Linking maternal mortality and girl child education: Why any Ugandan woman could still die in childbirth

Angela Kintu
Posted May 13, 2015 from Uganda

My name is Angela. I have a university degree and a good job. I am the only wife of a great husband who has never raised his hand to me. I have two healthy children – a nine year old boy, adopted, and a two year old girl, at whose birth I almost died.

I am not the poverty-stricken marginalised face of the African woman that usually accompanies the data on maternal and child mortality. But I live in Uganda, East Africa, and the systems in my country – or lack thereof – are just as likely to end my life as they are to end the life of a woman living several kilometres and several GDP points down the road from me. I am not the story you are likely to hear, but I am an African mother.

At 33, I would be considered quite old in the general childbearing age for women in my country. Perhaps this is why when I showed early signs of a difficult pregnancy, it was dismissed as late motherhood issues. I threw up all day every day from the day we confirmed I was pregnant to the day my child was born. I was told it would pass. It did not. I was told I could control it ‘if I wanted to’. I could not. I lost weight to the point that I was 10 kg below my average weight by the time the baby came. Eventually it came to the point where I was too weak to walk, let alone work. I spent most days in the dark of my room hooked up to IV fluids.

My workplace at the time was beyond supportive. They paid my salary the entire time and sent me what work they thought I could do from my laptop at home. I wondered how many women in my situation would have the same blessing. We tried and tried to find medical help, but none was forthcoming. I just kept getting the same message: It will pass. Everyone treated me as if I was simply not ‘tough enough’. Not ‘woman enough’. Not ‘African enough’. It especially hurt to hear fellow women dismiss my suffering as though it was self-inflicted. In another setting, my husband would probably have deemed me ‘cursed’ and abandoned me with my mother. In my world, he was my primary support.

Eventually, my husband trawled Google and put a name to my predicament: Hyperemesis Gravidarum. Simply put, I had severe morning sickness. Around the same time, the Duchess of Cambridge, Kate Middleton, was admitted to hospital for the same thing. I would not wish it on any pregnant woman, but in my heart I was glad Kate had it. Somehow it gave my suffering legitimacy. It made hyperemesis gravidarum a real disease. The Internet provided the assurance and counselling all the healthcare workers in my town had failed to give me.

Finally, the morning after my due date, my water broke. Only it wasn’t water. It was thickly clotted blood. We rushed to the hospital, where I was told ‘bleeding is normal’, despite my insistence that it was not regular bleeding. “This is your first child, what do you know?” responded the midwife. I was advised to walk around and drink warm black tea. I did that for three hours until a doctor who was a friend of my father decided to check on me. He examined me and immediately ordered that I be taken for an emergency C-Section. It turns out my placenta had already detached, my womb was full of blood and my baby was being choked.

Indeed, when my baby was cut out of me, she wasn’t breathing and had to be resuscitated. Every day I thank God for his faithfulness to me. And I cannot help wondering: If I had been anyone else, if I had been married to a man with three other wives, if I had not been at the one regional referral hospital in my district, if the doctor had not insisted on examining me despite what the midwife said about my bleeding being ‘normal’. If, if, if...

The Ugandan health system is plagued with many issues, but one of the most glaring for me is linked to education. Yes, we want girls in school, and it is important that they get an education, but is any education truly better than none at all? In Uganda, when a girl isn’t doing too well in school or there is no money to further her education, she will be forced to consider nursing as an option. Not because she wants to, or because her heart is in it. We train droves of frustrated girls right out of O-level to become nurses because it is a cheap and easy option, and because the jobs are available. No one is saying to these girls that they can become mechanics, farmers, or plumbers. No one is telling them they can start businesses. That is a privilege for boys. Nursing is a safety net to catch the broken dreams of so many girls. And when they are finally shoved into a career of constant giving and nurturing, they do not have the will, the dedication or the aptitude for it.

This is why a nurse on duty in a maternity ward can dismiss my concerns about bleeding and make me wait three hours to see a doctor when I could lose my child and even die in the process. This is why the increase in the number of health staff is not always an increase in the quality of health service provision. This is why so many mothers and babies are still dying. We are limiting the options and the vision of young women and, perhaps inadvertently, not giving maternal health care the importance it deserves. If there is an aptitude test for those intending to join law school, how much more for women intending to become midwives and nurses? Midwifery isn’t a last option; it is a gateway to life. I know three women, all in the same position as me, who did not fare as well. Two died in childbirth, one along with her baby. The third lost her baby. We were all in hospital, all able to afford healthcare and all in situations that could have been avoided.

If we are going to prioritise the wellbeing of mothers and babies, we must prioritise quality education for the healthcare professionals who handle them – most especially midwives. One committed, well trained and emotionally prepared midwife can do more than ten frightened teenage nurses. One well trained midwife will not tell me my pregnancy worries are imaginary. She can tend to my emotional, medical and physical needs and I can trust her with my precious baby.

I am not a marginalised African woman. I have choices, I have an income, and I have a voice. I pray someone hears me, because for every woman like me that dies in childbirth, there are hundreds of women less privileged than me who are in so much more danger.

The Path to Participation Initiative from World Pulse and No Ceilings

Comments 6

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Alyssa Rust
May 13, 2015
May 13, 2015

Dear Angela Kintu,

Thank you so much for sharing this personal story. I cannot begin to imagine all that you went through and how difficult this time your life must have been. You are an extremely strong woman to have endured all of this and come out on the other end ready to share your story, ready to fight for quality education, and ready to break down the systems in Uganda. I thought what you said about how women are often pushed into becoming a midwife if they do not do well in school because other professions such as being a mechanic or a framer is only for the privilege of boys was extremely eye opening for me personally. In order to ensure that every country has proper maternal care the people who are provide it must be invested in the work, must care about the outcome of every birth, and should be educated in order to provide support. No one should have to relay solely on the Internet in order to get the answers they seek when they are having health complications. We can use our voices to create awareness and affect change. Thank you again for speaking up about this issue.

Sincerely, Alyssa Rust 

Angela Kintu
May 13, 2015
May 13, 2015

Alyssa,

I could not agree with you more! You have to want to do something, or have a talent for it, if you have any hope of succeeding. And healthcare is just the most wrong area to be in without the desire or mental strength for it.

I have visited the nursing school in my town and I have seen first hand what the process of enrolling them entails. If those girls were presented with any other option, they would take it. And probably even excel at it.

My experience was horrible, but you always hope that by sharing the painful stuff that someone else could be helped or could avoid it. God willing.

Thanks for reading

Angela

Carrie Lee
May 13, 2015
May 13, 2015

Hi Angela,

Thank you for sharing your story.  I was very interested to read your perspective on maternal health and quality care in Uganda.  I did not know that many women are being pushed onto the nursing track without neccesarily wanting to be nurses, and its effects on health care for pregnant women.  In my last journal post, I linked to this paper, which may be of interest to you- it examines maternal health outcomes in Rwanda, Malawi, Niger and Uganda: http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinio...

I am glad you are here to share your story!

Warmly,

Carrie

Angela Kintu
May 13, 2015
May 13, 2015

Carrie,

the paper you refer to had been moved, but I found it again here:

http://r4d.dfid.gov.uk/PDF/Outputs/APPP/20120611-odi-briefing-paper-74-v...

It pretty much sums up the situation in my country, thanks for the link. Yes, nursing is a last resort solution for too many girls, as is nursery and primary school teaching.

You do not need to have an A-Level qualification to get a certificate or a diploma in nursing; plus, the certificate course is way cheaper than paying for a degree. So that means less school time and less money and an assured job at the end of it all because the government is trying to staff all its health centres. Damned if we don't train them - damned if we do.

The situation alarms me because we are putting frustrated, ill equipped, inept women in charge of mothers, babies and infant education. The end result cannot be good for anyone.

Thanks for reading,

Angela

Julia O
May 18, 2015
May 18, 2015

Hi Angela, I read your post on the edge of my seat. It was very eloquent and gripping and I appreciate you sharing your story so much. I learned a lot from it. I have read a fair bit about the dismal maternal mortality rates in various parts of Africa but your post provided a completely new perspective to me! It was very interesting to read from the perspective of someone educated and with choices and to hear how difficult everything still was for you. I also think your points about how teenage girls are pushed into nursing with no real interest and how this has serious consequences for Ugandan women everywhere is so perceptive and compelling. I am so glad you and your baby survived but I am mindful of the women and babies that did not. Thank you very much for sharing and for bringing attention to this matter.All my best wishes, Julia

Angela Kintu
Jul 10, 2015
Jul 10, 2015

Dear Julia,

Thank you for reading and empathising. It was a bad experience which thankfully did not have a bad ending. But for sure, there are too many women for whom such experiences end in ways that could have been avoided.

Education is a right, not a privilege, and that right should come with choice and honest guidance. We cannot expect young girls to be good healthcare providers when their heart was never in it in the first place.

I hope my sharing helps someone. Once again, thank you.

Angela