What choice do our Ugandan mothers have?

Once upon a time, there was a woman from eastern Uganda who walked all the way from Kamuda village to Soroti town 12 kilometres away only to deliver on the bare ground outside the hospital while people looked on.

By Williams Moi

Once upon a time, there was a woman from eastern Uganda who walked all the way from Kamuda village to Soroti town 12 kilometres away only to deliver on the bare ground outside the hospital while people looked on.

Luckily enough, I had visited the hospital administrator that day. He told me he had seen people gather around a woman in the hospital compound grounds.

“It was a pity as people continue to stare at her as she fell on the bare-ground on her back ready to deliver. She spreads and kicked her legs on the bare ground,” he said.

He continued: “I took about ten minutes to reach the scene where people had gathered to ascertain the truth of the matter. When I joined the onlookers watching her it was too bizarre and nasty for me to stay on then I left the scene.

“People gathered around her to look at her while a female nurse, who I identified by the glove on her hand only not her uniform, tried to remove the placenta remains. She took time dressing up the gloves while the mother lay in pain.

“Her legs were spread apart while she yelled as many people, mainly women and young children, enjoyed to glare at her private parts. The baby came out crying and I saw the beautiful baby fall on the bare ground. The baby cried with a big voice, about three times.”

I later found out that the village woman has delivered safely and without any difficulty but giving birth in this way is extremely risky. It is unbelievable that a woman should deliver in the hospital compound rather than in the labour ward or theatre.

A doctor who was nearby asked what had happened so I went to see with my own naked eyes what was going on.

I saw some of the women wrap the baby in a ‘laso’ piece of Kitenge cloth, which is made in the DRC and Kenya and is always used by women in Uganda as special dress, and to mean that something is nice, which meant the baby was also being seen as nice.

I saw a woman carry the wrapped baby delivered from the bare ground into the hospital while another two helped the mother by stretcher.

I saw a male nurse run from the out-patient department towards the administration block. He was running to complete an emergency transfer from the bare ground to the ward, which should have been done before by the nurses who are trained to care for women during and after delivery.

I began to wonder why a woman delivered in the compound of a hospital rather than within the facility.

I contacted hospital administrator Thomson Ebong who told me this was “normal with us here.” When I argued it was not normal to deliver outside the hospital rather than inside he agreed it is “unfortunate” for a woman to deliver in the hospital compound rather than inside but that it does happen.

I have since learned there was laxity in delivering this woman in the normal way. Even though the women delivered in the compound she was out of reach of the nurses so emergency action should have been taken or an ambulance sent. Even the nurses on duty were hard to reach until one sympathiser volunteered to help the woman. But this happened rather late, which does not conform to the nursing profession’s duty of care.

The rest of the people gathered were not medical staff but onlookers enjoying staring at the newborn child. Others laughed at the private part of the woman while she delivered in the compound’s pathway.

To a certain extent, ambulance services are paid for by the poor women of Uganda as a cost sharing fee. They pay this in order to deliver away from the hospital when one cannot reach it even though the government has urged for these fees to be scrapped.

But visiting Kichinjaji health center within Soroti municipality I found that it opens late at 9am instead of the government recommended time of 8.30am and closes early before 5pm. There are also no night emergency services.

Children who were clients there told me that the nurses do not work on Saturday and Sundays as if diseases and labour only attack people on weekdays not on the weekends. Similarly there were no services all over the Christmas week right the way up to New Year I am told.

When I visited on a Saturday to corroborate the children’s claims I did not see anybody, neither a patient nor a nurse. In fact I am told you can rarely see a doctor at the health centre at all.

Efforts to speak to the health centre in-charge were futile; maybe he was attending to other emergencies elsewhere.

What choice do women such as mother in this story have? Delivering at a health centre is hit and miss in terms of staffing but walking 12km to deliver on the bare ground is not appealing either.

The truth is, this is no choice at all.



  • comment-avatar

    Unbelievable, This seems to be the norm in our African Health systems. What is normal for a woman to give birth in public when giving birth is supposed to be a private affair not for public consumption! Something needs to be done to keep our health care providers on their toes 24/7. There is too much laxity, no wonder the high maternal and neo-natal mortality rates are high in our countries.

  • comment-avatar

    Thank you William for the article

  • comment-avatar
    Harry Strulovici, MD, MPH 5 years

    Williams Moi is spot on regarding the plight of women of reproductive age. LifeforMothers.org encountered the same challenges as described. Without a holistic/comprehensive strategy maternal/neonatal mortality will remain high and women along with their households will suffer. LifeforMothers employed CHWS who had mHealth technology (simple phones–not smart) and we were able to reach these women. The factors that restrict women from getting access to services are many, not limited to cultural, economic transport, stigma, poverty and lack of education. What is required is strong political will to overhaul the health care system from within. This will include the empowerment of women and male partner involvement. You can access lifeformothers’ draft report on its Pilot Project at its website under About Us.