5 - Cultural and Resource Determinants of Severe Maternai Morbidity: Lessons /rom Some 'Near Miss' Experiences
Corresponding Author(s) : Grace Bantebya-Kyomuhendo
African Sociological Review,
Vol. 8 No. 1 (2004): African Sociological Review
Abstract
In Uganda severe maternai morbidity remains a problem to reckon with. This paper reports part of a wider study conducted in Kiboga, Hoima and Kampala districts, Uganda between 1999 and 2000 (Okong et al. 2001), the aim of which was to document the circumstances that led women to death-threatening medical crisis situations. It emerged that severe maternai illness is not necessarily a result of direct (biomedical) causes per se but may stem from other factors deeply rooted in culture and gender relationships. These factors notwithstanding, women are hampered by deficiencies in the.formai health care system lncluding inter alia inexperienced health workers, especially at lower level units, poor referral systems and the lack qfà well1'unctioning transport system, limited space in the wards or operating theatre, and inability to access the busy health staff: These constraints often lead to critical delays, which aggravate women 's morbidity experiences. Appropriate interventions, including delivery of culturally accepted maternai health information and addressing the lack of quality maternai health services, are required.
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- Bonvier-Colle, M. H, B. Salavane, T. Y. Ancel, and N. Varnoux. 1996. '
- in Intensive Care Units and Materna! Mortality', European Journal of Obstetrics Gyneacology (Reproductive Biology), vol. 65, pp. 121-5.
- Caldwell, J. C., and P. Caldwell. 1990. 'High Fertility in Sub-Saharan Africa', Scientific American, May, pp. 118-25.
- Diallo, A. B .. 1991. "'A Tora Mousso Kale La": A Call Beyond Duty, Often Omitted Root Causes of Maternai Mortality in West Africa', Issues paper no. 9, New York: UN Development Programme, HIV and Development Programme.
- Filippi, V., T. Gandaho, C. Ronsmans, W. J. Graham, and B. Alihonou. 1996. "'Near Misses': Are Life Threatening Complications Practical Indicators for Safe Motherhood Programmes?', IUSSP Committee on Reproductive Health, Population Institute, University of the Philippines. Fitzpatrick C., A. Halligan, T. Mc Kenna, B. N. Coughlan, M. R. N. Darling, D. Phelan.
- "'Near Miss" Maternai Mortality', Irish Medical Journal, vol. 1, no. 85.
- Graham, S. G., and M. C. Luxton. 1989. 'The Requirement for Intensive Care Support for the Pregnant Population', Anaethesia, vol. 44, pp. 581-4.
- Howson, P.C., P. F. Harrison, D. Hotra,M. Law.(eds.) 1996. Jn Her Lifetime: Female Morbidity and Mortality in Sub-Saharan Africa, Washington D.C.,
- lnstitute of Medicine, National Academy Press. Koblinsky, M. A., A. Tinker, P. Dally. 1993. 'Making Motherhood Safe', World Bank discussion paper, World Bank, Washington D.C.
- Kyomuhendo, B. G ., and R. MacNaim. 1998. 'Social Cultural Factors in Reproductive Health and Materna! Mortality', Unpublished report, FIGO Safe Motherhood Needs Assessment Project, Kiboga District, Uganda.
- Mantal, G. D., and E. Buchmann. 1997. 'Maternai Morbidity: A Dcfinition fora Maternai "Near Miss"', Proceedings of the l 6'h Conference, Priorities in Perinatal Care in Southern Africa, March 11-14, 1997, University of Pretoria.
- Ministry ofHealth. 1989. 'Macro International Inc. Uganda Demographic and Health Survey 1988-89', Kampala: MoH.
- Ministry of Planning and Economie Development. 2000. 'Uganda National Household Survey Report', Entebbe, Statistical Department.
- Mukhopadhyay, C. C., P.J. Higgins. 1988. 'Anthropological Studies ofWomen's Status Revisted; 1977-1987', Annual Review of Anthropology, vol. 17, pp. 461-95.
- Okong, P., A. Johansson, G. Bantebya-Kyomuhendo, B. Steffan. 2001. 'The Adoles cent Mother's Right to Survive: A Study on Teenage Maternai Mortality and Morbidity in Uganda 1999-2000', Unpublished report, Division oflntemational Health (IHCAR), Department of Public Health Science, Karolinska Jnstitutet, Stockholm, and Makerere University, Kampala). Sargent, C. 1990. 'The Politics ofBirth: Cultural Dimensions of Pain Virtue and Control among the Baariba of Benin', in Handwerker Penn, ( ed. ), Birth and Power: Social Change and the Politics of Reproduction, Boulder, Westview Press.
- Stones W, W. Lim, F. Al-Azzawi, M. Kelley. 1991. '
- An Investigation of Maternai Morbidity with Identification of Lifo Threatening "Near Miss" Episodes', Health Trends,vol.23,pp. 13-15. Ubot, S. 1992. 'Social Science and Medicine in Africa', in T. Fallola, D. Hyavyar, ( eds. ), The Politîcal Economy of Health in Africa, Athens, Ohio University Press. Uganda Ministry ofHealth. 1999.
- 'Uganda National Health Policy', Kampala: MoH. Uganda Ministry ofHealth. 200 l. 'Macro International Inc. Uganda Demographic and Health Survey 2000-200 l ', Kampala: MoH.
- Vlassoff, C., and E. Bonilla. 1994. 'Gender-Related Differences and the Impact of Tropical Diseases on Women: What Do We Know?', Journal of Bio Social Science, vol. 26, pp. 37-53.
- WHO/UNICEF. 1996. Revised 1990 Estimates of Maternai Mortality: A New Approach by WHO and UNICEF, WHO/FRH/MSM/96.11 and UNICEF/PLN/96.1, Geneva, World Health Organization.
References
Bonvier-Colle, M. H, B. Salavane, T. Y. Ancel, and N. Varnoux. 1996. '
in Intensive Care Units and Materna! Mortality', European Journal of Obstetrics Gyneacology (Reproductive Biology), vol. 65, pp. 121-5.
Caldwell, J. C., and P. Caldwell. 1990. 'High Fertility in Sub-Saharan Africa', Scientific American, May, pp. 118-25.
Diallo, A. B .. 1991. "'A Tora Mousso Kale La": A Call Beyond Duty, Often Omitted Root Causes of Maternai Mortality in West Africa', Issues paper no. 9, New York: UN Development Programme, HIV and Development Programme.
Filippi, V., T. Gandaho, C. Ronsmans, W. J. Graham, and B. Alihonou. 1996. "'Near Misses': Are Life Threatening Complications Practical Indicators for Safe Motherhood Programmes?', IUSSP Committee on Reproductive Health, Population Institute, University of the Philippines. Fitzpatrick C., A. Halligan, T. Mc Kenna, B. N. Coughlan, M. R. N. Darling, D. Phelan.
"'Near Miss" Maternai Mortality', Irish Medical Journal, vol. 1, no. 85.
Graham, S. G., and M. C. Luxton. 1989. 'The Requirement for Intensive Care Support for the Pregnant Population', Anaethesia, vol. 44, pp. 581-4.
Howson, P.C., P. F. Harrison, D. Hotra,M. Law.(eds.) 1996. Jn Her Lifetime: Female Morbidity and Mortality in Sub-Saharan Africa, Washington D.C.,
lnstitute of Medicine, National Academy Press. Koblinsky, M. A., A. Tinker, P. Dally. 1993. 'Making Motherhood Safe', World Bank discussion paper, World Bank, Washington D.C.
Kyomuhendo, B. G ., and R. MacNaim. 1998. 'Social Cultural Factors in Reproductive Health and Materna! Mortality', Unpublished report, FIGO Safe Motherhood Needs Assessment Project, Kiboga District, Uganda.
Mantal, G. D., and E. Buchmann. 1997. 'Maternai Morbidity: A Dcfinition fora Maternai "Near Miss"', Proceedings of the l 6'h Conference, Priorities in Perinatal Care in Southern Africa, March 11-14, 1997, University of Pretoria.
Ministry ofHealth. 1989. 'Macro International Inc. Uganda Demographic and Health Survey 1988-89', Kampala: MoH.
Ministry of Planning and Economie Development. 2000. 'Uganda National Household Survey Report', Entebbe, Statistical Department.
Mukhopadhyay, C. C., P.J. Higgins. 1988. 'Anthropological Studies ofWomen's Status Revisted; 1977-1987', Annual Review of Anthropology, vol. 17, pp. 461-95.
Okong, P., A. Johansson, G. Bantebya-Kyomuhendo, B. Steffan. 2001. 'The Adoles cent Mother's Right to Survive: A Study on Teenage Maternai Mortality and Morbidity in Uganda 1999-2000', Unpublished report, Division oflntemational Health (IHCAR), Department of Public Health Science, Karolinska Jnstitutet, Stockholm, and Makerere University, Kampala). Sargent, C. 1990. 'The Politics ofBirth: Cultural Dimensions of Pain Virtue and Control among the Baariba of Benin', in Handwerker Penn, ( ed. ), Birth and Power: Social Change and the Politics of Reproduction, Boulder, Westview Press.
Stones W, W. Lim, F. Al-Azzawi, M. Kelley. 1991. '
An Investigation of Maternai Morbidity with Identification of Lifo Threatening "Near Miss" Episodes', Health Trends,vol.23,pp. 13-15. Ubot, S. 1992. 'Social Science and Medicine in Africa', in T. Fallola, D. Hyavyar, ( eds. ), The Politîcal Economy of Health in Africa, Athens, Ohio University Press. Uganda Ministry ofHealth. 1999.
'Uganda National Health Policy', Kampala: MoH. Uganda Ministry ofHealth. 200 l. 'Macro International Inc. Uganda Demographic and Health Survey 2000-200 l ', Kampala: MoH.
Vlassoff, C., and E. Bonilla. 1994. 'Gender-Related Differences and the Impact of Tropical Diseases on Women: What Do We Know?', Journal of Bio Social Science, vol. 26, pp. 37-53.
WHO/UNICEF. 1996. Revised 1990 Estimates of Maternai Mortality: A New Approach by WHO and UNICEF, WHO/FRH/MSM/96.11 and UNICEF/PLN/96.1, Geneva, World Health Organization.