CORAL SPRINGS, Florida — The maternal mortality ratio, or the number of women dying from pregnancy-related causes, has long concerned developing countries. However, the ratio has declined in recent years. The maternal mortality ratio plummeted by 38% worldwide between 2000 and 2017. Still, maternal mortality in Uganda is among the highest rates in the world.
The Decline in the Maternal Mortality Rate in Uganda
In March 2021, the Uganda Bureau of Statistics reported that the maternal mortality rate dropped from 438 deaths per 100,000 births in 2011 to 368 deaths per 100,000 in 2021. This drop reflects a steady decline, which began from 2000 onwards. Regardless, maternal mortality in Uganda is still far above the global average, which was 152 deaths per 100,000 live births in 2020. Experts have carefully examined the root causes of the problem.
Causes of Death
In Uganda, the causes of maternal death are generally preventable. The leading causes of maternal death include hemorrhage, high blood pressure, unsafe abortions and infections. Experts use a specific approach to examine and describe why these preventable issues lead to maternal mortality in Uganda despite their preventable nature.
The Three Delays
Most studies examining the maternal mortality rate use the three delays approach. The three delays are a framework that explains what causes maternal deaths in a country, such as those in Uganda. The delays include delays in seeking care, delays in arrival at health facilities and delays in providing adequate care. The three delays model is crucial because it diagnoses the reasons behind maternal deaths. This allows experts to rectify the problem as soon as possible.
The Borgen Project spoke about the three delays in Uganda with a medical doctor, who has chosen to remain anonymous for privacy reasons. During medical school, the doctor traveled to Uganda to examine the three delays and develop solutions to maternal mortality. They said, “I created focus groups, mainly comprised of community leaders, to identify challenges that predispose maternal mortality.” They also consulted with women in rural villages and organized health fairs to allow these women to share their experiences. In addition, the doctor used the three delays to identify and diagnose the severity of the challenges fueling maternal mortality in Uganda. They argued that the three delays are access to information, roads and health care facilities.
NGOs, IGOs, nonprofits and governmental organizations have used the three delays approach to explain maternal mortality in Uganda. The first delay includes obstacles that impact a 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. According to the doctor, “based on their paternalistic society, a lot of the decisions regarding when to seek medical care weren’t up to them.” As a result, pregnant women facing complications may not get the immediate treatment they need, resulting in serious consequences.
Delays in arrival at the health facility also play a strong role in maternal mortality in Uganda. Pregnant women need access to Emergency Obstetric and Neonatal Care facilities within two hours. However, this is not always viable. For example, Ugandans in rural areas rely on motorcycle taxis known as “boda bodas” for transportation to medical facilities. Some women may not be able to afford boda bodas. In addition, other factors may affect arrival at the health facility, such as distance to the actual facility and road infrastructure.
Lastly, delays to adequate health care contribute to maternal mortality in Uganda. Experts have said that if a woman is experiencing a complication in her pregnancy, she must receive quality treatment promptly. Therefore, facilities need the correct equipment and well-trained staff upon the arrival of patients.
In Uganda, this delay is present. As the doctor noted, “once a woman overcame the obstacle of deciding when to seek care and finding a way to get to the facility, it was sometimes hard to get the appropriate care there based on supplies and resources and if the facility was equipped to handle more emergent situations with labor.”
A Positive Outlook
The three delays create many challenges. However, the nation is not alone in its battle against maternal mortality. For instance, in July 2020, the Republic of Korea and the World Health Organization (WHO) pledged to give a total of $10 million to improve several health services across Uganda, including maternal health. The pledge will directly combat the three delays by purchasing ambulances, training workers and improving health facilities.
Estimates say that more than half a million pregnant women and another half a million newborn babies will directly benefit from the support. Though the $10 million pledge is not sufficient to end maternal mortality in Uganda, it is certainly a step in a positive direction.
– Richard J. Vieira