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Securing the Right to Motherhood in Uganda: International Women's Initiative's Safe Birthing Project.

Although progress has been made, given that between 2000-2010 neonatal mortality decreased from 32 to 26 deaths per thousand live births (2.2% per year) (Mbonye et al 2012), more needs to be done if Uganda is to meet its MDG 5 commitments.

In Uganda around sixteen women die giving birth each day (MDG report, 2010). The urgency to combat high maternal mortality is critical given that women give birth to on average seven children, the third highest in the world ((Uganda Bureau of Statistics and Macro International Inc. 2007). Such high rates of births increase the likelihood of complications, such as haemorrhaging, infection and eclampsia, which account for 90% of neonatal mortality (Waiswa et al, 2010). Yet these are all preventable causal factors. This underscores the need for adequate and efficient medical treatment and education. At present rates, Uganda is unlikely to meet its targets on reducing maternal mortality under MDG 5 by 2015. However, with the assistance of the Safe Birthing Programme more progressive steps will be made to ensure the reduction and prevention of maternal deaths.

The poor state of Uganda's healthcare is the result of over three decades of civil conflict, particularly in the Amolatar district where SBP is based. Amolatar district, with the heavy presence of the Lords Resistance Army, has experienced continuous cycles of insecurity. Health care has paid a heavy price: the ongoing humanitarian crisis and mass forced displacement has put unrelenting pressure on Uganda's public health sector. Currently, the stay on conflict as a result of successful peace negotiations between the LRA and the Ugandan Government has encouraged the return of internally displaced persons back to their communities. However, the disintegration of the health care system, infrastructure and lack of skilled health practitioners' means that the health care needs of communities are currently not being matched. For instance, Amolatar district's only referral hospital does not yet have a designated maternity ward. Women have been the hardest hit in their maternal health needs, especially where such services and human resources have become increasingly obsolete in rural districts affected by the conflict.

SBP was borne out of this necessity to meet community deficits in healthcare as a result of Uganda's turbulent and traumatic past. Founded as a community based initiative, SBP aims to promote maternal health and in doing so reduce maternal mortality in Amolatar District, Uganda. The objective is to recruit and train locally based Community Change Agents (CCAs) who will raise awareness amongst women, their families and the community on the importance of prenatal healthcare and family planning. CCAs will be selected by our sister organisation, Hope Development Initiative (HDI) and are instructed with two core functions in mind: firstly ensure pregnancies are monitored, with potential complications being referred to appropriate medical practitioner(s). Inherent in this delivery of care is providing access to services through the provision of safe transportation. The second function relates to addressing public misinformation that exacerbates gender inequality around seeking care during pregnancies and family planning. Community workshops will help promote basic healthcare and maternal care activities whilst also advocating for Skilled Birth Attendants during pre and postnatal periods in the Amolatar district. The need and necessity for the recruitment and training of women into CCAs is clear, considering only 42% of births are attended by skilled health professionals, adding to the increased risk in childbirth (WHO, 2013). The work of SBP will gradually help alleviate some of the social adversity and governmental taboo around talking about sexual health. Dialogue is often the first step to acceptance and utilisation of local health services.

IWI has developed three Safe Birthing Kits that will assist in adequately resourcing medical facilities with equipment and supplies and in so doing increase the capacity of the CCA's in their service delivery. The first of these Safe Birthing Kits is the Facility Birthing Kits (FBK); the Community Care Agent Kits and the Personal Care Kits. The provision of sterile equipment, water purification tablets, baby blankets, topical alcohol and mosquito nets help to combat preventable infections, a major cause in maternal deaths as a result the traditional preference for home births. In addition, prenatal vitamins and supplements ensure that women's nutritional levels are maintained to reduce complications arising from dietary inefficiencies. Together, these basic but necessary kits help to promote healthy pregnancies and infant care through ensuring that vital equipment and medicine are available and accessible when needed.

IWI takes the view that securing the maternal health for women means educating all sectors of society, including the participation of husbands, local leaders, and religious figures to encourage greater utilisation. The role of men in securing women's rights is intrinsically linked to addressing the cultural acceptance around child marriage and female genital mutilation, which introduce additional difficulties during birth. Uganda has one of the highest rates of child marriage in the world. IWI advocates for the prioritisation of education for girls' to prevent early marriage and premature motherhood.

Although progress has been made, given that between 2000-2010 neonatal mortality decreased from 32 to 26 deaths per thousand live births (2.2% per year) (Mbonye et al 2012), more needs to be done if Uganda is to meet its MDG 5 commitments. Needless to day, the reduction of maternal mortality will be gradual. However, with the persistence of IWI's work through SBP and collaboration with Hope Development Initiative, steps are being taken to achieve the long-term sustainable decline in maternal mortality in the Amolatar District. The ambition will be to roll out SBP's to more districts to increase women's access to pre and postnatal maternal care within their communities. With each success story, more is being done to ensure that all women have the right to motherhood in Uganda.

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