Pandemic Pushes Maternal Health Care Toward Crisis

KAMPALA, UGANDA — On a misty Friday morning, Nancy Kakuru carries her newborn girl around her home. A small-scale farmer in Kifumbira village, just outside Kampala, the capital, Kakuru passes the baby to her husband and other relatives, who hold and cuddle the infant.

It is the end of a long and bittersweet journey for Kakuru. The night she went into labor, she arrived at the Kabuyanda Health Centre IV at 1 a.m., only to find about 30 other women in the maternity ward.

She was pregnant with twins. Nurses told her they were waiting for her labor to progress, and that turned into two hours. By the time she gave birth, “only one made it,” says Kakuru, 40, who is now a mother of six. “The other died in the womb.”

Kakuru is part of a pandemic-driven pregnancy boom in Uganda that has further stretched the country’s maternal health services, which have long been beset by a host of problems, including a lack of equipment and personnel, and allegations of corruption.

“We have been advocating for improved maternal services and not much has been done,” says Maxensia Nakibuuka, executive director of Lungujja Community Health Caring Organisation, a local advocacy organization that focuses on HIV/AIDS. “A lot of resources were invested in combating coronavirus, and the government did not give much attention to other health services, such as access to family planning services.”

Now, with the soaring number of mothers seeking prenatal and delivery services, health workers worry that they will see a corresponding rise in complications for both pregnant women and babies.

Uganda has one of East Africa’s highest fertility rates, estimated at five children per woman, according to the World Bank. Maternal mortality rate is still relatively high – 375 deaths per 100,000 live births, according to a 2020 UNICEF report.

About 28% of women who want family planning services can’t get them, according to Uganda’s 2016 demographic health survey. The government’s stay-at-home orders and other coronavirus restrictions only deepened the crisis, as many women found it harder to access contraceptives or maternal health services.

Justine Nakamatte, a midwife at Kisaasi Church of Uganda Clinic and Maternity Centre, says that prior to the pandemic, an average of 97 pregnant women sought prenatal services at her facility every month. Since mid-2020, that figure has doubled.

“These families are stressed because the pregnancies were unplanned,” Nakamatte says. “There is likely to be an increase in premature births.”

Since the pandemic erupted, baby deliveries and abortions have spiked at Mukono General Hospital in Mukono, a town just east of Kampala, says Alex Namara, the senior nursing officer.

After recording 45 abortions between July and December 2019, the hospital saw that number for the same period in 2020 leap to 89. Likewise, for the same two periods, first-time prenatal visits shot up from 5,257 to 8,066.

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The hospital, which serves a major population center, has historically drawn large numbers of women seeking maternal services, Namara says. As a result, inadequate supplies, for example, have always posed a challenge.

But the pandemic made things worse.

“Because of the surge in numbers, there is limited space and congestion,” Namara says. “Hence it’s challenging to observe the COVID-19 [restrictions] or give the mothers adequate attention and time.”

Instead of spending a half-hour with a mother, he says, doctors and nurses may spend only five minutes. “There are others to be attended to,” Namara says.

Eunice Karega, 38, a food vendor in Owino market, is eight months pregnant with her fourth child. In the past, she has gone to Kampala’s Kawempe National Referral Hospital for prenatal care, but long wait times at the government-run facility forced her to use a private hospital this time.

“We had to wait for nine hours at Kawempe National Referral Hospital before we could get attention and eventually borrowed money to go to a private hospital,” Karega says. “There were so many women seeking services.”

Each month the government sends resources to facilities that need the most help with prenatal care and delivery services, says Dr. Jesca Nsungwa Sabiiti, commissioner for the department of reproductive and child health in the Ministry of Health.

Corruption was an issue in the past, she adds. Problems ranged from bribery to pilfered medications to ghost workers – staffers on the payroll who never showed up – in health care facilities.

The Medicines and Health Delivery Monitoring Unit, established by President Yoweri Museveni’s office, has stamped out wrongdoing, she says.

After five children, Kakuru says she wasn’t ready for another. But the lockdown meant she didn’t have transportation to health facilities, where she could get contraceptives.

A tall woman with a ready smile, Kakuru recalls being in pain the night she went into labor. Two midwives went from patient to patient in the maternity ward to check how their labor was progressing. Some women groaned quietly. A few screamed.

Kakuru tried to tell a midwife that she was in distress. One tried to help her.

“But they were overwhelmed by numbers,” she says.

At first, she says, she was angry. In Ugandan culture, Kakuru and her husband, Stephen Kakuru, would have been a Nalongo and a Ssalongo, respectively – cherished titles for parents of twins. It means the parents are blessed, and that other people can ask the couple to bless them.

Now, though, Kakuru says the anger has ebbed, and she and her husband are grateful for their healthy baby girl.

They named her Fortunate.