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.