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Abortions claim 68,000 girls annually – study

By Doreen Murungi

Uganda spends sh7.5bn each year treating complications resulting from unsafe abortion, a new study reveals.

The World Health Organization guidance on abortion-related services reveals that in Uganda, about 300,000 abortions are carried out every year.

“Abortion related complications are one of the leading causes of admissions to gynaecological wards in hospitals across the country,” Professor Florence Mirembe, an associate professor at the department of obstetrics and gynaecology at Mulago hospital said last week.

She was speaking at a three day national conference on reducing maternal mortality from unsafe abortion that brought together different participants in government and the private sector.

Dr. Charles Kiggundu, a consultant gynecologist and obstetrician says many women, especially youth die from complications of unsafe abortion in Uganda.

“There is evidence that whatever the law or restrictions attached to abortion, the practice only goes underground and kills more women,” Kiggundu says.

Dr.Olive Sentubwe a WHO reproductive and maternal health expert revealed that 85,000 women are treated for complications from abortion every year. An estimated 68,000 die every year from unsafe abortion and many more are injured, some permanently. Not only is this a weighty magnitude but there are major financial costs involved.

A study by Guttmarcher, an institute seeking to advance sexual and reproductive health shows that $83 (sh205,000) is spent treating post abortion complications per patient in Africa and jumps to $114(sh280,000) when overhead and capital costs are included.

This means that a country like Uganda, with 85,000 women treated for abortion complications every year, could be spending at least $7m about sh17.6bn.

“Treating complications of unsafe abortions overwhelms impoverished healthcare services and diverts limited resources from other critical health care,” Sentubwe said.

According to the medical experts, nearly all unsafe abortions are because of unwanted pregnancies, the costs result from the failure to prevent those pregnancies through family planning or, to terminate them safely within constraints of the law.

“Health systems have a responsibility to provide these services and to build understanding of unsafe abortion as a critical public health issue, social justice and human right,” said Dr. Eunice Brookman-Amissah, the vice president for Africa of Ipas, a global nongovernmental organization working to increase women’s access to reproductive health services.

The participants urged governments to compare the costs of unsafe abortion with the fairly reasonable costs of the actions that could prevent unintended pregnancies so as to better protect women’s health and cut down the costs spent on the implications of unsafe abortion.

“We need to remove blame, be non-judgmental and provide empathetic care to the victims who certainly do not need to die if there is comprehensive contraception, sexuality education everywhere especially for young people, safer abortion measures for those that must have the abortions and safe and quality post abortion care for the unfortunate ones,” Dr. Charles Kiggundu, recommends.

Source: http://www.newvision.co.ug/news/631950-abortions-claim-68-000-girls-annually-study.html

Ugandan women go to court over maternal mortality

KAMPALA, Uganda — More than 100 women die during childbirth each week in Uganda, a heartbreaking statistic that has energized activists to go to the Supreme Court in a bid to force the government to put more resources toward maternal health care to prevent the wave of deaths.

The activists say they want the country’s top judges to declare that women’s rights are violated when they die in childbirth, the kind of statement a lower court declined to give last week. In rejecting the petition, the Constitutional Court said the matter was for the country’s political leaders to handle.

The country’s top judges have a serious role to play: A declaration favoring the women activists would shame the government into action that drastically reduces mortality among childbearing women in Uganda, activists say.

“All we want is a declaration that when women die during childbirth it is a violation of their rights,” said Noor Musisi of the Center for Health, Human Rights and Development, a Kampala-based group that is championing the legal push. The groups presented the bid to the Supreme Court on Tuesday.

Uganda loses 16 women in childbirth daily, a figure some activists boldly emphasize on placards during regular marches in the streets of the Ugandan capital. Most of these deaths happen in villages where bad roads and poverty make it difficult for women to reach health centers. Even when they get there, some say, the available care is poor.

Health centers have been built in villages across Uganda, but the structures are usually devoid of equipment and medicine. Ugandan newspapers frequently tell stories of midwives and nurses who treat women in labor with a chilling lack of compassion. And at times, when the caregivers are overwhelmed, some women are left to die.

Valente Inziku, a Ugandan man who lost his wife and baby in such circumstances in 2010, blamed the government for his loss. The hospital in northern Uganda where his wife went had no gloves or a delivery kit that Sunday morning, and the midwives were greatly outnumbered by the patients, he said. The nurses asked him to buy gloves that were never used.

“She was not attended to,” Inziku said. “She waved her hands the whole day but no one responded. Then she started bleeding. She bled and bled and then she died in my hands.”

On a visit to Uganda in February, the head of President Barack Obama’s Global Health Initiative said she had asked Ugandan officials to take “greater ownership” of maternal health care and avoid sinking deeper into dependency on foreign benefactors.

“Far too many women lose their lives giving birth,” Lois Quam told reporters in Kampala. “When a mother bleeds to death a nation bleeds.”

The Ugandan government employs only about half of the health professionals the country needs, according to Samuel Lyomoki, a lawmaker and physician who has been prominent in calling for more action to improve maternal health. If the number rose to 65 percent, Lyomoki said, Uganda’s maternal mortality rate would fall substantially.

“The problem here is lack of commitment,” he said. “The point here is not the money. You cannot as a country look on callously and facelessly when we lose 16 women every day through preventable causes.”

The case now before the Supreme Court is supported by over 50 civil society organizations, and analysts say its practical impact would be to embarrass a government that claims to have done more than the previous regimes to address women’s issues.

“We just want the government to meet its obligations,” said Ben Twinomugisha, a law professor at Uganda’s Makerere University who is advising the women activists.

Lyomoki, the lawmaker, said Uganda needs to hire 5,000 more medical workers and $60 million must be added to the health budget to accomplish that. Analysts say this money is available in a country where millions are lost every year through corruption and wasteful spending. Last year Uganda spent more than $700 million to acquire Russian-made fighter jets and military hardware when the country was not at war, and the president’s official residence is notorious for requisitioning huge sums that are rarely accounted for.

Fred Muhumuza, a development economist who advises the Ugandan government, said the issue of maternal mortality has proved difficult to tackle.

“Some of the problems we have with maternal health go beyond recruitment,” Muhumuza said. “There is a complex web of problems. Where are the people you are going to recruit? The supply of skilled workers is also a problem.”

He said some medical workers do not want to work in a village no matter how much they are paid.

Source: http://www.cbsnews.com/8301-505245_162-57452537/ugandan-women-go-to-court-over-maternal-mortality/

Uganda needs 3,000 surgeons

By Francis Kagolo

http://www.newvision.co.ug/news/631729-uganda-needs-3-000-surgeons.html

The high rate of brain drain is continuing to wound Uganda’s health sector with fresh revelations indicating the country is short of over 3,300 surgeons.

An expert said many people who would have survived treatable surgical conditions like cataract blindness, hernia, clubfoot and injuries end up dying due to inadequacy of surgeons in the country.

“Every year, Makerere University, other institutions and hospitals pass out surgeons. But due to low pay, many quit the country for greener pastures abroad,” said Dr. Edward Naddumba, the secretary general of the College of Surgeons of East, Central and Southern Africa (COSECSA).

“Currently we are less than 100 specialist surgeons for 34 million people. This means one surgeon for every 340,000 people.”

Other potentially productive people become disabled and destitute because of treatable surgical conditions, he said.

Naddumba made the remarks while briefing New Vision online on COSECSA’s efforts to improve the numbers and working conditions of surgeons in sub-Saharan Africa.

The efforts include offering specialized postgraduate surgical training at major hospitals like Mulago, Nsambya and Masaka.

The college passed out four graduates at its first graduation ceremony in 2004. About 113 trainee surgeons are to sit the COSECSA exams this year, 51 of whom are in their final year.

The college charges $1700 (about sh4.2m) as entry, examinations and graduation fees.

His revelations come amidst a public outcry over the underfunding of the health sector.

A report by Makerere University Medical School two years ago revealed that health spending in Uganda covers about a third of what the country needs to meet its minimum healthcare package.

It said Uganda spends only $14 per-capita on health. Of this, $9 is out-of-pocket and $5 from public sector (government and donor funding).

Today, less than 100 specialist surgeons available for 34 million Ugandans.

Yet, as the country’s health system remains in a coma, the Government still spends at least $150m (about sh368b) annually treating top government officials abroad.

This amount is nearly half of the combined budgets of health and education ministries.

Makerere’s development expert Prof. Augustus Nuwagaba recently argued that Uganda’s problem is not lack of medical practitioners but poor remuneration.

“Almost half of the 40,000 Ugandan professionals in North America are health personnel, which means our problem is not the human resource,” he said.

Health workers tip government on safe abortion

By FLAVIA LANYERO

Medical practitioners have urged government to relax restrictions on abortion and make reproductive health services available to the youth, if abortion is to be managed in the country.

The health workers during a national conference on safe abortion last week said most foetal terminations are as a result of unwanted pregnancies yet little guidance is offered, especially to young women in schools. The young women always end up in desperate measures to get rid of the pregnancies.

Strict law
Currently, the Ugandan law does not permit abortion except when the mother’s life is in danger and neither are medics facilitated to educate young girls about reproductive health issues and rights.

This is in addition to government ratifying several international treaties, conventions and agreements including the 1995 Beijing Platform for Action that recognises that abortion should be safe and available to the full extent of the law.

“Restrictive laws do not prevent abortions. New technologies like the vacuum aspiration and Medical Abortion bring safe abortion care closer to women and governments need to honour their obligations to protect, promote and fulfil human rights,” said Dr E. Brookman-Amissah, the vice president for Ipas Africa, one of the leading organisations in reducing maternal health in the continent.

Abortions
In Uganda, World Health Organisation estimates that 300,000 women carry out unsafe abortions every year, many of whom risking their lives and leading to complications including death. However, even safe methods of abortion in the early months of a pregnancy are not readily available and are quite often expensive.

Avail drugs
Dr Charles Kiggundu, a gynecologist and obstetrician with Mulago Hospital, said threatening girls from abortion does not solve anything as they are usually determined to get rid of an unwanted pregnancy and urged government to make available drugs like Misoprostol for safe abortions.

The Commissioner for the Reproductive Health at the Ministry of Health, Mr Anthony Mbonye, said unsafe abortion still remains a challenge which will require a multi-faceted approach to address. He urged, especially parliamentarians, to increase funding for the health sector in order to tackle such issues.

flanyero@ug.nationmedia.com

Source: http://www.monitor.co.ug/News/National/-/688334/1425602/-/agpb1tz/-/index.html

Ugandan Activists Pressure Government to Reduce Maternal Deaths

By Andrew Green

KAMPALA – Uganda’s health activists are demanding an increase in skilled medical workers to save the lives of the country’s mothers. An advocacy coalition has kept national attention focused on the issue for more than a year. But, as 16 women continue to die every day from complications giving birth, activists have yet to realize any new funding for health workers.

Tragic case recalled

Jennifer Anguko bled to death in a government hospital in October 2010, waiting to deliver her child. As her husband, Valente Inziku, begged health workers for attention, he says his wife told him she was dying and then lost consciousness. By the time Inziku convinced someone to help, it was too late. Their unborn child died as well. More than a year later, Inziku says he is still struggling to raise their older three children alone.

“How am I going to bring up the children? That’s now the question I’m asking myself,” Inziku wondered.

Calls for change

Anguko’s death became one of the rallying points for a coalition of Ugandan health activists to reduce maternal mortality. Uganda has seen maternal death rates almost cut in half in the past 20 years, but it remains one of the most dangerous countries in the world to give birth. The United Nations Population Fund says Uganda registers 310 maternal deaths per 100,000 live births.

Activists argue the majority of maternal deaths could be prevented with more health workers and consistent access to medical supplies.

Uganda has 2,500 government health centers, but nearly 50 percent of the positions are unfilled. That means at least one out of every two pregnant women has no skilled medical person to help them give birth. The U.N. Population Fund says at least 2,000 more midwives are needed to address the situation.

Without more midwives and nurses in the system, Rukia Nansubuga, a grassroots organizer in Kampala, says expectant mothers will continue to suffer and die, so they will not even go to medical centers.

“They fear to go to health centers, because the health centers are not well-facilitated. The health workers are not well-facilitated,”Nansubuga said. “The ones who go there are neglected.”

Civil society groups joined forces a year ago to more effectively pressure the government. Robina Biteyi is the national coordinator of the White Ribbon Alliance. “This is a very good development, because we have all worked on maternal and newborn health, but separately,” she noted. “We felt we needed to come together and make sure we have more strength in demanding for accountability for maternal, newborn and child health.”

The coalition took the unusual step last year of suing the government in constitutional court, arguing that women’s right to life was undermined by health worker shortages and a lack of supplies. They also initiated an international resolution calling for governments to prioritize safe motherhood, which was passed in April at a meeting in Kampala.

Setbacks

Although the efforts have raised the profile of the maternal mortality crisis, they have not yet resulted in a concrete victory. In early June, the constitutional court threw out the case against the government, saying it was a political issue.

Sylveria Alwoch, of the Uganda National Health Consumers Organization, says the decision was a setback, but it will not undermine the coalition’s larger efforts.

“We are still there and we are going to continue advocating. Advocacy doesn’t end in one day,” said Alwoch. “And, when you get disappointed, it doesn’t mean you go and cover your head and stop there.”

Despite the court setback and the Ministry of Health’s announcement that there would be no new funding for health workers this year, the groups are continuing to lobby the government ahead of the release of the budget this month, hoping money will be reallocated for hiring.

Source: http://www.voanews.com/content/ugandan-activists-pressure-government-to-reduce-maternal-death/1205834.html

Activists hold a peaceful march in the capital Kampla to protest the delay by a Ugandan court to deliver a ruling in a landmark lawsuit regarding the cases of two women who unattended bled to death during childbirth