Some of the measures put in place by the government in response to COVID-19 have negatively impacted maternal, child and neonatal health, according to the United Nations Population Fund (UNFPA).
UNFPA says the biggest and longest lasting impact is seen in complications of pregnancy, stillbirths and low-birth weight infants likely due to delayed care-seeking behaviour.
Routine analysis of service delivery data by UNFPA shows that since the onset of the COVID-19 pandemic in Uganda in March 2020, there has been an increase in maternal deaths by 10.4%, from 1,089 in 2019 to 1,202 in 2020, according to the Health Management Information System (HMIS).
Winnie Kizza an advocate for justice, human dignity and good governance says, that Ugandan women are at risk in light of the rising rates of the pandemic, especially women who are about to give birth and thus exposed to the risk of unexpected complications during or after childbirth.
“The risk increases with concerns about the lack of access to quality health care services and information, insufficient supplies, and the absence of health care providers and goods to respond to emergencies,” she said.
Angela Nakafeero, Commissioner of gender and women’s’ affairs at the Ministry of Gender, Labour and social development says that meeting health needs is affected by the deterioration of the situation during the COVID-19 pandemic.
“Measures such as closing places and other compulsory measures, clinical staff may be pre-occupied with the response of pandemic patients than providing health services to other patients. Or health centers may lack sufficient personal protective equipment to provide services safely,” she says.
38-year-old Sara Birungi, a mother of four, sought family planning services earlier this year, she settled for an intrauterine device (IUD). Unfortunately, the lockdown was announced and effected the day she was to have the coil inserted.
With public transport banned, Birungi could not get it inserted and hence conceived . She is now pregnant and cannot come to terms with the idea of having a fifth child.
“My desire was to have only four children and I thought I had succeeded. Now I wonder how I will cope amid the economic struggles of COVID-19,” ponders Birungi, a market vendor in Namungona.
Sadly, Birungi’s story mirrors that of many women facing unique challenges in accessing reproductive health services during the COVID-19 lockdown with transportation being high. Unlike her, many women resorted to abortion, but that, too, has had devastating effects on them.
Teenagers like Satia Nalubega have benefited from these services. The 17-year-old Senior Three student has been sexually active for two years. Recently, when a neighbour’s daughter got pregnant, Nalubega’s mother got a wake-up call.
“My mother took me to the health centre and talked to the nurse in private. It was the nurse who asked if I had started having sex. She then told me that I could get pregnant and I needed contraceptives. My mother and the nurse decided to put me on injectaplan,” she says.
Unknown to her mother, Nalubega had an abortion last year. “I was in a boarding school. When I got pregnant, a friend – a day scholar – bought for me a pill and antibiotics at a pharmacy. I swallowed the pill and the fetus came out at night and we buried it in a hole we had dug behind the pit latrine,” she says.
Abortion in Uganda is illegal, unless a licensed medical doctor deems the life of the woman to be at risk. In 2006, the Ministry of Health proposed an update to the Comprehensive Abortion Care Services section of the National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights.
With a restrictive policy environment surrounding termination of pregnancy, many abortions done in health facilities are poorly documented, or undocumented, for fear of litigation.
Ms Dorothy Amuron, a sexual reproductive health rights (SRHR) advocate with Centre for Health, Human Rights and Development (CEHURD), says few gynecologists have the skill to conduct safe abortions.
“Due to the scarcity of skills, clinical abortions and post-abortion care are expensive and are only accessible to the well-connected.”
Phiona Nyamutoro, the national female youth Member of Parliament, says that contraceptive prevalence rates in Uganda is one of the most important ways to achieve high levels of reproductive health but only 39% of adolescents have access to healthy family planningservices. And with the lockdown restrictions access to contraceptives has greatly reduced.
“More than half of all pregnancies in Uganda are unwanted; a third of those cases end up in unsafe abortion due to a combination of economic and cultural challenges,” she says.
“Unsafe abortion and its complications account for 5% of maternal deaths in Uganda, and worse still, treatment of complications from unsafe abortion poses costs to the Ugandan health care system,” Nyamutoro says.
“On average, post-abortion care costs about US$130 per patient, and women’s use of abortion as a means of fertility control has increased recently in Uganda in the intervening years,” she adds.
She also says that the government and Ministry of Health should work closely with civil society organizations to raise public awareness of medical referral services during the COVID-19 lockdown and their right to quality health care adding that there is need to find alternative means to ensure that young people and girls have access to information and services related to reproductive health and rights.