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

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.