By Alisha Horowitz and Kate Holt
Gertrude Namara knew it would take an hour to reach the Nyamuyanja Health Center from her mud-walled home in Western Uganda. Her four children had been born there, and this baby would be no different. Giving birth in a health facility with a skilled nurse or midwife is a major factor in surviving complications of childbirth in Uganda, where the maternal mortality ratio is 438 deaths per 100,000 live births. On a warm, mid-July day, as her labor steadily progressed, the 29-year-old set out on foot.
Namara was greeted by the familiar face of midwife Pulkeria Kyorasiime, one of a dozen health care providers who staff the center in Isingiro District, where Namara had attended prenatal classes. “Pulkeria and another health worker would examine me during my visits to the health facility and they gave me my expected delivery date so I was prepared for the birth and had everything in place,” says Namara.
Namara had a healthy girl and returned home. A week later, Kyorasiime was at her door. One-third of Ugandan mothers receive such visits within two days of a birth. Kyorasiime discussed nutrition and hygiene and made sure the baby was breastfeeding properly, especially important in a country with an under-5 mortality rate of 56 deaths per 1,000 live births. Kyorasiime also talked about postpartum family planning and the benefits to mother and baby.
The midwife is among nearly 100 health care providers in Uganda’s Isingiro District who have strengthened their emergency obstetric and newborn care skills with support from Jhpiego and the GE Foundation, in partnership with the Ministry of Health.
Women in Uganda often avoid seeking care in health facilities out of fear of mistreatment. As part of this project, Jhpiego introduced and emphasized the concept of humanistic or respectful care. “We have been encouraged to develop a new attitude to our patients so that we treat them better and they feel more respected,” says Kyorasiime. “This encourages women to come to the health clinic, which is what we want.”
One of 12 children, Namara knows the hardships of a large family. The average monthly income of a rural family is 222,600 Ugandan shillings ($86). Her husband, John, is a farmer. “I think now I have enough children and don’t really want more. Two of our children go to school and each child costs us around 35,000 Ugandan shillings ($13) per term,” says Namara. “I went to school up to grade seven but couldn’t continue because my parents didn’t have enough money to pay the school fees. With five children at least we can look after them properly. I want them all to go to school and get a proper education.”