By: David Kabanda

Many young innocents of 0 to 6 months babies in Uganda suffer a silent but dread violation of their rights to adequate food, health and life. In their very vulnerable/fragile stage of life with no voice or power to demand for appropriate action, many have succumbed to death and others have lived and continuing with wasted life with Daily life long disabilities.

Uganda ranks among the top 10 countries in the world for new-born and child mortality rates among the top 34 for burden of stunting. This is to a large extent contributed to the denied right to breastfeeding of these infants. Breast milk is not only food. It is a complete diet for children in the correct amount to ensure their growth and development at that particular age. Studies have shown that children who are breastfed perform better than their counterparts in school.

The World Health Organisation has for long recommended that breastfeeding is sufficient and beneficial for infant nutrition in the first 6 months of life. Breastfeeding immediately after birth also helps the uterus contract, which reduces the mother’s postpartum blood loss. As a means of providing nutrition while protecting health, breastfeeding supplies irreplaceable immunological benefits and protections to the immunologically fragile new-born through the protective factors of human milk.

Supplementing breast milk before the child is age 6 months is discouraged because it may inhibit breastfeeding and expose the infant to illness. At a later stage of the baby’s development, breast milk should be supplemented by other liquids and eventually by solid or mushy food to provide adequate nourishment.

What is the problem?

The 2016 Uganda Demographic and Health Survey revealed that contrary to the recommendation that children under age 6 months be exclusively breastfed, 7 percent of infants consume plain water, 6 percent consume non-milk liquids, 8 percent consume other milk, and 11 percent consume complementary foods in addition to breast milk. Two percent of infants under age 6 months are not breastfed at all. In Uganda, the percentage of children exclusively breastfed decreases sharply with age from 83 percent of infants age 0-1 month to 69 percent of infants age 2-3 months and, further, to 43 percent of infants age 4-5 months. Eleven percent of infants under age 6 months are fed using a bottle with a nipple, a practice that is discouraged because of the risk of illness to the child.

Breastfeeding a child until age 2 is recommended. However, the proportion of children who are currently breastfeeding decreases with increasing child age from 82 percent among children age 12-17 months to 50 percent among children age 18-23 months.

These, being the very vulnerable members of our society, government must accord them special protection in law. Although there are some policies on breastfeeding like the Policy Guidelines on
Infant and Young Child Feeding, which recognise exclusive breastfeeding within the first 6 months, the legal framework in Uganda does not support this. Many mothers who would have wanted to exclusively breastfeed are left with far reaching psychological torture of leaving their babies with attendants and the innocent babies are left with no option but to feed on substitutes (which are in most cases diluted) leading to nutrient deficiencies causing ill health, stunting, death and lifelong disabilities including intellectual ineptness and incomprehension of life skills later in life.

What is the law?

The government of Uganda has a constitutional obligation under objective 14 and 22 to make sure that all Ugandans (including the vulnerable children) enjoy rights and opportunities and access to food security. Government must take appropriate steps (which may include legislation) to encourage people (mothers) to grow and store adequate food (breast milk); establish national food reserves (breast milk banks); and encourage and promote proper nutrition (exclusive breastfeeding for the first 6 months in life of a baby) through mass education and other appropriate (including legislative) means in order to build a healthy State.

The rights in the constitution must be respected, upheld and promoted by all organs and agencies of Government and by all persons and all persons are equal before and under the law in all spheres of political, economic, social and cultural life and in every other respect and shall enjoy equal protection of the law according to Articles 20 and 21 of the constitution. The government’s failure therefore to make exclusive breast feeding of the babies from 0 to 6 months in Uganda is a violation of their right to adequate food, health and life.

Beyond the right to adequate food, the innocents are subjected to inhuman and degrading treatment when they are deprived of breastfeeding. The whole process of being feed by another person not the mother and all intervening inappropriateness in cleanliness and measurements mean a transition from bottle to a grave for the vulnerable babies. Under Article 34 of the constitution, children shall have the right to know and be cared for by their parents or those entitled by law to bring them up.

Evolutionarily honed to provide all the nutrients necessary for the survival, growth, and protection of the baby, human milk is a living tissue, with breastfeeding continuing the biological “dyad” established in utero between the infant and mother and providing optimal nutrition for the development and growth of the child.” Human milk contains all of the nutrients critical to infant growth-a unique balance of proteins, carbohydrates, water, antibodies, hormones, micronutrients, and macronutrients-with the balance of these components adjusting during each feeding and over the course of lactation to provide the most appropriate nutritional content to the infant.12 Even when the mother’s nutrition is poor, the components

Be it as it may, in Uganda a mother is only legally allowed sixty (60) working days following childbirth or miscarriage and in unfortunate circumstances of either her sickness or child, then eight weeks. It is even made too difficult because the employer has liberty to exercise his or discretion if she does not have medical records. The law to this extent is inconsistent with the rights to adequate food, health, life and freedom from inhuman treatment of the innocent baby citizens and the continued set of affairs without government’s action is a violation of the rights of the vulnerable Uganda citizens aged between 0 to 6 months. The law must allow the mothers time to exclusively breastfeed upto 6 moths.

At international level, Uganda signed the Geneva Declaration of the Rights of the Child of 1924, the Declaration of the Rights of the Child adopted by the General Assembly on 20 November 1959, the Universal Declaration of Human Rights, International Covenant on Civil and Political Rights (in particular in articles 23 and 24), the International Covenant on Economic, Social and Cultural Rights (in particular in article 10). Uganda is signatory to the African Charter on Humanand Peoples Rights which gurantees children rights and the right right to health under Article 16.
Under International Convention of the right of the child(CRC), Uganda agreed to protect the child’s enjoyment of the highest attainable standard of health and, in particular, to diminish infant and child mortality and to combat disease and malnutrition, including provision of adequate nutritious foods and clean drinking-water, and to ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition and the advantages of breastfeeding.

This codification of breastfeeding obligations in the canon of human rights in CRC transmute breastfeeding from aspirational health intervention to binding obligations on Uganda as a signatory to make these rights realisable by the rights holders. More to that 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) advanced both a right to “be free from hunger” and a right to “the highest attainable standard of physical and mental health,” this means that Uganda as a signatory is under a specific legal obligations for “the reduction of the stillbirth-rate and for the healthy development of the child.

Conclusion

The infants’ inherent fragility denies them the autonomy to claim their own rights and define their own capability in the absence of state intervention in Uganda. They are vulnerable to disease, very disadvantaged within families, and are powerless to speak out. Infants often suffer relative to other family members, diminishing their freedom to lead valuable lives in the years to come. With a single source responsible for the entirety of an infant’s nutritional intake (exclusive breastfeeding), the relative quality of that source is dispositive in building the health necessary for infant functioning.

The government, is under a legal obligation to protect these innocents, even from the multinational companies selling the breast milk substitutes. The government’s inaction and the loud silence on a legal framework to guarantee exclusive breastfeeding to the children aged0 to 6 months is violation for which they should be held to account. The government must quickly take action in the direction that protects the children in accordance with the constitution.

I have been in Uganda for a little over a month now and have already learned so much, both from my work as an intern at the Center for Health, Human Rights and Development (CEHURD) and from my daily life in Uganda. I have visited Ugandan courts, taken countless boda rides and visited the source of the Nile. My first challenges were mostly activities that usually seemed simple to me, such as getting to work. My colleague’s kindness and patience in showing me the way around allowed me to feel much more comfortable in Kampala and to focus on my work as a legal intern.

CEHURD was created to advance the right to health for vulnerable populations such as people living with HIV/AIDS, women, and children. It is divided in three complementary programs (1) the Research, Documentation and Advocacy (2) Community Empowerment and (3) Strategic Litigation. As a second year law student, I was assigned to the Strategic Litigation program. Their objective is to provide legal support to persons whose rights have been infringed upon in Uganda and to litigate issues with the potential to redress systematic problems in the country’s health system. I have supported their work by drafting legal opinions on incoming cases and federal bills, completing research papers, and putting together grant proposals. This experience has allowed me to witness the use of the law as not only a tool to solve a single fact pattern but as a tool with the potential to create population shifts and improve health conditions on a national scale.

Most of the cases move for the implementation of the right to health. However, the Constitution of Uganda lacks an express provision on the right to health, which makes the conceptualization of each case particularly demanding. The right is implied from other constitutional clauses, the national objectives and the directive principles of state policy, each with health-related facets such as the right to life, human dignity and women’s rights. Furthermore, the implicit nature of the right to health in Uganda makes it so that its realization largely depends on political goodwill, judicial interpretation and the treatment of the other rights from which it derives. This particular situation highlights the importance of advocacy and community engagement in the respect of human rights and the delivery of safe and acceptable health services.

As much as one may put together a case supported by persuasive evidence demonstrating a human rights violation in the delivery or lack of health services, the societal attitudes towards specific issues and vulnerable populations are often the last and most difficult barriers to overcome in obtaining justice. For example, CEHURD & Kabale Benon v Attorney General is a recent case that demonstrates the prevailing stigma surrounding claims made by individuals who have suffered from periods of mental distress. In addition to silencing the plaintiff based on his identity as an individual with a mental health disorder, the court also disturbingly put all medical decisions above the scrutiny of the law.

This message discourages Ugandans from taking initiatives towards ensuring the respect of their rights and towards keeping the government accountable in its actions. CEHURD has recently filed an appeal for this case.

Overall, I am very motivated by CEHURD’s work as they put forward that the right to health extends itself to the causal determinants of health such as adequate sanitation facilities, health infrastructure, trained workers and essential drugs. I hope to contribute to my team’s work as much as I can in the following weeks and am excited to learn more about the right to health in Uganda.

Catherine Labasi-Sammartino
Summer Intern – McGill University Ontario Canada

Grabbing by the purse strings: Global gag rule and International Funding
19:00-19:30 CET

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Panelists:

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  Planned Parenthood Global
  @ppglobe
• Joy Asasira @jasasira
  Center for Health, Human Rights and Development
  @CEHURDUganda
• Chloe Cooney
  Planned Parenthood Federation of America
  @PPFA

 

By Fahad Musisi and Mariana Kayaga

The international day of the African Child attracts our attention to the cries and tribulations, without exempting health, of children especially in Sub-Saharan Africa, including Uganda, that remain unprioritized and unattended to yet children make a significant demography in this part of the world. In Uganda for instance, the 1995 Constitution of the Republic of Uganda describes a child as someone below the age of consent, which is 18 years. This day that is celebrated annually also reminds us of the 1976 student uprising in Soweto South Africa who marched in protest of the quality of education they accessed, and demanding to be taught in their language.

This day is critical to raising awareness on the continuous need for improving the nature of education provided to children in Africa especially regarding access to information about their sexuality for informed choices. Children are inclined to making wrong decisions because education in Uganda has not fulfilled its mandate of streamlining access to sexuality information. It is not surprising that teenage pregnancies now stand at 25% according to the 2016 UDHS, neither is it by coincidence that discussions around access to contraception are highly polarised, yet national surveys (UDHS) indicate that Ugandan girls are having sex at the age of 15.7 on average and boys at an average age of 16.

The central question is then, does the education system which is not tolerant of sexuality education for children responsive to children’s needs given the statistics as presented above? Is the theme for this year’s commemoration (leave no child behind in development) a reality or a fiction?

Children are more vulnerable than adults and are classified as unable to make serious decisions whose consent must legally be under the care of a responsible adult or custodian. However, custodianship has also not saved children from early marriages below the age of consent. It is one of the commonest social and human rights issue in Uganda, with the 2016 UDHS indicating a 46 percent of girls marrying before they reach the age of 18, yet children are not equipped with enough information. This exposes them to early pregnancies which sometimes culminate into stillbirth, and sometimes unsafe births leading to preeclampsia and sometimes fistula that makes them lose their dignity in society due to the stigma and discrimination it is associated with.

Child marriages are considered illegal in Uganda. Article 34 of the Constitution provides that a child is entitled to basic education which shall be the responsibility of the state and the parents. Since the same constitution puts the age of consent at 18, the implication is it is unconstitutional to marry off any child who is not yet that age.
However, Uganda can still do something to stop child marriages. Empowerment programs for girls, such as the Legal Empowerment and Social Accountability mechanisms utilized by CEHURD in Mukono and Gomba Districts under the DREAMS innovation Challenge Project; Integrating Legal Empowerment and social accountability for Quality HIV Health services for AGYW, are key to providing an opportunity to build skills and knowledge, understand and exercise their rights and develop support networks. Access to information on sexuality must therefore be a central tenet of education since it guides on making right choices, respect for the rights and dignity of children and their peers. The Uganda Strategy to End Child Marriage and Teenage Pregnancy which was launched on 27th October 2015 is therefore an important precursor to protecting the girl-child and ensuring access to their education.

Lawmakers and enforcement institutions need to ensure that laws around early marriages are effectively implemented. Community participation on this must therefore be a pillar in acquisition of first-hand information from the people falling victim of early marriage with a conviction that community prosperity is mainly dependent on the guaranteed future of children, especially the girl-child. The local leadership, cultural and religious leaders must therefore use all the available platforms within their reach to communicate against early marriages and the health hazards this poses.

This will guarantee adequate protection for children with specific focus on the girl-child because their lives also matter and must be an integral part of development.