Uganda, like many developing countries, has high maternal mortality ratio at 153 per 100,000 live births. According to the World Health Organization (WHO), a maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. In situations where attribution of the cause of death is inadequate, another definition, pregnancy-related death was coined by the United States Centers for Disease Control and Prevention (CDC), defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.
For the past decades, billions of money have been invested in maternal health with less results being realized. However, worldwide, there has been a tremendous decline in recent years by 38% between 2000 and 2017 in the maternal mortality rate with higher income regions performing better than countries in lower income regions. This was clearly noted by WHO in 2017, where over 300,000 women died from pregnancy related complications of which 57,000 deaths were in South Asia and 200,000 in Sub Saharan Africa. Uganda a country in the Sub-Saharan Africa Region has a much lower maternal mortality ratio, 153 versus 500 deaths per 100,000 in the region. In March 2021, the maternal mortality rate in Uganda dropped from 438 deaths per 100,000 births in 2011 to 368 deaths per 100,000. This drop reflects a steady decline, which began from 2000 onwards. However, maternal mortality in Uganda is still far above the global average, which was 152 deaths per 100,000 live births in 2020. More so, the pooled estimate fertility rate in Sub Saharan Africa was 5 children per woman which is significantly less than that of Uganda at 4.6. This implies that Uganda is doing fairly well compared to other countries in the region.
This is suggesting that when compared to other nations in the same region, Uganda has more teen pregnancies and births. However, the region averages only 19 seats in parliament, which is much lower than Uganda. 22.2% of women in the region have at least a secondary education. This is significantly higher than Uganda suggesting that higher education for women is more difficult to achieve in Uganda compared to the average number in the region. 62.9% of women in Sub-Saharan Africa are actively participating in the labor force. Uganda seems to have greater participation from women than the region's average. Uganda is the average when it comes to contraceptive use in the region suggesting this is an issue of that entire region. 73.6% of women attend at least one antenatal care visit in the region. Uganda's is higher, suggesting more Uganda women take advantage of healthcare services than other women in the region. Uganda is also the average for the region in percent of births done with the aid of a skilled attendant also suggesting this is a regional issue.
Maternal mortality causes In Uganda, the causes of maternal death have changed over time and are generally preventable. The leading causes of maternal death include haemorrhage, high blood pressure, unsafe abortions and infections. These causes can be explained using the three delays model approach used by most studies examining maternal mortality.
The three delays model
This is a framework that explains what causes overwhelming maternal deaths and these include delays in seeking care, delays in arrival at the health facilities and delays in providing adequate care while at the health facilities. This allows the responsible people to rectify the problem as soon as possible. This model is very important because it diagnoses the reasons behind maternal deaths. Delay one includes obstacles that impact the woman and her family's awareness of complications or decision to seek health care. In Uganda, cultural norms significantly impact a woman's decision to seek health care. Specifically, decision-making in regards to health care is not the woman's jurisdiction alone, but rather the family's as a unit. As a result the pregnant women facing the complications may not get the immediate treatment they need resulting to serious consequences. Delay two in arrival at the health facility also plays a strong role in maternal mortality in Uganda and also delay three which is delayed adequate healthcare while at the health facility.
Previous causes of maternal mortality
This is similar to what we had previously where other factors attributable to this high MMR in Uganda, were often a reflection of access to health care services. Even when health care services are available, healthcare worker under-staffing is common often with low medical supplies such as essential medication which can also have an effect. The health of a mother impacts the family and even the entire community. Her ability and access to receive necessary healthcare largely determines health outcomes for herself and her baby. Traditionally, Ugandan women seek to handle birth on their own as it is a time when they can use their own power and make their own decisions which can also be a factor in such a high maternal mortality rate. Many women report mistreatment from healthcare personnel as an additional reason to avoid seeking professional care during pregnancy and labor. A study also found that a majority of Ugandan women lack health literacy and in turn seek care in more traditional or homeopathic ways. Malaria is also a substantial issue. Pregnant women and their newborn babies are particularly susceptible to complications related to malaria, which is endemic in Uganda. This is also an issue that needs to be addressed in order to improve maternal mortality in Uganda.
Maternal health as a capability and why it matters
The WHO defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Furthermore WHO defines health as the enjoyment of the highest attainable standard of health and is one of the fundamental rights of every human being. Amartya K. Sen, a feminist economist, adds to that as he said that health is among the most important conditions of human life and a critically significant constituent of human capabilities which we have reason to value. It has been found that healthier nations, or those with a greater life expectancy and lower infant mortality, see greater economic growth and prosperity. The argument has also been made the other way that economic growth contributes to healthier nations. It is not just the overall availability of resources that improves health, but access by the public to those resources. Sen argues that health only improves during economic prosperity if there is a shift in resource allocation towards health and education, equitable distribution of income, and extensive employment programs to decrease the unemployment rate.
Sen writes, "The factors that can contribute to health achievements and failures go well beyond health care, and include many influences of very different kinds, varying from (genetic) propensities, individual incomes, food habits and lifestyle, on the one hand, to the epidemiological environment and work conditions, on the other...We have to go well beyond the delivery and distribution of health care to get an adequate understanding of health achievement and capability."
UNICEF found that healthy children need healthy mothers. A woman in Sub-Saharan Africa has a 1 in 16 chance of dying in childbirth. The report found that at least 20% of the burden of disease in children below the age of 5 is related to poor maternal health and nutrition, as well as the quality of care at delivery and during the newborn period. Yearly, 8 million babies die before or during delivery or in the first week of life. Further, many children are tragically left motherless each year. These children are 10 times more likely to die within two years of their mothers' death. It has also been found that the health of the mother vastly affects the health of all of her children. The health of our mothers vastly impacts the health and success of our future generations.
Maternal mortality and morbidity The World Health Organization (WHO) defines maternal health as the health of women during pregnancy, childbirth and the postpartum period. According to estimates from Uganda Bureau of Statistics (UBOS), Uganda's maternal mortality ratio, the annual number of deaths of women from pregnancy-related causes per 100,000 live births stands at 343 after allowing for adjustments. Women die as a result of complications during and following pregnancy and childbirth and the major complications include severe bleeding, infections, unsafe abortion and obstructed labor.
Uganda is slow in its progress in the fifth goal of improving maternal health in its Millennium Development Goals. With the 2015 target for maternal mortality ratio at 131 per 100,000 births and proportion of births attended by skilled health personnel set at 100%, Uganda has a long battle in reaching its intended goals. Moreover, the methodology used and the sample sizes implemented by the Uganda Demographic Health Survey (UDHS) do not allow for precise estimates of maternal mortality. This suggests that the estimates collated are erroneous and it is conceivable that the actual rates could be much higher than those reported.
Uganda has over the years had a decline in infant and under-five mortality. The most common causes of under-five mortality are pneumonia (16 per cent), malaria (13 per cent), diarrhea (10 per cent) and HIV and AIDs (7 per cent). Child mortality is differently across the country. Karamojia, Southwest, West Nile and the western regions have the highest mortality. Although there is a decline in mortality, 1 out of 11 children dies before they turn five years old. Although the maternal mortality has increased from 435 in 1990 to 438 in 2011 per 1000 child, the neonatal mortality has dropped from 29 in 1990 to 27 in 2001 per 1000 child.
High maternal mortality rates persist in Uganda due to an overall low use of contraceptives, limited capacity of health facilities to manage abortion/miscarriage complications and prevalence of HIV/AIDS among pregnant women. Despite malaria being one of the leading causes of morbidity in pregnant women, prevention and prophylaxis services are not well established.
Human Development Report 2011