BUDUDA– The government banned traditional birth attendants from delivering mothers in 2010, in the hope of improving maternal-mortality conditions.
Eight years down the road at 336 deaths per 100,000 live births, the country’s maternal mortality rate is still among the highest in Africa and in the world.
Reports from the National Saving Mothers and Giving Life (SMGL) dissemination meeting indicate that despite the free prenatal care in government hospitals, many expectant mothers, especially in rural areas, still prefer to go to the Traditional Birth Attendants to be delivered.
Dr Godfrey Mulekwa, the Pallisa District Health Officer says more than 60% of rural women prefer TBAs to skilled attendants and that of these more than 10% are delivered by TBAs.
“The traditional birth attendants can’t handle haemorrhage in women, which contributes to 42 percent of maternal deaths and is the leading cause of maternal mortality in the country,” said Dr Mulekwa.
The Pallisa district health status report indicates that 27 percent of expectant mothers in Pallisa District do not go to antenatal services.
The report says that although giving birth at health centres has improved from 43-63 percent on average, the remaining 27 percent either deliver at home or visit traditional birth attendants.
Catherine Alupo says expectant mothers prefer TBAs to skilled health workers for their better handling of mothers, politeness, counselling and comfort during labour and childbirth.
“The TBAs are affordable, available, accessible and approachable and are in places where health centres are not, hard to reach areas,” says Alupo, a mother of three assisted by a TBA in all three deliveries.
She explained that the role of TBAs is vital to a rural woman and should not be under looked: they are highly respected members and proven assets in addressing poor maternal outcomes.
“TBAs have contributed to successful maternal, neonatal and child health interventions in hard-to-reach areas and if you abolished them, are you going to have no new cases of fistula or will you completely remove the maternal deaths [to have] Zero per 1000 deaths year?” Ms Alupo added.
Dr Muhammad Mulongo, the District Health Officer for Bulambuli district says the poor services at health facilities and demand factors such as poor transport systems, the terrain of the areas, inadequate information, lack of access to finances and community behaviours may be responsible for the sluggish progress in reducing maternal mortality.
“Like other LMICs, the maternal and prenatal deaths in Uganda occur from complications that occur during pregnancy, at the time of and after delivery and the majority of maternal deaths due to direct obstetric causes are linked to delays at the TBAs,” said Dr Mulongo.
He explained that on the demand side, poor transport systems, poor services at the health facilities, inadequate information and poverty were mentioned as the factors that stop rural women from utilising/accessing maternal service.
He urged government to provide essential drugs/equipment, health workers in health facilities and to address community challenges that stop some of the women from delivering at the health facilities.
Dr John Baptist Waniaye, the Commissioner for Emergency Medical Services at the Ministry of Health, said government is using the multi-sectoral approaches aimed at improving service delivery across the country to ensure expectant mothers don’t deliver at TBAs.
He noted that among many existing services to expand service delivery, procurement and effective use of ambulances were important to improve the quality of care for emergency cases by ensuring quick response during emergencies.
“The key resources for operation are human resources such as ambulance crews, fuel and maintenance of the ambulances is crucial to effectively run the ambulance services and the ministry is developing an Emergency Medical Services Policy, Standards and Strategy which will spell out the coordination of ambulances in different regions in the country,” said Dr Waniaye.
(Dr. Imelda Tumuhaire, the Medical Superintendent Bududa Hospital asked government to check Traditional Birth Attendants activities in rural areas in order to reduce on the infant and maternal mortality rates.
Dr Tumuhaire said whereas it is vital to integrate TBA in aiding pregnant mothers far from health centres in delivery, the TBA should be restricted from handling cases beyond their means. She revealed that pregnant women suffering from Hypertension, Diabetes, heart conditions, those expecting twins and those above the eighth delivery have died in rural areas unreported during delivery in the hands of TBA.
US Ambassador Deborah Malac while speaking at the launch of the National Saving Mothers and Giving Life (SMGL) at Protea Hotel in Kampala in July said they have joined the celebrations for launching the SMGL since every two minutes a woman dies somewhere in the world during pregnancy or childbirth.
“We are here because an estimated 80 per cent of maternal and newborn deaths are preventable with the implementation of known evidenced-based, high-impact interventions. We want to save that 80 per cent,” Ms Malac said.
Ms Sarah Opendi, the State Minister for Health [General duties] said government is aware that, nearly 355 per cent of women in Uganda, especially those in rural areas, deliver from banana plantations or at TBAs although the country has more than 55 per cent access to health facilities.
Ms Opendi said government health facilities have much more to offer a mother than what many people think.
She revealed that government through the Ministry of Health has trained the Village Health Team workers, recruited new health workers, refurbished health facilities, availed transport systems to have quality services in these districts and that there was no reason why an expectant mother should go to a TBA.
“I am asking expectant mothers to go to government facilities for deliveries in the hands of qualified/skilled health workers because their babies will be immunised at birth, something that is not the case with deliveries done in the villages or in banana plantations,” she said.
She said her ministry was pushing for a policy that would require all expectant mothers to visit health facilities at least 8 times from the four times during the pregnancy cycle to reduce the risk of stillbirths and pregnancy complications at TBAs.
She said as Uganda is struggling to contain the high maternal mortality rates, it was important that district leaders worked jointly with the communities to identify the TBAs in rural areas and stop them from handling deliveries to avoid deaths.