WAKISO, UGANDA — When Evelyn Nalugo discovered she was pregnant, she kept it a secret until she was seven months along. She worried that someone might use witchcraft to curse her.
To keep her pregnancy hidden, she also steered clear of her local health center, just a kilometer (0.6 miles) away from her home. Her first visit to a doctor was on the day she gave birth to her son.
“You never know what people are truly feeling or thinking about your baby, so my not going to a health center was the best way keep my pregnancy a secret,” Nalugo says. “I didn’t want any member of the community to know I was pregnant until the pregnancy spoke for itself.”
According to tradition, Nalugo did the right thing. But health officials say this practice contributes to high rates of maternal mortality in Uganda and counteracts the government’s efforts to extend health services to more communities.
A 2014 survey by the Ministry of Health shows that the country met its goal to provide at least one hospital or primary-care facility for every 100,000 people. Despite this increased access to care, Dr. Placid Mihayo, a gynecologist and obstetrician with the Ministry of Health, says many women still fail to complete the recommended four visits to an antenatal specialist during their pregnancies. Cultural beliefs may be part of the problem.
A 2016 health survey by the Ugandan government found that only 29 percent of women who had given birth in the previous five years visited a specialist during their first trimester.
“A significant number of women will not come for early antenatal care in the first and second trimester, because the pregnancy is most vulnerable at that stage, and they believe they will be seen and bewitched by those who don’t wish them to have children,” Mihayo says.
He cites such fears as a contributing factor in Uganda’s maternal mortality rate of 343 deaths per 100,000 live births – a figure well above the global average of 216 deaths per 100,000 live births, according to the United Nations Population Fund.
Dr. John Bosco Mundaka, a gynecologist and obstetrician at Kamuli General Hospital, says families also pressure women to avoid medical care.
Mothers “encourage [their daughters] to depend on herbs until delivery day, when they come to a health center,” he says.
But, he points out, avoiding prenatal care increases the risk of cord prolapse (a condition that causes the umbilical cord to exit the cervix ahead of the baby prior to or during delivery) as well as high blood pressure, anemia, hypertension and premature birth.
Mihayo says greater community education about the benefits of prenatal care is vital and that health workers should seek out and identify pregnant women individually, to encourage them to visit health centers.
Still, Nalugo says she saw no reason to go to a health center while she was feeling well.
“Every pregnant woman who loves their pregnancy will seek professional help when they need to, but when it comes to witchcraft or a blasphemy eye, you can’t seek help from a doctor, so the best way to protect your baby and self [is to] keep to yourself and husband,” she says.
Christine Nabasumba, a mother of three, agrees. She says she waited six months to visit a health center during each of her pregnancies.
“You know how people love to stare at pregnant women, talk about pregnant women,” Nabasumba says. “It’s irritating sometimes, so to stop the staring and talking, which in most cases don’t mean well, you limit the movements.”
Some interviews were translated from Luganda.