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Posted on Categories Article, Featured

Women’s Economic Empowerment and Health Vulnerabilities

By Shiena Serikawa, edited by CEHURD

My name is Shiena Serikawa, a recent graduate from the University of British Columbia, Canada with an interest in women’s economic empowerment. I had an opportunity to intern at the Center for Health, Human Rights and Development (CEHURD), where I visited communities in Namutumba District in Eastern Uganda. I was intrigued to explore the barriers to health among vulnerable communities to achieve ‘equitable health and human rights for all’ as CEHURD’s goal states, which resonates with my personal thoughts about health as a human right. My visit to the community, discussions with stakeholders, and review of relevant literature allowed me to understand the multidimensional socioeconomic factors that affect women’s health, notably harmful gender norms along with women’s economic disempowerment.

One of the major health concerns in Uganda is HIV/AIDS. As of 2023, approximately 1,500,000 adults and children were living with HIV in the country, of which around 60% consisted of women and girls aged 15 and above.[1] While HIV/AIDS has usually been associated with poverty, recent studies show that it is a disease of inequality due to its intricate connections with socioeconomic vulnerabilities and dependency that compel people in poverty, especially women, to make certain choices around sexual behaviour.[2][3]

One such factor is education. Schools are considered a crucial space for youth to gain sexual and reproductive health education, thereby reducing the risk of getting HIV and other sexually transmitted infections (STIs) for girls.[4][5] One study in South Africa found that young women aged 15-24 years without high school education had a higher prevalence of HIV than those with high school education, suggesting that education may prevent girls from getting HIV.[6] Yet, educational opportunities for boys are often prioritized over girls under economic hardships, as girls are expected to take care of households.[7][8] Girls may drop out of school for other reasons, such as a lack of sanitation facilities or early pregnancy.[9] Combined with the well-established association of education with employment opportunities, these findings suggest that girls who drop out of school for various reasons may face a higher risk of HIV infections and dependency.[10]

Moreover, a qualitative study in rural South-West Uganda showed that young women and girls, especially those who drop out of school, may engage in transactional sex with older men in exchange for money or material goods, which reinforces their economic dependency on men.[11] Young women may not have much say over sexual behaviour in such relationships, further escalating the risk of getting HIV and other STIs.[12]

Women’s agencies are limited not only in sexual interactions but also within households, which can lead to intimate partner violence (IPV) or gender-based violence (GBV). Violence against women is widespread in Uganda, as it has been considered an acceptable method to resolve conflicts within households.[13] Given that husbands are the primary decision-makers within households in Uganda, women have little power over household decisions.[14][15]

During my internship, I attended legal aid clinics conducted by CEHURD. The topics brought up included domestic violence and issues with their husbands not providing for their families, underlining harmful gender norms and women’s economic dependency on men. What is worse, even if they report their husbands for committing IPV, they may not be able to support themselves and their kids economically. According to Francis Serunjogi, the Manager of the Community Empowerment Department at CEHURD, some women stay in abusive relationships because they cannot provide for themselves and their families. Reporting spouses may not only exacerbate IPV but also generate stigma within their communities.

A study also found a critical role that household economic stress may play in the prevalence of IPV; household wealth and educational attainment of both partners were negatively correlated with reported IPV in Sub-Saharan Africa.[16] Yet, the relationship between IPV and women’s economic status is not clear-cut. The same study shed light on women’s relative economic empowerment, which found that when only women worked or earned more than men, IPV increased significantly.[17] Another study showed similar results; women’s economic status, such as their employment and earnings, was associated with an increase in spousal violence in Sub-Saharan Africa.[18] These findings suggest that economically empowered women were considered a threat if their male partners did not enjoy the same opportunities, highlighting the deeply entrenched gender norms.[19][20]

The evidence reveals that women’s health vulnerabilities consist of multiple socioeconomic factors that are intricately intertwined.[21][22] Such factors include but are not limited to poverty, education, and gender norms, which contribute to women’s economic dependency on men.[23]

Barriers to Health Services

A study found that 61.5% of women face barriers to health services in Sub-Saharan Africa.[24] Primary barriers include lack of money and distance to healthcare facilities, making general and maternal healthcare services less accessible for women.[25][26][27][28]

Lack of education may also prevent women from accessing healthcare. A study in Sub-Saharan Africa revealed that women with no or little formal education faced more barriers to healthcare services.[29] Other studies also identified women’s education as one of the determinants of the utilization of general and maternal healthcare.[30][31][32] A study in Malawi found that the negative association between the distance to health facilities and the utilization of maternal healthcare became stronger for women with limited health knowledge.[33] Educated women are more aware of the importance of healthcare, allowing them to make informed decisions.[34][35][36] Educational attainment may also determine their employment, which can affect their ability to afford healthcare.[37]

Women’s economic contributions to households may shape their access to healthcare. A study in Tanzania found that women’s contribution to household incomes was associated with an increase in the utilization of maternal healthcare services, suggesting that economically empowered women may use their income on their healthcare services without bargaining.[38] Yet in reality, women may not enjoy the benefits, given that male partners are the primary decision-makers and women have limited control over their health and well-being.[39][40][41]

Would economic empowerment alone reduce women’s health vulnerabilities?

Some interventions demonstrated a positive impact of women’s economic empowerment on health-related outcomes. A study in Malawi showed that cash transfer to female students aged 13-22 and their parents led to a reduction in the prevalence of HIV and risky sexual behaviour after 18 months.[42] Another study implemented a 5-year family-based economic empowerment intervention in Uganda, which improved HIV viral load suppression among adolescents of both genders aged 10-16.[43]

Yet, women’s economic dependency on men and its socioeconomic factors cannot be separated from the deeply entrenched gender norms. In Uganda, it is socially normalized for men to have decision-making power over household matters.[44][45] One qualitative study in Uganda revealed that, despite the positive impact of Village Savings and Loan Associations (VSLAs) on access to healthcare for children living with HIV, gender norms and men’s control over household decisions prevented some participants from attending activities.[46] Such social norms, along with the lack of accessible schools and household economic challenges, can hinder girls from going to school, further impeding their employment opportunities and economic independence.[47] We also discussed in the previous section the complex relationship between economic status and IPV—while greater household wealth was associated with an increase in IPV, women’s relative economic empowerment was associated with an increase in IPV.[48][49] The association of women’s relative economic empowerment with the prevalence of IPV can be derived from gender norms that do not appreciate women gaining power.[50][51]

It is evident that women’s health vulnerabilities and barriers to accessible healthcare are oftentimes driven by women’s economic dependency on men and deep-rooted gender norms that suppress women’s agencies. In fact, researchers emphasized gender inequalities caused by harmful gender norms as one of the structural factors of IPV, combined with other socioeconomic factors such as poverty, unemployment, and lack of economic activity.[52] Therefore, women’s economic empowerment interventions that incorporate gender-focused capacity building for both women and men may be crucial to eliminating health-related barriers.[53][54]

Although legal aid clinics run by CEHURD are not about economic empowerment, they help with gender-related matters from a legal perspective. Community sensitization provides a space for both women and men to learn about the fundamental human rights they deserve and realize any issues they face.

Women face unique health vulnerabilities and barriers to healthcare. Various socioeconomic factors are deeply interconnected and reinforce women’s economic dependency on men, which further fuels their vulnerabilities. Harmful gender norms that justify women’s subordination and gender-based violence against women are embedded in the communities in Uganda, accelerating their dependency and health vulnerabilities. Our discussion suggests that establishing healthcare services and facilities alone may not effectively address women’s access to healthcare. Approaches to the structural factors behind their vulnerabilities, such as gender-focused training for both women and men, may be necessary.

Ends.

Bibliography

African Development Bank Group. “Uganda Country Gender Profile.” African Development Bank. African Development Bank Group, February 2016. https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/UGANDA_COUNTRY_GENDER_PROFILE-2016.pdf.

Anik, Asibul Islam, Muhammad Ibrahim Ibne Towhid, and M Atiqul Haque. “Association of Spousal Violence and Women’s Empowerment Status among the Rural Women of Sub-Saharan Africa.” Journal of Biosocial Science 55, no. 1 (November 8, 2021): 55–73. https://doi.org/10.1017/s0021932021000602.

Aseweh Abor, Patience, Gordon Abekah‐Nkrumah, Kojo Sakyi, Charles K.D. Adjasi, and Joshua Abor. “The Socio‐Economic Determinants of Maternal Health Care Utilization in Ghana.” International Journal of Social Economics 38, no. 7 (June 7, 2011): 628–48. https://doi.org/10.1108/03068291111139258.

Bain, Luchuo Engelbert, Richard Gyan Aboagye, Robert Kokou Dowou, Eugene Justine Kongnyuy, Peter Memiah, and Hubert Amu. “Prevalence and Determinants of Maternal Healthcare Utilisation among Young Women in Sub-Saharan Africa: Cross-Sectional Analyses of Demographic and Health Survey Data.” BMC Public Health 22, no. 647 (April 5, 2022): 1–20. https://doi.org/10.1186/s12889-022-13037-8.

Baird, Sarah J., Richard S. Garfein, Craig T. McIntosh, and Berk Ozler. “Effect of a Cash Transfer Programme for Schooling on Prevalence of HIV and Herpes Simplex Type 2 in Malawi: A Cluster Randomised Trial.” Lancet 379 (April 7, 2012): 1320–29. https://doi.org/10.1016/S0140-6736(11)61709-1.

Kim, Julia, Paul Pronyk, Tony Barnett, and Charlotte Watts. “Exploring the Role of Economic Empowerment in HIV Prevention.” AIDS 22, no. Suppl 4 (December 2008): S57–71. https://doi.org/10.1097/01.aids.0000341777.78876.40.

McGuire, Finn, Noemi Kreif, and Peter C. Smith. “The Effect of Distance on Maternal Institutional Delivery Choice: Evidence from Malawi.” Health Economics 30 (June 6, 2021): 2144–67. https://doi.org/10.1002/hec.4368.

Nobelius, Ann-Maree, Bessie Kalina, Robert Pool, Jimmy Whitworth, Janice Chesters, and Robert Power. “Sexual Partner Types and Related Sexual Health Risk among Out-of-School Adolescents in Rural South-West Uganda.” AIDS Care 23, no. 2 (January 22, 2011): 252–59. https://doi.org/10.1080/09540121.2010.507736.

Pettifor, Audrey E, Brooke A Levandowski, Catherine MacPhail, Nancy S Padian, Myron S Cohen, and Helen V Rees. “Keep Them in School: The Importance of Education as a Protective Factor against HIV Infection among Young South African Women.” International Journal of Epidemiology 37, no. 6 (July 9, 2008): 1266–73. https://doi.org/10.1093/ije/dyn131.

Piot, Peter, Robert Greener, and Sarah Russell. “Squaring the Circle: AIDS, Poverty, and Human Development.” PLoS Medicine 4, no. 10 (October 23, 2007): 1571–75. https://doi.org/10.1371/journal.pmed.0040314.

Rujumba, Joseph, Carmen Roebersen, Susan Namara, Richard Ochen, Sharon Eva Ahumuza, Allen Tushabe, Mathias Akugizibwe, et al. “‘I No Longer Worry about Money for Transport to the Health Centre’ – Economic Empowerment of Caregivers of Children Living with HIV through Village Savings and Loan Associations: Experiences and Lessons from the ‘towards an AIDS Free Generation Program in Uganda (TAFU).’” BMC Health Services Research 25, no. 203 (February 4, 2025): 1–13. https://doi.org/10.1186/s12913-025-12303-w.

Seidu, Abdul-Aziz. “Mixed Effects Analysis of Factors Associated with Barriers to Accessing Healthcare among Women in Sub-Saharan Africa: Insights from Demographic and Health Surveys.” Edited by Yuka Kotozaki. PLOS ONE 15, no. 11 (November 9, 2020): 1–16. https://doi.org/10.1371/journal.pone.0241409.

Ssewamala, Fred M., Darejan Dvalishvili, Claude A. Mellins, Elvin H. Geng, Fredderick Makumbi, Torsten B. Neilands, Mary McKay, et al. “The Long-Term Effects of a Family Based Economic Empowerment Intervention (Suubi+Adherence) on Suppression of HIV Viral Loads among Adolescents Living with HIV in Southern Uganda: Findings from 5-Year Cluster Randomized Trial.” PLOS ONE 15, no. 2 (2020): 1–13. https://doi.org/10.1371/journal.pone.0228370.

Stöckl, Heidi, Anushé Hassan, Meghna Ranganathan, and Abigail M. Hatcher. “Economic Empowerment and Intimate Partner Violence: A Secondary Data Analysis of the Cross-Sectional Demographic Health Surveys in Sub-Saharan Africa.” BMC Women’s Health 21, no. 241 (June 12, 2021): 1–13. https://doi.org/10.1186/s12905-021-01363-9.

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UNESCO. “Booklet 2: HIV & AIDS and Supportive Learning Environments. Good Policy and Practice in HIV & AIDS and Education (Booklet Series).” UNESCO Digital Library. Paris: UNESCO, 2008. https://unesdoc.unesco.org/ark:/48223/pf0000146122.

Westeneng, Judith, and Ben D’Exelle. “How Economic Empowerment Reduces Women’s Reproductive Health Vulnerability in Tanzania.” The Journal of Development Studies 51, no. 11 (September 2015): 1459–74. https://doi.org/10.1080/00220388.2015.1041514.

 

[1] UNAIDS, “Uganda,” UNAIDS (UNAIDS, 2023), https://www.unaids.org/en/regionscountries/countries/uganda.

[2] Julia Kim et al., “Exploring the role of economic empowerment in HIV prevention,” AIDS 22, no. Suppl 4 (December 2008): S57-61, https://doi.org/10.1097/01.aids.0000341777.78876.40.

[3] Peter Piot, Robert Greener, and Sarah Russell, “Squaring the circle: AIDS, poverty, and human development,” PLoS Medicine 4, no. 10 (October 23, 2007): 1571, https://doi.org/10.1371/journal.pmed.0040314.

[4] UNESCO, “Booklet 2: HIV & AIDS and supportive learning environments. Good policy and practice in HIV & AIDS and education (Booklet Series),” UNESCO Digital Library (Paris: UNESCO, 2008): 30, https://unesdoc.unesco.org/ark:/48223/pf0000146122.

[5] Audrey E Pettifor et al., “Keep them in school: The importance of education as a protective factor against HIV infection among young South African women,” International Journal of Epidemiology 37, no. 6 (July 9, 2008): 1269, https://doi.org/10.1093/ije/dyn131.

[6] Ibid.

[7] African Development Bank Group, “Uganda country gender profile,” African Development Bank (African Development Bank Group, February 2016): 5, https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/UGANDA_COUNTRY_GENDER_PROFILE-2016.pdf.

[8] Audrey E Pettifor et al., “Keep them in school: The importance of education as a protective factor against HIV infection among young South African women,” International Journal of Epidemiology 37, no. 6 (July 9, 2008): 1270, https://doi.org/10.1093/ije/dyn131.

[9] UNESCO, “Booklet 2: HIV & AIDS and supportive learning environments. Good policy and practice in HIV & AIDS and education (Booklet Series),” UNESCO Digital Library (Paris: UNESCO, 2008): 22, https://unesdoc.unesco.org/ark:/48223/pf0000146122.

[10] Ibid.

[11] Ann-Maree Nobelius et al., “Sexual partner types and related sexual health risk among out-of-school adolescents in rural South-West Uganda,” AIDS Care 23, no. 2 (January 22, 2011): 257, https://doi.org/10.1080/09540121.2010.507736.

[12] Ibid.

[13] African Development Bank Group, “Uganda country gender profile,” African Development Bank (African Development Bank Group, February 2016): 11, https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/UGANDA_COUNTRY_GENDER_PROFILE-2016.pdf.

[14] Ibid.

[15] Joseph Rujumba et al., “‘I no longer worry about money for transport to the health centre’ – economic empowerment of caregivers of children living with HIV through Village Savings and Loan Associations: Experiences and lessons from the ‘Towards an AIDS Free Generation Program in Uganda (TAFU),’” BMC Health Services Research 25, no. 203 (February 4, 2025): 9, https://doi.org/10.1186/s12913-025-12303-w.

[16] Heidi Stöckl et al., “Economic empowerment and intimate partner violence: A secondary data analysis of the cross-sectional Demographic Health Surveys in Sub-Saharan Africa,” BMC Women’s Health 21, no. 241 (June 12, 2021): 4-7, https://doi.org/10.1186/s12905-021-01363-9.

[17] Ibid., 5.

[18] Asibul Islam Anik, Muhammad Ibrahim Ibne Towhid, and M Atiqul Haque, “Association of spousal violence and women’s empowerment status among the rural women of Sub-Saharan Africa,” Journal of Biosocial Science 55, no. 1 (November 8, 2021): 64, 68, https://doi.org/10.1017/s0021932021000602.

[19] African Development Bank Group, “Uganda country gender profile,” African Development Bank (African Development Bank Group, February 2016): 16, https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/UGANDA_COUNTRY_GENDER_PROFILE-2016.pdf.

[20] Heidi Stöckl et al., “Economic empowerment and intimate partner violence: A secondary data analysis of the cross-sectional Demographic Health Surveys in Sub-Saharan Africa,” BMC Women’s Health 21, no. 241 (June 12, 2021): 7, 12, https://doi.org/10.1186/s12905-021-01363-9.

[21] Julia Kim et al., “Exploring the role of economic empowerment in HIV prevention,” AIDS 22, no. Suppl 4 (December 2008): S57-61, https://doi.org/10.1097/01.aids.0000341777.78876.40.

[22] Peter Piot, Robert Greener, and Sarah Russell, “Squaring the circle: AIDS, poverty, and human development,” PLoS Medicine 4, no. 10 (October 23, 2007): 1571, https://doi.org/10.1371/journal.pmed.0040314.

[23] Ibid.

[24] Abdul-Aziz Seidu, “Mixed effects analysis of factors associated with barriers to accessing healthcare among women in Sub-Saharan Africa: Insights from Demographic and Health Surveys,” ed. Yuka Kotozaki, PLOS ONE 15, no. 11 (November 9, 2020): 9, https://doi.org/10.1371/journal.pone.0241409.

[25] Patience Aseweh Abor et al., “The socio‐economic determinants of maternal health care utilization in Ghana,” International Journal of Social Economics 38, no. 7 (June 7, 2011): 643-645, https://doi.org/10.1108/03068291111139258.

[26] Luchuo Engelbert Bain et al., “Prevalence and determinants of maternal healthcare utilisation among young women in Sub-Saharan Africa: Cross-sectional analyses of Demographic and Health Survey data,” BMC Public Health 22, no. 647 (April 5, 2022): 5, https://doi.org/10.1186/s12889-022-13037-8.

[27] Finn McGuire, Noemi Kreif, and Peter C. Smith, “The effect of distance on maternal institutional delivery choice: Evidence from Malawi,” Health Economics 30 (June 6, 2021): 2158, https://doi.org/10.1002/hec.4368.

[28] Abdul-Aziz Seidu, “Mixed effects analysis of factors associated with barriers to accessing healthcare among women in Sub-Saharan Africa: Insights from Demographic and Health Surveys,” ed. Yuka Kotozaki, PLOS ONE 15, no. 11 (November 9, 2020): 11-13, https://doi.org/10.1371/journal.pone.0241409.

[29] Ibid., 12.

[30] Patience Aseweh Abor et al., “The socio‐economic determinants of maternal health care utilization in Ghana,” International Journal of Social Economics 38, no. 7 (June 7, 2011): 642, https://doi.org/10.1108/03068291111139258.

[31] Luchuo Engelbert Bain et al., “Prevalence and determinants of maternal healthcare utilisation among young women in Sub-Saharan Africa: Cross-sectional analyses of Demographic and Health Survey data,” BMC Public Health 22, no. 647 (April 5, 2022): 5, https://doi.org/10.1186/s12889-022-13037-8.

[32] Abdul-Aziz Seidu, “Mixed effects analysis of factors associated with barriers to accessing healthcare among women in Sub-Saharan Africa: Insights from Demographic and Health Surveys,” ed. Yuka Kotozaki, PLOS ONE 15, no. 11 (November 9, 2020): 12, https://doi.org/10.1371/journal.pone.0241409.

[33] Finn McGuire, Noemi Kreif, and Peter C. Smith, “The effect of distance on maternal institutional delivery choice: Evidence from Malawi,” Health Economics 30 (June 6, 2021): 2158, https://doi.org/10.1002/hec.4368.

[34] Patience Aseweh Abor et al., “The socio‐economic determinants of maternal health care utilization in Ghana,” International Journal of Social Economics 38, no. 7 (June 7, 2011): 642, https://doi.org/10.1108/03068291111139258.

[35] Luchuo Engelbert Bain et al., “Prevalence and determinants of maternal healthcare utilisation among young women in Sub-Saharan Africa: Cross-sectional analyses of Demographic and Health Survey data,” BMC Public Health 22, no. 647 (April 5, 2022): 9, https://doi.org/10.1186/s12889-022-13037-8.

[36] Abdul-Aziz Seidu, “Mixed effects analysis of factors associated with barriers to accessing healthcare among women in Sub-Saharan Africa: Insights from Demographic and Health Surveys,” ed. Yuka Kotozaki, PLOS ONE 15, no. 11 (November 9, 2020): 12, https://doi.org/10.1371/journal.pone.0241409.

[37] Ibid.

[38] Judith Westeneng and Ben D’Exelle, “How economic empowerment reduces women’s reproductive health vulnerability in Tanzania,” The Journal of Development Studies 51, no. 11 (September 2015): 1471, https://doi.org/10.1080/00220388.2015.1041514.

[39] African Development Bank Group, “Uganda country gender profile,” African Development Bank (African Development Bank Group, February 2016): 11, https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/UGANDA_COUNTRY_GENDER_PROFILE-2016.pdf.

[40] Joseph Rujumba et al., “‘I no longer worry about money for transport to the health centre’ – economic empowerment of caregivers of children living with HIV through Village Savings and Loan Associations: Experiences and lessons from the ‘Towards an AIDS Free Generation Program in Uganda (TAFU),’” BMC Health Services Research 25, no. 203 (February 4, 2025): 9, https://doi.org/10.1186/s12913-025-12303-w.

[41] Judith Westeneng and Ben D’Exelle, “How economic empowerment reduces women’s reproductive health vulnerability in Tanzania,” The Journal of Development Studies 51, no. 11 (September 2015): 1459, https://doi.org/10.1080/00220388.2015.1041514.

[42] Sarah J. Baird et al., “Effect of a cash transfer programme for schooling on prevalence of HIV and Herpes Simplex Type 2 in Malawi: A cluster randomised trial,” Lancet 379 (April 7, 2012): 1327-28, https://doi.org/10.1016/S0140-6736(11)61709-1.

[43] Fred M. Ssewamala et al., “The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial,” PLOS ONE 15, no. 2 (2020): 8-10, https://doi.org/10.1371/journal.pone.0228370.

[44] African Development Bank Group, “Uganda country gender profile,” African Development Bank (African Development Bank Group, February 2016): 11, https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/UGANDA_COUNTRY_GENDER_PROFILE-2016.pdf.

[45] Joseph Rujumba et al., “‘I no longer worry about money for transport to the health centre’ – economic empowerment of caregivers of children living with HIV through Village Savings and Loan Associations: Experiences and lessons from the ‘Towards an AIDS Free Generation Program in Uganda (TAFU),’” BMC Health Services Research 25, no. 203 (February 4, 2025): 9, https://doi.org/10.1186/s12913-025-12303-w.

[46] Ibid.

[47] Audrey E Pettifor et al., “Keep them in school: The importance of education as a protective factor against HIV infection among young South African women,” International Journal of Epidemiology 37, no. 6 (July 9, 2008): 1271, https://doi.org/10.1093/ije/dyn131.

[48] Asibul Islam Anik, Muhammad Ibrahim Ibne Towhid, and M Atiqul Haque, “Association of spousal violence and women’s empowerment status among the rural women of Sub-Saharan Africa,” Journal of Biosocial Science 55, no. 1 (November 8, 2021): 69, https://doi.org/10.1017/s0021932021000602.

[49] Heidi Stöckl et al., “Economic empowerment and intimate partner violence: A secondary data analysis of the cross-sectional Demographic Health Surveys in Sub-Saharan Africa,” BMC Women’s Health 21, no. 241 (June 12, 2021): 5, https://doi.org/10.1186/s12905-021-01363-9.

[50] African Development Bank Group, “Uganda country gender profile,” African Development Bank (African Development Bank Group, February 2016): 16, https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/UGANDA_COUNTRY_GENDER_PROFILE-2016.pdf.

[51] Heidi Stöckl et al., “Economic empowerment and intimate partner violence: A secondary data analysis of the cross-sectional Demographic Health Surveys in Sub-Saharan Africa,” BMC Women’s Health 21, no. 241 (June 12, 2021): 7, 12, https://doi.org/10.1186/s12905-021-01363-9.

[52] Ibid., 2.

[53] Julia Kim et al., “Exploring the role of economic empowerment in HIV prevention,” AIDS 22, no. Suppl 4 (December 2008): S61, https://doi.org/10.1097/01.aids.0000341777.78876.40.

[54] Heidi Stöckl et al., “Economic empowerment and intimate partner violence: A secondary data analysis of the cross-sectional Demographic Health Surveys in Sub-Saharan Africa,” BMC Women’s Health 21, no. 241 (June 12, 2021): 12, https://doi.org/10.1186/s12905-021-01363-9.

Posted on Categories Article, Featured

Reflections on My Internship at CEHURD: A Journey of Learning and Growth

By Shiena Serikawa 

As I write this on my way home from Uganda, I can easily remember the first day of my internship at the Centre of Health, Human Rights and Development (CEHURD). Entering the office extremely nervous, I was surprised that it was half-empty. Later I learned that most of the team was away in the field. This reflects the nature of work at CEHURD which values direct interactions and engagements with communities.

My first day began with a conversation with Jane, one of the lawyers at CEHURD, which I hold dear to my heart to this day. She told me that she strives to fight for the fundamental health and human rights everyone deserves and that the smiles on the faces of community members and the words of thank you after bringing legal services closer to them are more than enough to keep her going. Although my understanding of the work at CEHURD was far from complete at the time, her words inspired me to work with a sense of responsibility and determination.

On the same day, I was told we would be off to a week-long staff retreat in a few days. It was a perfect opportunity for me to interact with everyone at CEHURD, hear about their work in the field, and learn about what CEHURD has done and aims to do in the next ten years. I am so grateful for the warm and welcoming environment I was surrounded with at the staff retreat, and for everyone who taught me how to dance the whole night on the last day of the retreat.

The tight-knit bonds among the staff members go beyond the organization. In one of the stakeholder meetings with healthcare workers I attended as part of the Strategic Litigation (SL) Programme, some of the team members repeatedly emphasized that we are here to learn from healthcare workers on the ground because they face various challenges on a daily basis which we aim to tackle. To ensure we receive insights from every participant in the meeting, papers were distributed and later collected by the team for reference.

Providing legal support for vulnerable populations is unarguably one of CEHURD’s strengths. Yet I realized that the quality of their services is also made possible by the strong bonds of trust with stakeholders including healthcare workers, local authorities, police officers, community health advocates, and others.

Other than attending meetings with stakeholders, my duties at the SL included drafting reports, research papers, and opinion responses to judgments. Through these activities, I got to learn in-depth about how the concepts of equality, discrimination, and rights of women and children are defined in the Constitution of Uganda and how cases of defilement and sexual violence are categorized in a way that undermines the welfare of certain groups of people, particularly adolescent girls above 14, under the current Penal Code Act.

I spent my last two weeks at the Community Empowerment Programme (CEP). The highlight of my time at the CEP is a week-long field trip to one of the districts in Uganda to take part in legal aid clinics and a meeting with district stakeholders. It was full of learning experiences, as I got to delve into the gender- and health-related challenges through the interactions and discussions with community members, stakeholders, and the CEHURD team. The experience underscored the critical role of legal aid clinics and community sensitizations in raising awareness of health and human rights within communities, as they may not know about their rights and find legal services unaffordable and/or inaccessible, according to some of the team members. The conversations with stakeholders and the team shed light on the common issues faced by women and girls in the communities, such as gender-based violence, intimate partner violence, barriers to education and health services, and harmful gender norms.

As someone with an economics background, I wish to touch briefly upon what I witnessed from an economic perspective. Although I discussed them in greater detail in my other post, I explored the economic aspects of the health vulnerabilities among women and girls through field observations, discussions with the team, and relevant literature. One thing that stood out to me is the deep-rooted gender norms, and how they can increase their vulnerabilities through myriad channels. For example, discussions with some of the team members revealed how women may have little control over economic activities, which can confine them in abusive relationships and put them at a higher risk of intimate partner violence. Some issues, such as extra fees illegally charged by healthcare workers and/or police officers and barriers to education among pregnant girls, repeatedly emerged in discussions and meetings with stakeholders. Based on general observations in the field and the conversations with the team and stakeholders, I came to realize that these socioeconomic issues above may not only exacerbate the risk of gender-based violence but also keep the survivors away from reporting and/or seeking treatment.

Throughout my time at CEHURD, I witnessed both the innovative ideas and relentless effort poured into community-based projects and the difficulty sustaining them in the long run. The reasons can range from political and economic situations to the constant need of funds, and they were especially evident following the recent executive and legal actions on foreign aid from the US. Some of the team members revealed the uncertainty around the long-term sustainability of some of their impactful programs. I have heard of and seen organizations that struggle with similar issues of locally driven programs. I sincerely hope their commitment and determination to address structural injustices will be widely recognized and appreciated in and outside the country.

So far, I have gone over my learning experiences at CEHURD. Yet, I cannot wrap it up without mentioning what I miss the most as I write this essay: the people. From the first day to the last day, everyone at CEHURD offered me the most welcoming and warmest environment I could ever ask for. Starting every single day with greetings in Luganda and a cup of African tea made me feel like I had been there for a long time. The list of memorable things goes on, from being splashed with water by a water truck while on boda and laughing about it together, singing a notorious Valentine’s song (if you know, you know), to cutting a cake with my name on it together on my last day. No words can fully express how grateful I am to everyone at CEHURD for their support, warmth, and passion for ‘equitable health and human rights for all’ that made my time at CEHURD invaluable. I would also like to extend my sincere gratitude to Dr. Miya, Betty, and Edith from The AIDS Support Organization (TASO) Uganda for connecting me with this amazing organization. My experience would not have been possible without the foundation I gained through the research experience at TASO and your continuous support after the program.

Shiena Serikawa is a recent graduate from the University of British Columbia, Canada, with an interest in women’s economic empowerment. She has also been an intern at the Center for Health, Human Rights and Development (CEHURD).

Posted on Categories Article, News

CEHURD Empowering Women Through Legal Aid and Justice – A Story of Hope | International Women’s Day

CEHURD’s article in the New Vision : Empowering Women Through Legal Aid!

Below is CEHURD’s feature in today’s (8th March) @newvisionwire, celebrating International Women’s Day! Learn how we are empowering women in Uganda through legal aid, fighting for justice in cases of gender-based violence, maternal health violations & more.
Over the years, we have supported 311+ women & girls. Our legal aid clinics reached over 20,437 vulnerable people in 2024!
Read Rose’s inspiring story of survival, a testament to the transformative power of CEHURD’s support after enduring horrific abuse. CEHURD and Kyampisi Child Care Ministries helped her seek justice and rebuild her life.
Learn how you can Support CEHURD’s work by donating to our legal aid fund for survivors.
#InternationalWomensDay #CEHURDLegalAid
Posted on Categories Article, Featured

CEHURD’s Efforts Transform Lives in Napak District, Karamoja!

By @Kitandwe Rhodine
| Lawyer, CEHURD

For years, CEHURD has worked tirelessly to address the social determinants of health, and today, we celebrate a milestone in Napak District!

Earlier in December, during a mobile legal aid camp, community members of Lokopo sub-county raised concerns about their lack of access to clean water. With over 1,017 people and 180 households relying on an unsafe water supply, this issue couldn’t wait.

  • The pond that was being used by animals and domestic use

We escalated the matter to the district leadership, Lokopo Sub-county leadership and the district water office, asking them to act. Within just a month, a borehole was constructed to serve this resilient community of Lolemuyek village, in Lokirikitae Parish, Lokopo sub-county.

During post-camp follow ups, we visited the borehole with the sub-county leaders and met with the Water User Committee (WUC) to provide guidance on proper usage and sustainability. This borehole is not just a source of water—it’s a source of hope, health, and dignity.

At CEHURD, we remain committed to empowering communities, advocating for their rights, and ensuring everyone enjoys their right to health.

  • The borehole that was constructed to serve the community with clean water.

A version of this article was originally published on February 5th in the articles section of CEHURD’s X page.

Posted on Categories Article, Featured

The impact of Trump’s Executive Orders on Uganda’s Health System

On 3rd February 2025, CEHURD convened a one-day strategic meeting to examine the implications of President Trump’s orders/policies on Uganda’s health system, (particularly their impact on provision of sexual and reproductive health services, HIV health services) and develop strategies to ensure the health rights of Ugandans remain protected.

This gathering brought together key stakeholders, including civil society organizations (CSOs), health workers, vulnerable communities , and social workers to raise awareness about the effects of these policies, and to ensure that all stakeholders understand their vital roles in safeguarding health rights for all Ugandans. From the #GlobalGagRule (GGR) to PEPFAR funding freezes, these orders have disrupted essential services such as HIV prevention and treatment, contraception, maternal care, and infectious disease management.

Some of the immediate actions taken by Donald Trump’s administration was to reinstate the Mexico City Policy, commonly known as the Global Gag Rule (#GGR), cutting off over $68 billion in foreign aid that supports critical sexual and reproductive health services, HIV/AIDS programs, and infectious disease treatment worldwide. In Uganda, this has led to halted PEPFAR funding, disrupting HIV prevention and treatment services, restrictions on family planning services, affecting access to contraception and maternal care, increased health risks for marginalized populations, including key populations and young girls.

From a panel discussion with representation from different movements, it was clear that Uganda’s health system is under threat. With Trump’s policies disrupting critical health funding, the civil society in Uganda must come together, strategize, and engage the government and relevant ministries to prioritize essential services such as HIV, TB, Malaria, and family planning.

❝Trump’s policies come at a time when our health system is already struggling. What does it mean when life-saving medication is withdrawn, and jobs are lost? Each of these executive orders has a direct or indirect impact on our lives. We risk seeing a rise in gender-based violence, teenage pregnancies, and unsafe abortions. The challenges we face—both nationally and globally—demand that we unite, raise a collective voice, and critically ask ourselves: Are we prepared to navigate this reality and hold the government accountable?” ~ @Nakibuukam, Deputy Executive Director, CEHURD, speaking at a CSO strategizing meeting in response to Trump’s executive orders.

❝We have a ‘People Living with HIV Forum’ in every district, representing the 1.5 million Ugandans living with HIV. The past two weeks have been incredibly difficult since President Trump issued his first executive order halting U.S. government funding for HIV programs. For the past 22 years, the U.S. government has been a major supporter of HIV funding, contributing about 80% of the total budget. Cutting off this support is essentially a death sentence for the 1.3 million people currently on antiretroviral treatment. As people living with HIV and as CSOs, we are devastated and in shock—this decision was abrupt, and many of our centers have already been asked to shut down. Think about the lives at stake – the people affected, drained, and traumatized. Mothers who have just tested positive, those in labor, and countless others now face an uncertain future without adequate care. We need urgent action. Can we increase the health budget? Establish an emergency fund? As CSOs, we must call on the government and Members of Parliament to prioritize communities and take decisive action if we are to achieve our 2030 goal.❞ ~Executive Director NAFOPHANU @FlaviaKyomukama 

❝We can all learn from the resilience of the HIV community—we must stand together, work in solidarity across movements, and actively engage our government to invest in our well-being. We need to brace ourselves for challenges ahead before things improve. The Trump administration’s patriarchal and misogynistic approach affects us all. With 97% of key populations relying on funding from @PEPFAR or the @GlobalFund, the impact is devastating. The government must step up to ensure that everyone in need of life-saving commodities can access them without stigma or discrimination.” ~ @richardlusimbo, @UKPC_UG founder, speaking during a panel discussion a CSO panel discussion on the impact of Trump’s executive orders.

❝Living with both a disability and HIV presents a double burden, increasing the risk of mental health struggles for both caregivers and those receiving care. Imagine a woman with a disability raising a child with HIV, unable to access life-saving medication, while also facing job loss. This situation brings about self-stigma, isolation, and, in some cases, even death. HIV does not discriminate based on sexual orientation or any other factor. We must redouble our efforts to drive meaningful, sustainable change.❞ ~ Panel submissions during the CSO strategizing meeting in response to the Trump administration’s orders.

❝As the Network of Young People Living with HIV, we have been implementing several projects under PEPFAR and USAID, working closely with various partners and district networks to support young people living with HIV. However, since last week, we’ve received multiple calls from young people and their guardians reporting that they are unable to access health facilities – many have been shut down, leaving them without essential refills. These restrictions on reproductive health and HIV prevention services will inevitably lead to new infections and reinfections among young people. We risk undoing the progress we have made.” ~ @Riobarbie6| ED @UNYPA1, Panel submission during the CSO strategizing meeting in response to the Trump administration’s orders.

❝The U.S. has played a key role in global public health leadership, supporting numerous health programs. However, our work is now under threat due to executive orders issued at a time when we lack a social contract policy that would allow our government to fund us directly. Programs like BMTCT, where we were on the verge of eliminating mother-to-child transmission, are at risk – without urgent intervention, at least 41 children will face new HIV infections daily. As CSOs, our mandate is rooted in the constitution – we complement government efforts and hold it accountable. Yet, it is concerning that much of our work relies on foreign funding, despite directly contributing to government programs.” ~ @MBKeno |@hepsuganda during a CSO panel discussion on the impact of Trump’s executive orders.

Speakers emphasized the urgent need for government action as health facilities close, refills run out, and essential programs like BMTCT face setbacks – threatening to reverse years of progress.

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