General
East Africa’s high maternal death rate
Judith Awino died on her 25th birthday as she gave birth, on a dusty roadside, to her second child.
She had endured a long and difficult labour but was unable to get admitted to hospital because of a nurses’ strike.
Her baby also died.
Her short life symbolises the tragedy behind the high maternal death rate in Kenya where the maternity system faces extreme pressure.
Whereas Kenya’s overall crude death rate is on a par with Europe, its maternal death rate in 2015 was 43 times higher than that seen in high-income countries?—?with 510 women dying in every 100,000 live births.
And that picture is not just restricted to Kenya.
Across Africa, countries are unlikely to hit the Sustainable Development Goal to significantly reduce preventable maternal deaths.
A team from the University of Leeds, Makerere University in Uganda and the Catholic University of Eastern Africa is investigating a new approach to improving maternal health. It is funded by the UK’s Global Challenges Research Fund (GCRF), money from the UK’s aid budget with the aim of bringing the best research to target the big, intractable problems facing the world.
The UK Government believes research excellence is achieved by people from different academic backgrounds working in collaboration and across borders.
The project in Kenya has researchers with a medical humanities background working alongside medical and public health specialists, bringing fresh insight into why maternal death rates are high.
One of the issues that’s emerged is that a high proportion of pregnant women seek maternity care very late in their pregnancy.
Jane Plastow, Professor of African Theatre in the School of English and History at Leeds, said her approach is to use drama-based workshops to allow women and their families to feel at ease in speaking about their experiences or to act out what has happened to them.
Professor Plastow said: “We have been able to show that there are good reasons why many poor women are not able or willing to interact with health professionals and these need to be much better understood and taken into account if services are to respond well.
“The research is revealing that the challenges facing women are immense. Most people using the public health service are poor and live in remote villages, and for many it was impossible or costly to access antenatal care.”
She also commented that people felt ambulances could not be relied on. The women spoke about being treated badly when they went for antenatal advice or went into labour?—?with feelings that nurses would be dismissive, disparaging or judgmental, particularly if they regarded the patients as poor or illiterate.
Maternity units were reportedly overwhelmed, with many women not being assessed quickly enough. Both hospitals and rural clinics lacked blood products and equipment.
The research is suggesting that women have become more vulnerable because of the changes in the support they get from their families, sometimes with women under pressure to return to work days after giving birth.
Shane Doyle, Professor of African History at Leeds who is leading the project, said: “One of our goals is to encourage hospitals to adapt their maternal health provision in light of this research, so that, for example, greater attention is devoted to ongoing care and delivery and discharge.”
The researchers are working with Kenyan TV to reveal the problems faced by poorer women and it will feature the case of Judith Awino.
The project will also look at the relationship between patients and healthcare staff who often work under extreme pressure.
Professor Doyle added: “One of our aims is to show that this cross-cutting research opens up a fresh understanding of the experiences of pregnant women and health care workers.
“Kenya has attempted to improve the maternal death rate by introducing free maternity services and opening new hospitals but they’ve not had the impact that was hoped.
“Research that understands the socio-cultural issues and health issues in maternal death rates is likely to suggest more sustainable ways of tackling the problem.”
The University of Leeds has been hugely successful in securing support from the Global Challenges Research Fund. It was established in 2016 and over five years will allocate a total of £1.5 billion to UK science with the aim, the Government said, of ensuring Britain meets its “…moral obligation to the world’s poorest.”
The UK Medical Research Council awarded the GCRF grant. Dr Mark Palmer, Director of International Relations at the MRC, said: “Improving on maternal and neonatal health is a major global health challenge that we are committed to tackling.
“This research is pivotal to better understanding why maternal death rates are so high, taking a multidisciplinary approach to gain insight into how to help pregnant women, along with the healthcare workers and communities that support them. The findings could lead to positive changes and better outcomes for maternal health around the world.”
The University of Leeds is involved in 70-plus projects financed through the fund covering a range of issue from equipping scientists in the developing world with technology to safely make vaccines, low-cost endoscopy for stomach cancer and the ways people can protect themselves from the kidnapping epidemic in Mexico.
Find out more about the University of Leeds and GCRF.
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The Gender Mainstreaming Directorate (GMD), Makerere University on 14th September 2021 presented findings from phase one of the study on Enhancing Women’s Participation and Visibility in Leadership and Decision-Making Organs of Public Universities in Uganda through Action Research. The study team led by the Director GMD and Principal Investigator (PI), Dr. Euzobia Mugisha Baine also consists of Assoc. Prof. Consolata Kabonesa, Dr. Anna Ninsiima, Ms. Frances Nyachwo, Ms. Susan Mbabazi and Mr. Eric Tumwesigye.
The team is also made of coordinators from participating Universities such as Busitema University-Ms. Elizabeth Birabwa, Kabale University-Sr. Dr. Eva Tumusiime, Mbarara University of Science and Technology (MUST)-Dr. Specioza Twinamasiko, Muni University-Ms. Amandru Stella Wawa, and Gulu Univeristy-Sr. Rosalba Aciro.
Funded by the Government of Uganda through the Makerere University Research and Innovations Fund (Mak-RIF), the study was inspired by the fact that women are persistently few in numbers as staff, more so in leadership and decision-making organs of Ugandan Public Universities. “This is despite all the various efforts at national and international levels; the numbers are not growing as fast as needed to meet development goals of the country” explained Dr. Euzobia.
Based on this background, the study team therefore sought to conduct a situational analysis of the gender terrain of the six public universities to obtain baseline information encompassing the composition of governance and leadership organs and senior staff by sex, as well as a needs assessment and profiles of potential mentors and mentees.
Furthermore, the team sought to explore the capacity to conduct gender-responsive research as well as the role of male staff engagement in gender equity interventions within the universities as the drivers of development.
Dr. Mugisha-Baine shared that results of the baseline would then be used to design participatory training manuals or guides on gender and leadership. The manuals would cover; Institutionalized mentorship, How to conduct gender-responsive research, gender and equity budgeting, among others.
“Within these manuals, we shall have a male staff engagement strategy in gender equity interventions in universities” she explained.
The development of the aforementioned materials would then be followed by their adoption and use to build capacity for women not only in leadership of participating and other public university but also beyond. “We shall periodically evaluate whether the capacity we have built has influenced women’s participation in leadership and decision-making organs of the university” supplemented the PI.
The capacity building trainings for women, it is envisaged, will lay the foundation for the formation of a functional Uganda University Women’s Think Tank, starting with the six participating universities. Dr. Mugisha Baine added that through this Think Tank, a monitoring and tracking system for gender representation in recruitment, promotion, retention/turnover and leadership of public universities shall be established and maintained.
At the conclusion of phase one, the study team had drafted participatory training manuals in gender and leadership with content on; gender specific critical analysis of the leadership spectrum of public universities, positioning of individual women within the institutional framework and strategies for their advancement, gender equity advocacy in the university setting, institutional mentorship, building capacity in conducting gender-responsive research, among others.
“This content will be validated by the participating universities before the actual research training is conducted” added the PI.
On behalf of the research team, Dr. Mugisha Baine thanked the Government of Uganda for providing the resources that facilitated phase one of the study and prayed that the Mak-RIF Grants Management Committee (GMC) would support the next phase of capacity building.
Speaking on behalf of the Mak-RIF GMC Chairperson, Prof. William Bazeyo, Dr. Helen Nambalirwa Nkabala thanked and congratulated the team led by the Director GMD upon the milestones registered in the critical research.
“We are very proud of that work that is being done by all researchers in Mak-RIF and we would like to most sincerely thank Management for all the support throughout this process” she remarked.
Dr. Nkabala encouraged the research team to continue disseminating and using the findings for the furtherance of gender mainstreaming, particularly through the aspect of male staff engagement in gender equity interventions.
Prior to delivering the keynote address of the day, the Executive Director National Council for Higher Education (NCHE) Prof. Mary Okwakol thanked the Vice Chancellor, Prof. Barnabas Nawangwe for inviting her to the important forum, noting that women’s participation in decision making and governance is a priority area of the Uganda Gender Policy 2007.
She commended Makerere University for being at the forefront of gender mainstreaming in Uganda, noting that this prominence was one of the reasons why the Gender in Education Policy 2007 provides for replicating the institution’s strategy in all other Higher Education Institutions.
Prof. Okwakol whose keynote address was punctuated incisive personal examples reaffirmed the statistics that women are generally not visible in leadership of Universities. That notwithstanding, in instances where they rise to leadership and decision-making positions, they are regularly subject to roles traditionally deemed as women’s inconsiderate of their managerial seniority and experience.
She nevertheless rallied the women to play their respective roles in enhancing participation and visibility at a personal level. The following were some of the strategies she proposed; work hard to acquire academic credentials so as to compete favourably with men, acquire necessary administrative training and experience, network among women, join professional networks as well as do research and publish.
On joining professional networks, she shared her personal experience as a young zoologist who joined UNESCO’s Tropical Biology and Fertility Programme. “Within a short time I was appointed Coordinator for Africa and after two years, I was elected as a Member of the International Board of Management. After serving for two years, I became Vice Chairperson of that Board and finally I became Chairperson of that International Board.”
At the institutional level, Prof. Okwakol appealed to the Chairperson Council and Vice Chancellor to proactively recruit women who meet the requirements for leadership positions even if it means actively seeking out the reluctant ones. In this regard, she shared that it would be useful for the university to develop a database of women and their qualifications to ease this process.
She shared that NCHE has in recognition of female underrepresentation at every level in Higher Education approved the establishment of a Gender and Equity Unit with the aim of promoting inclusive gender participation in the sub-sector.
“This unit has been placed under the Directorate of Quality Assurance and Accreditation which implies that as we look out for and regulate quality, gender will be a very important aspect of that regulation” she reassured.
Prof. Okwakol concluded by urging participants to read the; Third National Development Plan (NDPIII), Uganda Vision 2040, and Sustainable Development Goals (SDGs) noting that there is no way all three can be achieved while women are left behind because they each make a case for inclusion of the female gender.
“What we are addressing here are historical injustices” said Prof. Barnabas Nawangwe as he commenced his remarks, “And in the case of Makerere University, it is well known that the institution started as a male-only institution and we all know the original motto was ‘Let us be men’” he added.
Citing examples from history such as; Marie Curie – one of the smartest physicists, Hatshepsut, Nefertiti and Cleopatra – prominent Pharaohs of Egypt, George Eliot, Rosa Luxemburg and Hypatia – all great philosophers as well as Chancellor Angela Merkel – first female Chancellor of Germany, the Vice Chancellor said there is no plausible argument that there are things women cannot do as well as their male counterparts.
He said it was against this knowledge and in a bid to correct historical injustices that Makerere University pioneered initiatives such as putting in place affirmative action for girls, establishing a Gender Mainstreaming Directorate as well as a School of Women and Gender Studies. The Vice Chancellor nevertheless stressed the need to go beyond pioneering to protecting these gains through legislation. “Historically we have seen that discrimination can only be addressed by laws and policies.”
Prof. Nawangwe thanked the Government for providing funds to support Mak-RIF as well as the Funds GMC and Secretariat for ensuring that these funds are put to good use. He equally thanked the Chairperson of Council, Mrs. Lorna Magara for her not only her support but also sparing time to attend a good number of the research dissemination events.
Delivering the concluding remarks, Mrs. Magara acknowledged that the study was timely and relevant the contemporary University, as one of the critical drivers of the national and international development agenda. She therefore reechoed the Vice Chancellor’s thanks to the Government of Uganda for generously supporting the University’s research through Mak-RIF.
Turning to the keynote speaker she said, “I thank Prof. Okwakol for ardently discussing the critical issues affecting the female gender, the strategies to overcome the challenges, including sharing her inspiring personal experiences.”
Mrs. Magara equally thanked Prof. Okwakol for her very instructional analysis, providing mentorship guidance with the resultant impact of enhancing the female gender in decision-making positions. In the same breath she congratulated the PI and her team upon successfully concluding phase one of the project.
“Phase one has generated insights in understanding the status of women in leadership in public universities, the legal and policy framework and its implications on women’s visibility, the institutional mentoring systems and the gaps therein” she observed.
The Chairperson of Council acknowledged that the challenge of underrepresentation of women in leadership roles cannot be resolved at an individual level. She therefore advocated for broad based strategies that can address deep-seated structural and cultural biases facing women. “These include developing mentorship networks, enacting laws and policies that address the imbalances and providing training programmes to address the leadership gaps.”
She therefore pledged the University Council’s unwavering support to the Gender Mainstreaming Programme by ensuring an enabling policy environment that facilitates gender-responsive teaching, learning, research innovation and community service.
The research dissemination was moderated by the Principal Public Relations Officer (PRO), Ms. Ritah Namisango and the Director Communications, Learning and Knowledge Management, ResilientAfrica Network (RAN) and PRO Mak-RIF, Ms. Harriet Adong.
