Structural interdict: a plausible means to ending Uganda’s entrenched abuse of the right to maternal healthcare
Abstract
Uganda is a party to a host of international and regional instruments that explicitly demand for provision of avenues that enable enjoy¬¬¬ment of good maternal health; and in September 2015, Uganda together with the rest of the world, made a commitment to improve maternal health and as result, Goal 3 of the Sustainable Development Goals (SDG) came into existence.
Uganda’s mortality rate as of 2016 (Nationally representative data on these indicators are measured every five years using Uganda Demographic Health Survey data) stood at 336 deaths per 100,000. The estimated annual rate of decline of 5.2 percent is below the 7.5 percent established in the Health Sector Development Plan (2015/16–2019/20) as the rate required to achieve the SDG target of 140 by 2030. Significant effort is also required to meet the National Development Plan III target of 211 by 2025.
The right to maternal health is one of the most abused rights in Uganda and one that has gone without long term redress.
Luisa Cabal and Morgan Stoffregen report that globally, over a half a million women die each year due to complications during pregnancy and childbirth, with 99% of these deaths occurring in the global south. They further report that nearly all of these deaths are preventable because the majority of deaths are caused by hemorrhages, sepsis, hypertensive disorders (particularly eclampsia), prolonged or obstructed labor, and unsafe abortions
According to UNICEF, Uganda has registered slight progress in reducing child and maternal mortality, according to the Uganda Demographic Health Survey (UDHS) 2016. It still ranks among the top 40 countries in the world for high maternal, newborn and child mortality rates. The UDHS 2016 estimated 368 deaths per 100,000 live births - approximately 15 pregnant women dying every day due to direct causes like hemorrhage and hypertensive disorders compared to 438 deaths per 100,000 live births in 2011 (UDHS 2011).
The New Humanitarian, an independent Journalism website reported that, “Bribes, poorly trained medical staff and the lack of medical care for pregnant HIV-positive mothers are among the reasons for high rates of infant and maternal mortality in Uganda. NGOs want to see more government action.”
The Health Sector ranks among the least of the government’s priorities. In a span of over half a decade, its financing has never exceeded 10 percent of the national budget, yet most Ugandans cannot enjoy the highest attainable standard of physical and mental health.
Accounts of preventable maternal deaths are not uncommon. In 2011 Sarah Boseley reported for The Guardian, a British news agency, two of such accounts which were now matters in the Constitutional Court of Uganda:
She further reported that expectant mothers have continued to die in government hospitals under similar circumstances. Nurses and doctors solicit money out of them and other maternal health consumables and in the event that they fail to raise the money or other materials they are left unattended to which leads to their death and this violates their right to life and that Uganda is not spending the money it promised on maternal and child health. The World Health Organisation mother and baby package, which the government agreed to implement, specifies spending of $1.40 per capita. Uganda spend(s) just 50 cents