Respectful maternity care will improve maternal health outcomes for less advantaged populations

Dec 20, 2019 | Blog

By Dr. Yvonne Kidza Mugerwa (OBGYN), Project Director for Kampala Slum Maternal and Newborn Health Project

I went to the hospital, but they did not treat me very well.

When Namukwaya Sarah (name changed for privacy) asked for transport money to return to her hometown for care while pregnant, her partner wanted to know if she had gone to the health center first. They stay in the Kampala, the capital of Uganda, so it should follow that they did not need to go to a traditional healer for care. There were health centers in the city.

But Namukwaya had tried that, and she had left the health facility after hours of waiting, where she was shouted at and her needs were not taken care of.

“I returned home and stayed in pain for 3 days,” Namukwaya said. Finally, she decided to return to her rural home for care at the traditional healer.

As efforts continue in Uganda and across the developing world to improve the care-seeking behavior of pregnant women and new mothers, poor treatment at the health facility remains a big barrier. Quality of care at the health facility must always recognize the fundamental rights of women to be treated with dignity and respect.

The maternal mortality rate in Uganda currently stands at 336 deaths per 100,000 live births. One of the driving factors for this has been mismanagement of emergency obstetric conditions outside of the healthcare system, for example with a traditional healer that might be more trusted by women but less trained to handle emergencies.

The USAID-funded Kampala Slum Maternal and Newborn (MaNe) Health project is testing approaches to address supply and demand barriers affecting care seeking, effective referral and provision of quality care for better maternal and newborn health outcomes in slum populations in Kampala.

Participants at the co-design workshop re-enact care at the facility. Photo: Monica Fox/USAID

The project worked with both healthcare workers in the private and public system, and the urban poor. Research proved that abusive treatment did not just ruin the birth experience for women but also actively kept them away from the healthcare system.

The urban poor population is uniquely placed to critique the equity of care, as despite being located within the urban centers, evidence shows us that maternal and neonatal mortality rates remain higher within the pockets of slum populations. These are populations that have often moved for better opportunities but are characterized by poverty, low education, and low bargaining power.

Unfortunately, evidence on the uniqueness of this population is limited and the Kampala Slum Maternal and Newborn Health project is working to contribute to documentation and learnings that will hopefully be replicable across different poor urban populations.

What we have learned through our formative studies is that care-seeking behavior and effective referrals would be improved when every woman who gets into the healthcare system is treated with respect and dignity. When their rights are respected, despite their income and social status, they are more likely to access care and refer friends.


Participants at the co-design workshop re-enact care at the facility. Photo: Monica Fox/USAID