COVID-19, Pregnant Women, and the Right to Maternal Healthcare in Uganda
*By Michele Lynda Mugenyi
The COVID-19 pandemic has had a number of effects on women across the globe. One of these has been the obstruction of women’s rights through restricted access to urgent maternal healthcare. On March 30th, Uganda’s President Yoweri Kaguta Museveni announced a 14-day ban on public and private transport. Since majority of Ugandans rely on private transport to get to hospitals and ambulances are in short supply, this policy has made it difficult for pregnant women to access health services when they go into labour. As a result, a number of them have died during labour.
Uganda has made progress in reducing maternal mortality. According to data from the Uganda Demographic and Health Surveys of 2011 and 2016, the maternal mortality ratio dropped from 438 deaths per 100,000 live births to 336. Nonetheless, maternal mortality is still an issue of great concern in Uganda. And the worry is that recent measures that have been taken to contain the spread of COVID-19 have, and will continue to exacerbate the issue. Past experience has shown that pregnant women suffer in the midst of pandemics.
During the 2013-16 ebola virus outbreak in Sierra Leone, fewer women accessed the necessary maternal health services as a result of the government’s containment efforts. According to research from Laura Sochas et al (2017), utilization of facility deliveries, family planning, and antenatal and postnatal care services decreased by a total of 49 percentage points. Though there is not a lot of data on the direct effects of the outbreak on the maternal mortality rate, research from Sochas suggested that the decrease in utilization of the above maternal services translated to “3600 additional maternal, neonatal and stillbirth deaths in the year 2014–15 under the most conservative scenario”.
The government of Uganda has ratified a number of international human rights treaties, legally binding them to the protection of the rights and dignity of its citizens. Specifically, the rights of each individual to enjoy “the highest attainable standard of physical and mental health”, and the provision of “appropriate services in connection with pregnancy.”. Although the 1995 Ugandan constitution lacks an explicit provision on the right to health, it mentions the state’s obligation to provide basic medical services and protect the rights of women because of their “unique status and natural maternal functions in society”. This obligation is to be taken as the “Supreme Law of the Land under Article 2(1).”. Failure to ensure pregnant women are provided with basic minimum healthcare is therefore unconstitutional.
Although private transport is allowed for health emergencies, individuals have to get a movement permit from Resident District Commissioners (RDCs) first. However, RDCs are difficult to reach because of the distance between them and a number of their residents. Wakiso District Headquarters, for example, is located in the centre of the district, 7.9 km from Nansana in the East and 10.9 km from Sentema in the West. Because of the ban on public and private transport, most individuals have to walk several kilometers to their RDCs to get a permit. In addition, according to the National Population and Housing Census 2014, the median district population size was 240,000 people and 59 out of 112 districts had a population of under 250,000. With only one RDC office in an entire district, these offices become overwhelmed and delay in issuing permits.
However, these issues are interlinked. Centralizing permit issuance to the office of one individual is ineffective in making sure the needs of all the people are heard without overwhelming the permitting authority. In order to tackle the issues, the government should decentralize this authority to other lower local government officials, such as the Chief Administrative Officers (CAOs) and local council (LC) chairpersons. Permitting authorities must be made aware that they are under legal obligation to promote the welfare of their residents under the 1997 Local Governments Act by ensuring all requests are processed in a timely fashion. With any luck, decentralizing the process should ensure more people’s permits are processed faster, and more pregnant women can access the healthcare they need before it is too late.
* Michele Lynda Mugenyi holds a BA(Hons) International Relations and Development, University of Sussex UK.
The views expressed in this entry belong solely to the author.