Transport-related delays and maternal mortality in Uganda: the effects of managed and controlled mobility on maternal health and well-being
MetadataShow full item record
Maternal Mortality Ratios (MMRs) in poor countries have been identified as a critical priority for development policy and intervention. MMRs in Uganda, specifically, remain extremely high at 440 maternal deaths per 100,000 live births. The delay in arriving at a health facility for care has been acknowledged as a leading non-clinical factor in maternal mortality, and a growing body of evidence suggests that inadequate transport is a significant factor in explaining maternal deaths. Despite this, emergency transport, the efficacy of referral systems, and barriers to mobility continue to remain largely neglected within the study of maternal health. This research study primarily intends to describe, in detail, the subjective experiences of women who require and seek emergency obstetric care and to illuminate what specific factors contribute to transport-related delays. This research took place predominantly in Wakiso District, Uganda. Surveys and interviews were conducted at health centers located in Kabubbu, Kasangati and Buwambo, all within a 22 km radius of Uganda’s capital city Kampala. A combination of quantitative and qualitative methods was used; 47 in-depth interviews were conducted. This is inclusive of interviews conducted with health center patients, health workers and health administrators. A total of 182 health center patients completed surveys. The results of the study reveal that gendered norms and practices significantly influence women’s mobility in this context. While the relative inaccessibility of health centers, the limited availability of transport methods, and the expensive nature of emergency transport are all factors contributing to mobility limitations, interviews suggest that within the population studied, gendered norms governing the management and control of resources for mobility contribute most significantly to mobility constraints. Male partners (who are often the sole wage earners) frequently manage family finances and control women’s daily access to spending money. If women experience an obstetric emergency, they rarely are in possession of an adequate amount of money to pay for appropriate or safe transport. Transport-related interventions can empower women socially and economically, thereby contributing to the reduction of maternal deaths and the improvement of maternal life.