Maternal Health in Uganda in a time of COVID-19.
By Winnie Naigaga Kyobiika*
Goals #3 and #5 of the United Nations Sustainable Development Goals speak directly to issues of good health and well-being, and gender equality respectively. What do these goals mean for women who traditionally lack access to services for maternal and child health? The current COVID-19 pandemic poses an increased risk for women in low income communities around the world, and Uganda is no exception.
On 18th March, places of public gatherings including schools, educational institutions, places of worship, pubs, weddings, funerals, music shows, rallies, cultural gatherings among others were banned for 32 days. Foreigners arriving from high risk countries into the country would have to first undergo 14 days of quarantine in hotels designated by the government. Uganda confirmed her first case of COVID-19 on 21st March. As I waited for labour I did not think the pandemic was going to interrupt my way of life. I was in for an unprecedented shock.
I gave birth to my bundle of joy on 23rd March. I however, could not be discharged because my baby was still held up in the special care unit. During my time at the hospital, the hospital administration started restricting visitors. I was asked to choose one person to attend to me. Naturally, I picked my mother as my attendant. This meant I could not have my partner present during my postpartum recovery. I missed the opportunity to celebrate with him, and it was torturous having a sick baby in special care unit without my partner present. I missed his support psychologically and physically. I was to spend a week in hospital and on being discharged, I realized the world as I knew it had changed. I went into labour in a free world and emerged out of the hospital into a lockdown!
While in hospital, more cases of COVID-19 had been confirmed. On 25th March, public transportation was suspended for 14 days. Five days later, private cars followed suit. A curfew of 7pm – 6.30am was also declared. For one to move due to an emergency, permission from the office of the presidential representative in one’s district had to be sought. This was a struggle. My baby needed to have 3 hospital reviews. I did not know who the presidential representative in my district was, nor did I know his office!
The government measures to curb COVID-19 has had adverse effects not only on me, but on many other expectant women and postpartum mothers both in Uganda and across Africa. Under “normal” conditions, access to maternal health for most women in Uganda and Africa as a whole is limited and outright unavailable in some instances. However, the pandemic brings new challenges that worsens an already sad situation. Many birth plans have been interrupted. Pregnant women now face the possibility of giving birth alone in and out of quarantine without a midwife-led birth and some are losing their lives and those of their babies in the process. Those who had planned to have a caesarean section are grappling with making special arrangements. Husbands stand a high chance of not sharing the first moments of life of their new bundles of joy.
This discussion may appear trivial since available scientific consensus appears to be that the spread of COVID-19 is most effectively controlled by limiting movement; isolating those who might have been exposed to the virus and treating those who test positive. However, should cases of maternal death increase in a bid to protect 40 million Ugandans from the pandemic? Women’s issues in Uganda and most probably across Africa rarely make it into public discourse due to various inequalities propagated by gender stereotypes. In Uganda, maternal health jurisprudence is relatively new. The Ugandan judiciary in response to COVID-19 has scaled down its operations to a skeletal staff manning a few courts. Cases to be handled are limited to those which are “exceptional” or “urgent”.
The judiciary administration has also encouraged the use of teleconferencing. More questions arise with this state of affairs. How well can a court being manned by a skeletal staff do justice to a case involving maternal health? How will other cases involving gender-related issues such as domestic violence, rape, defilement, child maintenance, child custody, divorce, right to alimony and property among others be handled? How well is the Ugandan judiciary ready to make use of ICT such as teleconferencing? We risk having more gender-related issues falling through the cracks.
In conclusion, these are unprecedented times for Uganda as a young democracy. With only 53 confirmed cases as of 12th April, the measures being taken appear to be working. However, it is imperative for the government to go a step further to incorporate gender-related issues into its response to the COVID-19 pandemic. The state should not open itself up to more legal challenges which could have been easily avoided by a more careful and considered action. It also does not make sense averting a crisis while creating a new one.
*Winnie Naigaga Kyobiika is a Research Officer, Judicial Training Institute, Uganda and a recipient of the Hubert H.Humphrey Fellowship at American University Washington College of Law, USA.
The views expressed in this entry belong solely to the author.