By Rebecca Racheal Apolot, FHS Researcher, Uganda
World Health Day has come and gone this year, but nevertheless, it is very important for us to continue to remember our commitments towards health care delivery, such as equitable health systems. Most efforts to improve Maternal and Newborn Health (MNH) outcomes in Uganda have focused on access and quality of care for women in general, paying no attention to special populations such as women with walking disabilities who have a high likelihood of poor MNH outcomes.
We as Makerere University School of Public Health, as part of the Future Health Systems consortium, have had an opportunity to listen to the voices of women with walking disabilities during community meetings in Kibuku district, Uganda as part of a community scorecard project. The experience shows that the MNH needs of women with walking disabilities have been given very little attention. Approximately 12.5% of the total population of Uganda is living with one form of disability. Given that 51% of total population is female, disabled females would therefore account for approximately 6.25% of the total population. There are 1,578 physically disabled persons in Kibuku district, of which about 789 of these are women. Some might say this isn’t many, but have they forgotten their equity lenses? They may be few, but they are contributing to the maternal mortality of Uganda, which is at 336 per 100,000 live births. We should remember that the fertility rate of women with disability in Uganda is 6.3, while that of women without disability is 5.6; these statistics speak volumes. Let’s not bury our heads in the sand, let’s face it and address it.
In public health facilities - especially in rural districts like Kibuku but possibly also in some urban districts - there are no provisions for women with walking disabilities. Let us look at the MNH needs of a woman with walking disability from the time she is getting into a health facility. There is no ramp, so she has to crawl up the steps with such difficultly to access the facility. When she gets in, there is no seat suited for her height, so she must sit on the often dirty floors to queue as she waits for the service. When she is called to the examination room, the bed is too high for her to climb, so she will be examined on the floor where other mothers and midwives walk with their shoes (often dirty floors). When the mother visits the latrine, there are no disabled facilities, so she must crawl into the soiled latrines on her hands and knees. If the mother came to the health facility for delivery, the delivery bed is too high for her to climb, so the midwife must carry the mother unto the bed (but how easy is this for the midwife?). The resting beds after delivery are equally too high for her, so she will lay her bed on the floor to take a nap with her newborn while other mothers are on the comfortable facility bed. How about the midwives - do they know what the needs of disabled women are and how to handle them?
The voices of the women with walking disabilities in Kibuku district-Uganda
What is the impact of having no ramps, seats, examination beds, delivery beds, and maternity beds and latrines adapted for disabled women in public health facilities, and midwives being rude? Women with walking disabilities will see no benefit in seeking MNH care at health facilities since a nearby Traditional Birth Attendant (TBA) might be a better refuge. The TBA is very close, latrine not adapted to the disabled but at least clean with fewer users, she is friendly to the mother and they will deliver from a ‘clean’ floor. This will contribute to maternal and newborn deaths that could otherwise be avoided if we acted on our commitments and promises.
Leadership at the Ministry of Health, districts, health facilities and sub-counties should look into innovations to provide ramps, seats, beds and latrines for the disabled. The innovations don’t need a lot of money off the budgets; it is just prioritization and using the resources we already have to serve all people equitably. If we have four latrine stances in the health facility, let’s modify one to have rails for disabled support. Carpenters and welders around us in our trading centers can make climbing supports for our beds at very reasonable costs. Midwives can be given regular training on handling women with walking disabilities without warranting training allowances. It doesn’t have to be big budgets; it has got to be prioritization. We need to prioritize the needs of the women with walking disabilities to make our celebrations more inclusive. Let us work towards this so that next year, women with walking disabilities in Uganda can also say ‘YES IT IS INDEED WORLD HEALTH DAY!
A version of this blog post first appeared on the website of the Makerere University Centre of Excellence for Maternal Newborn and Child Health, and also appears on the RinGs blog.