Antenatal care is one notable way to foster safe motherhood. However, there is a growing concern that a number of expectant mothers do not complete the four visits, which the Ministry of Health has recently pushed to eight to heed the World Health Organisation’s directive.
Studies show that women in rural areas are two times less likely to attend antenatal care than those in urban areas. Most women in Uganda have registered late antenatal care attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits.
The fate of this has partly seen persistent high rates of maternal and neonatal mortality in Uganda, which currently stand at 336 deaths per 100,000 live births, according to the 2016 Uganda Demographic Health survey.
Because of this, Kalisizo Hospital authorities have decided to use a free safe kit commonly known as mama kit as a bait to seduce mothers to have timely, and complete visits.
Initially, the government had in 2012, launched a new safe motherhood project, where every woman that delivers in a public health facility started getting a free mama kit.
The development, according to Dr Ruth Aceng, then director general of health services in the Ministry of Health, followed a realisation that most women in Uganda shunned giving birth in public hospitals because they were neglected for not having money to procure the Shs10,000 maternal health kits.
Although the initiative realised results as many mothers started delivering from health facilities, authorities at Kalisizo General Hospital in Kyotera District, realised that mothers were not embracing antenatal visits and simply came to hospital to give birth because they wanted free mama kits.
Then, about 20-30 per cent of the mothers were completing the four required visits, but when it came to hospital-based deliveries, the figure was higher. This, according to Patricia Dungu, a registered midwife at the hospital’s maternal and child health department, saw them change tactics.
“We resolved that the kit is only given to expectant mothers who had completed the four antenatal visits, not just coming for one or two visits and resurface for delivery,” Dungu shares.
The free kit, which costs about Shs30,000 in clinics and drug shops contains a towel, a pair of gloves, soap, surgical blade and cord ligature which cuts and ties the umbilical cord respectively, one cotton roll, gauze and plastic sheet which is put on the delivery bed to avoid infections.
Juliet Nakamya, the assistant hospital administrator, says they have since registered an increase in the number of mothers who complete the four antenatal visits, as opposed to the past.
“It is now at 80 per cent and with the intervention of other players, we are hopeful it will hit 95 or even 100 per cent,” she says.
Nakamya says this achievement has been realised with the help of other partners including Brick by Brick, a non-governmental organisation which runs a programme dubbed ‘Babies and Mothers Alive’ (BAMA) in which mothers are sensitised about the need to have antenatal visits.
Dungu says some mothers still find it hard to complete the visits, much as they are aware of the need to do so.
“A number of factors come into play, mostly lack of spousal support. Some mothers come from very far and need transport but they say their spouses do not want to give them transport to the hospital,” she says. “We normally have their contacts and when they miss, we call them but all they say is they lacked transport as they castigate their men for not contributing,” she adds.
Jessica Nabulime, an expectant mother from Kirumba Sub-county, says she needs Shs10,000 to reach the hospital, but she sometimes fails to come for antenatal because she fails to get the money.
“When I ask my husband for transport, he tells me I do not look sick and therefore do not need medical attention,” Nabulime says.
She adds: “Even when I try to explain to him that I need to have regular visits, my efforts yield nothing. So this means I have to miss and wait for the next visit.”
Low male involvement
As officials boast of these figures, they are concerned about the fact that men have not embraced the good health practice of escorting their spouses for antenatal visits.
Despite the incentives, such as giving first priority to mothers who come for antenatal care with their husbands, Dungu shares that men have failed to comply. “Only one in every 10 mothers come for antenatal care accompanied by a partner,” she says.
Fate of those who miss
Dr Kalema warns that expectant mothers who miss antenatal visits and simply come for delivery tend to face a lot of challenges. He says HIV positive mothers risk having their babies contract the virus, because they were not accorded the special care during pregnancy to reduce the risk factors.
For mothers who may have a history of bleeding after delivery, Dr Kalema says it is hard to know this unless they disclosed it during antenatal visits to enable doctors prepare blood in case there is need for transfusion after birth. Others may have a raptured uterus during delivery because it was not established during antenatal visits that they could be able to deliver normally. A raptured uterus may arise when the mother pushes the baby who is either big in size and would deserve a C section or may be in a wrong position. “But when we know about this earlier, we are able to recommend a caesarean delivery for such a mother,” he says.
There also cases of cord accidents where the baby’s umbilical cord gets tied in the neck and this can be detected by a scan.
“The umbrical cord can tie around the neck three times and in such cases, a mother is not allowed to push. All these complications can be known through regular examinations during antenatal visits,” the doctor advises.
He says when mothers present with such un-foreseen complications, chances are high either the baby or the mother will die, the reason he urges mothers to embrace antenatal care and have timely and completed rounds.
However, Dr Kalema notes it is not only about having antenatal care, but mothers need to ensure that the care is sought from a skilled trained midwife who is qualified to refer you in case of complications which they can not handle.