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Uganda: Pregnant mothers struggle to access sexual and reproductive health services due to COVID-19 lockdown measures

Milly Apiyo breaks into tears as she struggles to explain how she recently lost her unborn baby when she couldn’t get to a health service centre.

She lost the baby because her family could not raise money for public transport, which has tripled in cost because of preventive measures for COVID-19. She says, “I can`t believe that he is dead, my unborn child and first boy-to-be.”

Mrs. Apiyo is a 25-year-old mother of one who lives in Oroko Parish village in Uganda’s Gulu district. She is a small-scale farmer and her husband is disabled.

At the end of July, she lost her unborn child in the ninth month of pregnancy after developing birth complications, a condition doctors described as intrauterine fetal death (IUFD).

Mrs. Apiyo had recurring pain in her lower abdomen and uterus the day before she lost her unborn child.

She explains: “I sought medical attention at the nearby Oroko Health Centre III, about four kilometres away from my home. Medical doctors advised me to travel to Gulu Regional Referral Hospital in Gulu city, about 50 kilometres away, for immediate attention—or risk losing the unborn child.”

But Mrs. Apiyo’s family could not raise the money to afford the transport following the increase in fares due to COVID-19.

She explains: “Public transport fare to Gulu Regional Referral Hospital is 60,000 Uganda shillings ($16.06 US). The fare tripled because of the COVID-19 pandemic. The government also announced that each vehicle should carry half its capacity.”

She adds: “We struggled to try to raise the money but we failed because our petty businesses stopped performing due to the same COVID-19 effects. Together with my husband, we tried to ask for help from relatives and friends that live in town areas. But they too said that they had no money because their businesses had been crippled by the COVID-19 pandemic.”

With no possibility of accessing health services at the distant hospital, Mrs. Apiyo returned the following day to Oroko Health Centre III with severe pains.

To save her life and that of the unborn child, staff at the centre requested an ambulance from Gulu Regional Referral Hospital. But it was too late. She started bleeding and no one could attend to her in the ambulance.

She says: “I think the bad road contributed too much to causing my pain and the blood loss. The ambulance travelled over seven hours to reach the destination, but I had bled profusely and I knew that something was not right.”

When the ambulance arrived at the hospital, Mrs. Apiyo was almost unconscious. Nurses rushed her to the maternity ward.

Doctors said the unborn child died due to massive bleeding and fetal distress. Mrs. Apiyo says: “It is such a painful experience for me but I know God has a say over everything. The COVID-19 pandemic has not only deprived me of my livelihood, but has also contributed to the death of my child.”

She adds: “Several times I skipped antenatal and regular check-ups due to lack of transport to the health facilities. Whenever I was sick, I would buy painkillers from a nearby drug shop, thinking that all would be well.”

Antenatal check-ups are important and the World Health Organization recommends at least four.

Dr. Christine Akidi Susan is in charge of the maternity ward at Gulu Regional Referral Hospital. She says that, since the government enforced a nationwide lockdown because of the COVID-19 pandemic in March, Gulu Regional Referral Hospital is registering at least 16 cases of intrauterine fetal death and stillbirths weekly.

Dr. Akidi says: “The ban on public transport and a hike in transport fares because of COVID-19 has forced pregnant mothers to resort to self-medication and seek help from traditional birth attendants. This has put their lives and that of their unborn babies at risk.”

To avoid or minimize the type of incident that Mrs. Apiyo experienced, Dr. Akidi says that, in partnership with the COVID-19 task force, the hospital is now implementing a number of actions to help pregnant women.

She explains: “In the different regions, we have embarked on massive community sensitization on maternal health, community outreaches, and stand-by ambulances for responding to emergencies. We are also advocating for regular medical check-ups for pregnant mothers.”

This resource is undertaken with the financial support of the Government of Canada provided through Global Affairs Canada.

Photo: Dr Christine Akidi Susan inspects the maternity ward at Gulu Regional Referral Hospital.