Safer Deliveries for Women: Equipping Hospitals to Provide Quality Maternal CareBy Fred Ouma
Although Uganda has made progress in reducing maternal deaths over the last decade, it still has a high maternal mortality rate, with 336 maternal deaths for every 100,000 live births. However, attitudes toward home births—often a risky situation for women in labour—are changing.
“I delivered my oldest son at home”, says Brenda, a 33-year-old mother. She delivered her second baby at home and developed a terrible headache that lasted for days. She didn’t know it at the time, but she had eclampsia, a life-threatening condition. “I thought that it is only natural to deliver at home,” she says.
In 2012, Brenda gave birth to her third child at home and, as there was no trained health worker to manage the bleeding, she developed postpartum haemorrhage and had to be transferred to a hospital two hours away from her home. So, she chose to deliver her fourth child in a maternity ward at a health centre, but it was so cold and uncomfortable, especially for nursing a new baby, that she vowed to deliver her next child at home. “I had heard stories from other mothers that the maternity ward at the district hospital was not well equipped. I had to confirm it myself and decided it was not worth the effort to go back all the way to the facility.”
It was in this context that World Vision partnered with local governments, primary health care centres and communities to address some preventable causes of maternal and child deaths: delays in seeking maternity care or reaching a health facility, and lack of high-quality care once at a facility. The project focused on developing, equipping and upgrading four health facilities in Northern Uganda. The initiative aimed at increasing access to and use of maternal and child health, nutrition, as well as water, sanitation and hygiene services and practices in the communities.
Working with local governments, World Vision trained midwives, nurses, clinicians, community health workers, and other staff who are part of health service chain in perinatal care—including how to manage complications—and provided supportive supervision for health workers and mentoring for facility managers. The project also upgraded maternity wards with new equipment and supplies, working with health facility managers to improve the quality of care. One of these community health educators is Brenda's neighbour, who explained to Brenda the risks of home births, and that the reconstructed health facility and trained staff were now ready to help women deliver their babies safely.
Brenda gave birth to her fifth child in 2018 at a health centre which was fully reconstructed and equipped, clean and warm with running water. With the assistance of trained medical staff, Brenda had a safe labour and delivery. “It was a joy to give birth at the hospital. There was clean water and I could clean myself and the baby after giving birth,” says Brenda. “I felt safe and cared for by the staff, and the experience was a good one. I started to ask myself: Why would I deliver children at home?”
And in October 2020, Brenda once again chose to give birth at this health centre. Brenda encourages all expectant mothers not to wait until the time of delivery to visit the hospital. “If I have children again in the future, I have no doubt that I would attend all prenatal care visits and come back to the facility in time for delivery. I am happy to give birth there because it’s a different facility from the one World Vision found. It’s the epitome of hygiene and quality services.”