10 Pictures That Explain The Challenges Of Motherhood In Uganda

In recognition of the UN's International Day of Rural Women today -- 15 October -- we share stories of motherhood in rural Uganda. Compared to other countries, Uganda's maternal mortality rate is high. In 2010, it was estimated that 345 women died for every 100,000 births in the country (in the UK, that number is closer to 8.2!). In rural areas, that figure is even higher. Here are a few pictures that help to explain why (courtesy of a Photovoice research project undertaken by David Musoke at the Makerere University School of Public Health as part of Future Health Systems).

1. Health facilities in rural Uganda do exist

FHS Uganda Photovoice: Eria Mdidde / Via futurehealthsystems.org

OK, maybe it sounds obvious. But the problem isn't necessarily that there are no health care facilities for women. While a considerable number of women in Uganda do choose to give birth in their homes, it isn't necessarily because of a lack of facilities.

Despite stories of limited numbers of qualified health workers and the poor attitudes these workers can take towards pregnant women, they manage to serve many women and children.

Pictured here is a pregnant woman who is smiling after having received adequate care at a local health facility.

2. But that doesn't mean they're easy to get to!

FHS Uganda Photovoice: Denis Mpiima Mukooza / Via futurehealthsystems.org

To reach health facilities and trained health workers, women from this particular village in Central Uganda must travel over 7 kilometres (5 miles). It takes both time and money to travel there, which limits the number of antenatal and post-natal visits expectant and new mothers make.

A common way to get to the health facilities is on a hired motorcycle, known as a boda boda. These motorcycles are convenient, and they're one of the few means of transportation that can navigate the rugged terrain, but they're not a particularly safe way to transport pregnant women. But there is little choice.

In this picture a mother takes her young child to a health centre for an immunisation.

3. And frankly, getting there is only half the battle. It can be difficult to get seen at a clinic.

FHS Uganda Photovoice: John Ssewadda / Via futurehealthsystems.org

After walking or taking a boda boda to get to a facility, many would think that the hard part is over. But getting to a facility is just the first problem an expecting mother might face: often pregnant women must wait several hours for a consultation.

Here, two pregnant women lay on the grass outside the health centre waiting for the health workers to arrive.

4. And 'free' doesn't really mean 'free' when it comes to getting health services in Uganda

FHS Uganda Photovoice: Annet Nakayima / Via futurehealthsystems.org

There are costs associated with getting to a health facility, but the Ugandan government says that health services provided at government facilities should be free. Apparently the Ugandan government doesn't define 'free' the way the rest of the world does.

Because of limited funding from the government and from international sources, many facilities are forced to charge for basic materials like latex gloves. In cases where women were expecting that they wouldn't need to pay, or who are simply too poor to pay, this can result in death.

In this picture, a woman counts money collected in a local savings group which can assist members when in need particularly pregnant women during time of delivery.

5. And within the communities, there is a lack of education on what it takes to be a healthy mother

FHS Uganda Photovoice: Anthony Mpanga / Via futurehealthsystems.org

For example many don't know the risks of teenage pregnancy, which is associated with greater complications for both the mother and child, which can often result in death. In Uganda, the median age for a mother at first birth is 18.6 years.

Pictured here is a pregnant teenager who is also carrying her first child in her arms.

6. And there still isn't a great use of contraceptives or other family planning

FHS Uganda Photovoice: Roger Mubiru / Via futurehealthsystems.org

Although several methods for contraception are available in Uganda, many couples do nothing to space their children. This is partly due to lack of awareness and availability of contraceptive services at many health facilities particularly in rural areas. The country’s unmet need for family planning among married women is currently estimated to be around 34%.

In this picture are two siblings who can be mistaken to be twins -- an indication of lack of use of family planning methods. As the older is only learning how to crawl, the younger one is already starting to sit.

7. Fathers aren't often in the picture when it comes to the health of mothers

FHS Uganda Photovoice: Annet Nakayima / Via futurehealthsystems.org

The Ministry of Health in Uganda has made efforts to increase male involvement in maternal and child health issues. Indeed, pregnant women who are accompanied by their spouses to public health facilities for antenatal care are attended to first before those who are alone. However, male involvement is still very low.

Here, a pregnant woman not accompanied by their spouse for antenatal care waits to be seen by a health worker at a government health centre.

8. It's not just at the facility where her partner might be absent -- being pregnant doesn't necessarily mean much relief from household chores either

FHS Uganda Photovoice: Roger Mubiru / Via futurehealthsystems.org

Women in rural Uganda do a lot of domestic work. This includes gardening, washing clothes, cooking, fetching water and other household chores. One would imagine that when these women are in their final weeks of pregnancy and soon after delivery, they are relieved of some of these strenuous duties. However, this is not the case in most households.

In this picture is a pregnant women a few weeks from delivery as she was from collecting water from a distant water source for household use.

9. While sanitary conditions are a problem overall, it certainly doesn't help during pregnancy

FHS Uganda Photovoice: Denis Mpiima Mukooza / Via futurehealthsystems.org

Poor water and sanitation can lead to diarrhoeal diseases that can greatly affect women during pregnancy. It is therefore recommended that women have access to safe water and sanitation facilities during pregnancy.

In Uganda, access to safe water is 70% and 64% for rural and urban areas respectively. It is therefore common to find use of inappropriate water sources in both rural and urban areas.

This picture shows a pregnant woman reaching to avoid stepping in the accumulated waste water while collecting water from a source that was in a bad state.

10. Many of the women are aware of these issues and work to overcome them. To save for pregnancy, some take on jobs.

FHS Uganda Photovoice: Juliet Anyango / Via futurehealthsystems.org

Women require money for various purposes, including health care during pregnancy and after child birth. However, for many, their spouses seem not to appreciate this and hardly provide any financial support to them. Despite women having several domestic responsibilities, many have gone an extra mile to start up small income generating activities to support themselves during pregnancy.

This picture shows women learning how to make snacks from foodstuffs that they can sell and earn some money to help them during times of need.