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Last Updated: Friday, 24 October, 2003, 07:46 GMT 08:46 UK
Helping pregnant Ugandans stay alive
By Will Ross
BBC, Uganda

In the village of Kiyunga, 40 kilometres from the capital, Kampala, Theresa Nakanwagi clings onto photographs of her granddaughter and daughter.

They died within a year of each other; her daughter just two days after giving birth, her granddaughter when she was seven months pregnant.

Theresa Nakanwagi , with photos of her family
My granddaughter Unia was bewitched. She died when she was just 15
Theresa Nakanwagi
United Nations agencies this week said that an unacceptable number of women in developing countries are dying in childbirth and that access to specialist care during labour must be improved as a matter of urgency.

Sitting in Theresa Nakanwagi's home as she recalls how her relatives died, it is clear that a great deal of educating is still needed.

Theresa's daughter, Mariam, was 38 and expecting her eighth child.

"I have given birth seven times without any problems so why should I go to the hospital this time," Mariam had told her midwife.

Mariam gave birth without complications but due to the negligence of the midwife, her baby then bled through the umbilical cord and died the next day.

"When she saw her dead baby, Mariam's own condition worsened. She also lost a lot of blood. We tried to get her treated but the following day she died at the gates of the hospital," recalls Theresa.

Educating men

The official figure in Uganda is that for every 100,000 pregnancies, 505 mothers die. That is close to one in 200, compared to one in 2,500 in the United States.

But midwives say the true figure is likely to be far higher because the data is not always collected.

Photo of Mariam
Mariam died after the birth of her eighth child
The Uganda Private Midwives Association aims to reduce the maternal mortality rate with its "Life Saving Skills" initiative.

This involves offering training to more than 600 midwives spread throughout the country.

The association has produced a list of the major obstacles to progress and number one on the list is poor male involvement.

Mary Goretti of the Life Saving Skills initiative says the husbands or boyfriends must be educated about the dangers of pregnancy.

"You find a husband will not allow his wife to deliver in a hospital. He says he was born in a banana plantation, so sees nothing wrong with his wife doing the same."

Jealous wife

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Never is one more at risk than at birth, and as long as women die in childbirth, that nation will lack stability
VIT, USA

But Mary Goretti says it is not just the men who need to change, it is the whole community.

"My granddaughter Unia was bewitched. She died when she was just 15," laments Theresa.

When she was seven months pregnant by a married man, Unia began going into convulsions or fits.

"We tried to counter this with herbal remedies," Theresa says.

Unia's unborn baby died in her womb and when she was finally taken to hospital it was too late for the doctors to save her.
Mothers often turn up at the clinic with a flask and pretend it is full of tea when in fact it contains traditional medicine
Mary Goretti
Ugandan midwife

Unia's fits were symptoms of pre-eclampsia - a condition which is caused by high blood pressure during pregnancy.

But to this day, Theresa's family believe the jealous wife of Unia's baby's father used herbs to bewitch her.

Educating girls

Local midwife Sarah Nakitto, who works with the Life Saving Skills project, says lessons can be learnt from these two deaths.

"They don't know what can cause maternal mortality and what preventative measures can be taken.

Sarah Nakitto (l) and Mary Goretti (r)
Sarah and Mary have a big battle on their hands
"We have to educate people about family planning because Unia was so young. And her mother was delivering almost every year so if she had known more about family planning she would not have died," she says.

Theresa says girls' education is the key to reducing maternal mortality in Uganda.

"Every girl should go to school - if a girl has education she can decide her own future," says Theresa, remembering that Unia didn't even make it to the end of primary school when she became pregnant.

A high number of the maternal deaths are due to girls getting pregnant at a young age, Mary Goretti says.

"Such girls often fear telling their parents that they are pregnant and so consult their fellow adolescents. Then they induce abortion by inserting objects in the vagina or they drink local remedies which often prove fatal," she says.

Uphill task

The danger caused by unregulated traditional medicines is another challenge for the midwives.

Chance of death in childbirth and pregnancy
Sierra Leone, Afghanistan: one in six
Angola, Malawi, Niger: one in seven
Nepal: one in 24
Pakistan: one in 31
India: one in 48
Uganda: one in 200
Malaysia: one in 660
China: one in 830
US: one in 2,500
South Korea: one in 2,800
Britain: one in 3,300
Japan: one in 6,000
Sweden: one in 29,800
"Mothers often turn up at the clinic with a flask and pretend it is full of tea when in fact it contains traditional medicine," says Mary Goretti.

There are many factors contributing to high maternal mortality. While better equipped health centres and more midwives in the rural areas would certainly help, general poverty is a major barrier.

It is not unheard of for health workers to demand payment before seeing a mother.

The midwives have an uphill task. Malaria and HIV/Aids are both working against them and in the last five years the number of deaths has merely changed from 506 per 100,000 to 505.

But the deaths of Theresa's daughter, Mariam, and granddaughter, Unia, could both have been prevented with better knowledge.

So the Life Saving Skills team sees education as key and will continue to work with the entire community, including the men and those who use witchdoctors.




SEE ALSO:
Drive to cut maternal deaths
10 Oct 02  |  Scotland
Fighting for life in birth
11 May 01  |  Africa
The causes of maternal death
23 Nov 98  |  Health


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