By ANTHONY WESAKA

The absence of female police officers at majority of the police posts in the districts of Gomba and Mukono, is hampering the fight against sexual violence against women, an official has said.

Ms Noor Nakibuuka Musisi, an official from a Center for Health, Human Rights and Development, explained earlier today that the absence of the female police officers has made some women/girls to fear to report sexual abuses committed against them.

Ms Nakibuuka, named Mamba Police Post in Gomba District and Nkonge Police Post Mukono as some of the posts without female officers attached to them.

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Today the Center for Health, Human Rights and Development (CEHURD), Nnamala Mary and Simon Kakeeto have dragged the Government of Uganda to the Constitutional Court for failing to put in place shelters for women who have been raped or defiled. CEHURD also challenges the unequal punishments that the law provides for sexual offenders as being unjust.

Men charged with rape are liable to suffer a maximum penalty of death whereas the law provides for the offense of ‘defilement’ for persons between the ages of 14-17 and sexual offenders against girls of that category are only given a few years of a jail term. This difference in penalties towards perpetrators who commit the same offense is unjust and offends the principle of equality and non-discrimination before the law. It also has an effect of increasing sexual violence against girls in that particular age group.

According to the Uganda Demographic Health Survey of 2016, 1 in 5 women have suffered sexual violence in Uganda. Uganda Police has also released the Annual Crime Report of 2017 where defilement was rated the 3^rd leading crime in the country with 14,985 cases reported and police recorded 1,335 rape cases. It is important to note that in cases of sexual violence, many women do not report due to fear, stigma and the trauma that is associated with the offences. The police reports are just a tip of the ice bag of the magnitude of the violence that women face on a daily basis in this country.

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By Joy Asasira

There is not a day that goes by that we do not hear of a mother somewhere in Uganda who has lost her life (and that of her baby) while delivering.

In many of the local dialects in Uganda, there is a word to describe this death. To say the least, this has been accepted as, “normal”, but is it? What is unfortunately a common practice, is that when women are faced with complications related to pregnancy or delivery, these women continue to choose high risk options such as delivering at home or with the assistance of traditional birth attendants.

The factors that lead to maternal death are known, these have been explained categorized to include; the socio-economic, cultural and accessibility and actual quality of care of health facilities. These contribute to what have been referred to as the three delays. These delays include; delay of women at home in making the decision to seek care, delay by the women to identify and reach the medical facility and delays at the health facility for the woman before receiving adequate and appropriate treatment.

Whereas the first and second delays are complex to address owing to the need for attitudinal shift, economic empowerment and doing away with deeply rooted cultural practices. The third delay, which is characterised by poorly-equipped facilities that lack among others; health workers, medicines, equipment and blood for transfusion as has been the case in Uganda in the recent past due to rampant blood stock outs. Maybe addressed through systemic and programmatic interventions can improve financing of health care and particularly maternal health care.

As we commemorate the maternal health month, I cannot help but wonder whether the non-affordability of maternal health services among others, is not one of the reasons our women continue to die form preventable maternal mortality causes.

Universal Health Coverage then becomes a possible solution for addressing the high cost of healthcare for maternal healthcare. Simply put, Universal Health Coverage (UHC) refers to the idea of access to health services for all without exposing the user to financial hardship. This is not to say that Universal Health Coverage is a silver bullet, however, it would mean one more step towards accessibility of healthcare, including maternal health services and family planning.

Ensuring affordable, accessible, acceptable and good quality health care for Uganda’s women of reproductive age is inevitable if we are to tackle the persistently high maternal mortality that stands at 336 per 100,000 live births.

The reality is that many Ugandans are just getting by and for every two Ugandans that get out of poverty, three more fall back into poverty. Since reproduction is not a reserve of those with means, those living in poverty also find themselves pregnant and in need of good quality and dignified maternal care.

This means that of the more than two million pregnancies in Uganda annually, many of these happen to women that are living below the poverty line (and these same women probably already have more children than they can care for). Let us not forget about our teenage girls; one in four of these girls have either had sex or been pregnant before their 19th birthday, but can they afford the healthcare that they desperately need?

It is not a surprise that that the media is awash with stories of women giving birth in taxis, at the entrance of hospitals, in corridors and on floors. There is also a new practice of detention of women in health facilities due to failure to clear the medical bills.

It is a fact that the high cost of healthcare is forcing women to make life threatening decisions about how to manage their pregnancies and where to deliver. This high cost must be addressed in order to ensure universal health coverage through a multi-pronged approach that includes investing such as primary healthcare, where we would have issues like malaria in pregnancy addressed.

Secondly, through building upon and strengthening partnerships between the public and private sector, this also includes regulating the operations of the private sector, including the pricing of services.

Thirdly, the creation of innovative financing models such as Uganda’s proposed National Health Insurance Scheme (NHIS). However the proposed NHIS is not without criticism even as its efficacy remains to be seen. Some have pointed out that a scheme that seeks to operate within a health system that is plagued by inequalities, including access to and distribution of health facilities between the rural and urban areas and disparities in staffing levels between facilities of the same level in different parts of the country.

There are lessons to be learned from countries like Rwanda that developed and is currently implementing the Community Based Health Insurance (CBHI) scheme, where a scale of the population based on their income and then worked to subsidize income the contributions for those considered the poorest and vulnerable.
While others considered able, pay a contribution towards their healthcare. It is no wonder that Rwanda was able to achieve Millennium Development Goal 5A, which was to reduce by three quarters between 1990 and 2015, maternal mortality ratio.

Rwanda reduced its maternal mortality ratio by 78% from 1,300/100, 00 live births to 567/100,00 live births in 2005 and 290/100,000 live births in 2015. It is also not surprising that the most significant changes were registered in rural areas where best practices like the women have embraced facility-based birth as opposed to home births.

The cost of health services continues to influence women’s choice of whether to seek health care during pregnancy and also skilled attendance at birth, With the number of women living in abject poverty, the need for government and stakeholder interventions to ensure access to health care without the fear of facing financial hardship becomes a pertinent issue for consideration in order to ensure improved maternal and child health outcomes in Uganda
Address maternal mortality in Uganda by ensuring affordable, accessible, acceptable and good quality health care service delivery.

A crossroad of ideas reflective of cultural and religious morals, beliefs and values affects young people of all social standings without sufficient attention given to scientific evidence that speaks to Sexual Reproductive Health and Rights SRHR issues. Teenage pregnancies have increased according to the 2016 Uganda Demographic and Health Survey, the school dropout rate especially in the hard to reach areas is still outrageous, sexually transmitted infections are still on the rise with 500 HIV infections happening among young people every week according to UNAIDS. Unsafe abortions also happen in a setting that still remains open to quack doctors operating in an unregulated environment due to the stay and disownment of different SRHR policy guidelines and service standards.

While they are at the center of SRHR decisions and service provision, cultural and religious leaders still remain a critical constituency that has not been tapped into by advocates for a progressive SRHR legal and policy environment in Uganda. They are a significant constituency because policies cannot be declared right with engaging them through consultations. However, this is a constituency that remains out of reach of scientific evidence that gives a clear and true picture of Uganda’s laughable SRHR record in comparison with other East African countries.

It is at this time that advocates must recognize that the influence of cultural and religious institutions cannot be go unnoticed, and they hold the key to ensuring that young people’s SRHR is realized. The role of religious and cultural institutions in child and human development is seen in church programs like Sunday school, youth camps/guild, and missions, the Kisakaate of the Nabagereka of Buganda and the girl-power conference of Pastor Jessica Kayanja for instance. Some of Uganda’s communication platforms are equally owned and operated by the religious and cultural institutions.

These include lighthouse television, Top TV and Radio, CBS Radio, Power FM, BBS Telefayina, Radio Sapientia, Radio Maria among others as important channels that we can leverage to enforce our support for the young people. Religious founded institutions through the Catholic Education Secretariat, Church of Uganda Schools, UMEA, and tertiary institutions like Uganda Christian University, Busoga University, Muteesa I Royal University, Ndejje University, and Uganda Martyrs University among others is other avenues in the education arena that are critical. It is therefore to the advantage of young people that this is another avenue the government is considering in the implementation of the recently launched Sexuality Education Framework.

The cultural and religious camps need to embrace access to SRHR information by young people through this avenue. They are equally at the center of health service provision and handle health predicaments of a significant number of people, including the SRH of young people.

The Medical bureaus (Uganda Catholic Medical Bureau, Uganda Protestant Medical Bureau, and Uganda Muslim Medical Bureau) are centers of power in determining the kind of services provided including on SRH. It is therefore important to emphasize these synergies with cultural and religious institutions in ensuring provision and access to a wide range of SRH services that remain out of reach by the young people. This is when Uganda will be able to score high on the different SRHR indicators.

Dennis Jjuuko
Programme Officer – Research, Documentation and Advocacy
Center for Health, Human Rights and Development

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.