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Auma Joyce during her First ANC visit at a health facility in Gulu city


GULU: WEDNESDAY,Jun 15, 2022

When Knight Akwero, a resident of Patwol ward in Anaka town council, Nwoya district conceived her first baby in 2006, she hoped to deliver at a health facility under the care of a trained midwife.

When labor pains hit her during the final hours to deliver, Akwero gathered a few belongings and walked for two miles to Anaka General Hospital.

But to her surprise, the expectant young mother was received by a nurse who subjected her to all sorts of demeaning questions, all related to her state of disability.

“The nurse left me on the floor and went to do her own things and I struggled to deliver my first son. By God’s grace, I safely delivered him on the floor without any assistance from the midwife,” recounted Akwero.

Akwero was struck by the deadly polio virus at a tender age which crippled her, making mobility difficult.

Struggling to hold back tears of a sad memory, she narrates that the midwife shouted at her when she returned, asking: “why did you deliver alone? Do you want me to lose my job? Why do you want to give birth if you know that you are disabled?”

While she thought that this could have been a one off incident, fate repeated itself when Akwero conceived the second child two years later.

She says that when she went for antenatal care, no one attended to her that she got discouraged to go for subsequent visits.

“I went to the hospital, no one attended to me and later when time for delivery came I went back to the hospital but I was again mistreated,” disclosed Akwero.

“They said climb up the delivery bed. They knew I couldn’t climb the bed, so I silently picked and laid my plastic mat on the floor and delivered my child from there.”

Widespread Concern

Such tales are not uncommon among women living with disabilities in Acholi sub-region where accessing maternal health care in a friendly environment remains a tough task.

Many of the women with disabilities recall encounters of discrimination, negligence and stigma from health workers and lack of sensitization on maternal health and inaccessibility of health facilities’ equipment for safe and convenient delivery.

Delivery Bed at Bar – Dege Health center III in Gulu city

As a result many mothers with disabilities end up dying or losing their babies, health officials have admitted.

Yoweri Idiba, the acting Gulu district Health Officer, during a sexual and reproductive health program meeting held on April 26, 2022 confirmed that the institutional maternal mortality ratio in the district stands at 249 per 100,000 Live births.

He said  there is low antenatal attendance within the first trimester, standing at about 32%, hence it is difficult to complete Antenatal care (ANC).

Idiba called these figures alarming, pointing out that teenage pregnancy accounts for 27% of all ANC and 11 out of 32 maternal deaths are among teenagers. 

He added that persons with disabilities ANC attendance is very low in the rural areas of Acholi sub region.

“Quarterly we see the rise in the reported maternal health deaths in the Acholi sub region but there is still not enough that we are doing,” pointed Idiba.

“Therefore I call upon all stakeholders to join hands and see that the numbers of maternal deaths go down and also work towards improving ANC visits, especially for women living with disabilities,” he urged.

In 2010, CEHURD, under the Regional Network for Equity in Health in East and Southern Africa conducted a desk review of the constitutional provisions on the right to health in fourteen countries in the region which included Uganda.

The organization found out that the Government of Uganda decentralized its health system as a way of empowering its citizens to participate in the process of development and improve their livelihood in critical sectors such as health.

It says the decentralization of health services created two levels of health sector administration, one at the central government and the second as local government.

The Government Health Policy states that health center IIs are to be in every parish to do referrals to Health Center IIIs, which are meant to be in every sub county and health center IVs serve counties as mini-hospitals with capacity to admit patients and conduct surgery under the care of senior medical officers. 

However, many of them are non-functional units due to the lack of beds, water and electricity according to CEHURD findings.

This leaves many women with disabilities struggling to access maternal healthcare contrary to the UN Convention on the Rights of Persons with Disabilities which requires State parties to recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination.

The convention further mandates the States to provide persons with disabilities with the same range, quality and standard of free or affordable health care and programs as provided to other persons, including in the area of sexual and reproductive and population – based public health programs.  

Concy Apiyo, a mother of two who lost both legs to landmine explosion during the Lord’s Resistance Army Insurgency in the early 2000’s, revealed that during her first birth on May 24, 2014, at Anaka Hospital, she experienced great difficulties including a painful operation.

Concy Apiyo Disabled Woman with Physical Disability with her second born male child at her home in Anaka Town Council Nwoya District

“I have one major challenge that prevents me from going to that hospital to deliver again. We shared one latrine and shelter with able-bodied people and for me who has no legs, I usually find it hard to crawl on the shelter’s floor to ease myself.”

As such, Apiyo decided to go to Lacor hospital in Gulu City to deliver her second child which was done through a cesarean section.

She maintains that handling of mothers with disabilities is better at Lacor hospital (a private church based health facility), than in many government health centers where mockery, maltreatment and use of degrading language are a discouraging factor for mothers to seek antenatal and childbirth services. 

Margret Auma, a widow with hearing impairments in Patwol village, Palaro parish, Palaro Sub county in Gulu district states that the conditions are even more unbearable for them due to bad attitude and communication barrier with medics.

Midwife’s speak out

Mary Atim, the in-charge maternity ward of Anaka hospital, says whereas treatment of mothers with disability might not have been up to expectation in the past, their client care has tremendously improved.

She says the hospital offers the required maternal health services to both women living with disabilities and those without disability in equal ways. 

“When these mothers come for antenatal care and services like examination, we sometimes have challenge with handling the deaf and dumb especially when they do not come with their helpers,” Atim explained. 

Anaka hospital only has one bed for women with disabilities and the nurses have improvised wooden ladder as a supportive tool for crippled mothers to climb on to the delivery beds and the rest bed after delivery.

“Since my posting here, I have delivered three women with disabilities,” Atim said.

Clare Joyce Ajok, a midwife at Oroko health center II in Gulu district, says it is true that women with disabilities face a lot of challenges right from conception till childbirth.

She says some health workers also have negative attitudes towards women with disabilities which scares them from going for maternal health services.

Annet Aber, midwife In Charge maternity ward at Bar-Dege Health Center III noted that the relationship between the health workers and women living with disabilities are at stake since they do not know how to communicate to these women living with disabilities, especially those who cannot hear.

“Giving them health education is very hard especially for the deaf and it is also very hard for them to share with us their problems and for us to give them the full health packages as required by the ministry. Government should train us in sign language interpretations.”

While Bar-Dege Health Center III has a ramp to enable access to the maternity ward for persons with disabilities, the waiting section has high benches which are inaccessible by persons with disabilities. 

Nancy Acen, Midwife in charge maternity ward Alero Health Center III in Nwoya District

The health center has three delivery beds, two of which are in good working condition and five rest beds for mothers after delivery.

Continuous advocacy 

In a quest to improve the quality of maternal health care received by women with disabilities, Teddy Aciro, the chairperson of Gulu women with disabilities union has called for continuous advocacy.

Aciro Teddy Luwa, Chairperson Gulu Women with Disabilities Union

“Some health workers judge women with disabilities through their appearance when our fellow women visit the facility and they treat us differently as compared to other women,” she complained.

“We are also doing continuous advocacy for adjustable beds at the different health facilities within Acholi sub-region, especially in the five districts of Gulu, Amuru, Nwoya, Omoro and Gulu city,” she said.

There are over 8,000 women with disabilities registered as members in the union, however,  Denis Lakwonyero Ocen, the district councilor representing persons with Disabilities in Gulu district has urged the communities to back up the union in advocating for equal treatment of persons with disabilities within the district and region.

“We have to come out as a team, all stakeholders and implementing partners, let’s support this common course to see that people with disabilities receive equal treatment both at the health centers and in the community” Ocen said.

This article was produced with support from the Center for Health, Human Rights and Development (CEHURD) under the JAS Media Fellowship Program 2022.

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