to traditional beliefs about pregnancy/birthing, 2.) belief that health care providers were poorly trained, 3.) past experiences of abuse/neglect when accessing care.
Quick Stats on Uganda:
- Maternal mortality rate – 510 maternal deaths per 100,000 live births. (Switzerland’s MMR is 7 maternal deaths per 100,000 live births.)
- 14 women die every day during childbirth
- 1 in 8 women have a lifetime risk of dying from pregnancy complications.
- 80% of maternal deaths are attributed to sepsis, hemorrhage, unsafe abortion, obstructed labor and hypertensive disorders.
- 34% of health care workers are equipped to treat obstetric complications
- 42% of women who claimed to have pregnancy or delivery complications did not seek medical care.
Why don’t Ugandan mothers seek medical care?
According to study by Kyomuhendo, women in Uganda believe that seeking medical care during pregnancy or delivery is lazy, weak, or not respectable. Ugandan women hold superstitious beliefs that the outcome of pregnancy is predetermined before even going into labor. The woman who attempts to seek medical care when faced with complications is believed to be intervening with something that is beyond her control. The woman who endures pregnancy or labor with no outside help is esteemed, as if the positive outcome was determined by her own inner strength Ugandan women claimed that health care workers were unethical, rude, and verbally abusive when providing care.
Another complaint voiced by Ugandan women in this study was the supine position in which they were expected to deliver. Traditionally, women in Uganda deliver in a kneeling position, which is preferred because it makes delivery less painful. However, when health care workers were interviewed regarding this complaint, they revealed that they were not comfortable delivering babies in this position.
UNICEF and USAID can strengthen health infrastructure and provide state of the art medical equipment to facilities within Uganda, but those efforts should not be the only paths taken to reduce maternal mortality. The sensitization of health care workers to the cultural beliefs of Ugandan mothers is imperative.
Unabridged 
Thanks for the this important article. Its supportive much more for me who is interested in the reduction of maternal mortality in Uganda.
God bless you.
Jeconiah Franco Z.
Interesting to note the cultural values and thier negative effects on maternal mortality.
Fa
Sorry, but there is not such a thing as “cultural incompetence”. This is ethnocentric. For every cultural behaviour, no matter where, there are reasons, that can be understood out of the culture itself.
Actually, there are cultural believes towards pregnancy and delivery: For example, delivering alone has helped less priviledged women to generate social status; another reason is, that there is a feeling independence and and autonomy, because they are not subjected to the hierachical system of a hospital, let alone that they can decide in which position they can deliver. Actually, we western women do similar things, by deciding very carefully, where we go for our deliveries and for us too, there is a sense of autonomy and independence, when we manage to deliver at home or in specific birth centres just with the help of a midwife, in stead of a conventional clinic!
There are some studies about this subject:
Improving maternal health: Getting what works to Happen by Loveday Penn-Kekana and Barbara McPake and Justin Parkhurst
or:Low Use of rural maternity Services in Uganda: Impact of Women´s Status, traditional Beliefs and limited resources by Grace Bantebya Kyomuhendo
Best wishes,
Julia
Hi Julia,
Thank you for reading and commenting.
I am not sure I understand your statement on there being no such thing as cultural incompentence. This is a term widely used in the development and aid world that is used to describe an inability to decipher cultural cues and expectations, which often has fatal consequences. On the other hand, cultural *competence* stands opposed to ethnocentricity; it is trying to eliminate it. Futhermore, the rest of your comments suggest that you may have misunderstood most of the post and that ultimately, we share the same view when it comes to empowering Ugandan women.
My point was to demonstrate that by giving Ugandan women autonomy in all the decisions surrounding birth, including when, where and how they deliver, this would actually reduce maternal mortality and improve health overall. I cite several studies by G.B. Kyomuhendo that you referenced at the end of your comment. It may be worthwhile to reread carefully the post in its entirety because I believe we are saying the exact same thing. 🙂
It is an educative piece of write up. I am interested because I am doing research on maternal Health a case study in Mukono District. I surely find it very informative. Big up!! Get in touch we could share more on the same subject. Sylvia: skyobe@yahoo.com
its pleasure for me to b the part of your information.
Emily,
I run a nonprofit in Uganda working to reduce maternal and neonatal mortality by partnering projects aimed at addressing cultural conceptions and traditions with projects increasing access and quality of care. I just discovered your article and found it very interesting. I know you wrote it a while ago, but I would enjoy discussing it with you via email or phone if you’re up to it. Please let me know.
Thank you,
Jacquie
thanks for the wonder full information abut our nation, i only wish policy makers will make good use of this information
Nice post Em…
So interesting — excellent article, Em!