Written by Nurse Asha and Dr. Lorie
Mary*, a 36 year old mother of 6, says that she has delivered all her children with a Traditional Birth Attendant (TBA) in her village, 12 kilometers from the health facility. This was as a result of not having funds to transport herself to the health facility or to buy the necessary supplies during labor and delivery. When a team health worker from the government hospital had a community outreach program in her village, they gave out free health items including Maama Kits. In this outreach event, health workers like Asha shared the importance of having children born in a health facility with the basics required for a safe delivery.
The annual rate of maternal deaths in Uganda is notably high, due in large part to unsafe and unclean deliveries. In an effort to reduce maternal mortality and morbidity, the Maama kit is a cost-effective measure to ensure that child birth is conducted in a safe and clean environment. The Maama kit consists of basic supplies that are required at child birth: sterile gloves, plastic sheets, cord ligature, razor blades, tetracycline, cotton gauze, soap, and sanitary pads.
Maama kits provide information to women, men, and communities on the importance of delivering babies in a clean environment. Organizations such as the Youth & Community Health Counselling Initiative (YCHCI) work with partner organizations such as the ACCT to provide these kits for free so that all women may have access to a clean and safe birth. The goal is to supply Maama kits to all women who deliver in health care units and communities.
The Maama kit also improves the quality and utilization of reproduction health services, as they attract many mothers to attend Antenatal Clinics (ANC) with the opportunity to receive a free Maama kit. Mothers are then also more likely to give birth at the health units. The kit has also had the effect of improving the strained relationship between health workers, expectant mothers, and TBAs.
The Maama kit was launched in Uganda in 2003 with support of the World Health Organization in an effort to reduce infections and deaths of mothers associated with poor hygiene and unclean delivery environments. At the time of launch, it was estimated that about 60% of expectant mothers nationwide were delivering at home either by TBAs or relatives. Expectant mothers in labor are required to bring their own birthing supplies. Many mothers who cannot afford supplies will simply stay away from health units when told to buy items such as gloves. This contributes to the high maternal mortality rate of 500 women per 100,000 live births in Uganda compared to the maternal mortality rate of 20 women per 100,000 live births in the United States.
However, this high rate of maternal mortality can also be attributed a delay in seeking health care, often due to one of three reasons:
- Mothers delay to seeking healthcare services when they realize that they are pregnant until a few weeks before labor, or even at labor. When most women go into labor, they resort to herbs such as “wandering jew” to help speed up their labor. This detrimental herb is a potent muscle constrictor and can cause the uterus to contract against a closed cervix. This is a leading cause of uterine rupture.
- Secondly, travel in Uganda is difficult, since the means of transport are not readily available, and the roads are unpaved and often rutted – especially in the rural settings – so many mothers end up laboring and giving birth either at home or on the way to the health facility. This creates an unsafe child bearing environment and increases the likelihood of infection or even death. This risk is reduced with a Maama kit.
- Thirdly, there is a delay in instituting care at the facility. Because every mother in labor is expected to bring her own birthing supplies,many health workers will be hesitant to work on a patient with bare hands for fear of getting infections like HIV and Hepatitis, so the mother would be in labor longer or may bleed much more than expected because the health worker has nothing to use on her. In Uganda 75% of the population lives below the poverty line, with many people surviving on less than $1 per day so, As well, the doctor to patient ratio in Uganda is 1 doctor for 20,000 patients, which leaves the patients at the mercy of the doctor’s patience and resources. If a patient comes with even a bare minimum of a Maama kit, then they stand better chances of being served much earlier and avoiding negative outcomes.
Namazzi*, a 24 year old mother of 2, says her oldest has suffered his whole life. She says “As a young mother I never knew what labor pains were so I kept home as I waited for my husband, to tell him how I was feeling. My neighbor found me restless in the house and asked me to go to the health facility. While on our way I had my baby born and it was the well-wishers who helped to deliver me of my child. All I had was a small sheet (leesu) which I used to cover the baby until we reached the health center. At 2 weeks my baby started falling sick and the health worker told me that he had signs and symptoms of tetanus. This I think he got from the place of birth since it was unclean. The baby is still unwell and displays effects from the disease. I got all the necessary care and support for my other baby from the health workers since I knew what to do as I delivered from a health facility and I had a Maama kit which helped me to have a safe delivery from a safe environment.”
In a nut shell, the introduction of the Maama kit is a stepping stone in the prevention of maternal deaths, especially for low-income populations in Uganda. Maama kits also give health workers the assurance of not transmitting infections to the mother and the new born.
Mr and Mrs Mukisa* of Kyanja, a suburb of Kampala, have had 4 children born from a clinic near their home. In the clinic all the antenatal services and necessary items needed during labor are paid for. One day a friend told them of the free services offered in a government facility of Komamboga, which they decided to take on. “One day while my husband was away, I had no money to go for my next appointment in a clinic so I wanted to borrow money from my neighbor Sarah.* She had no money too but told me she has had 2 children born at Komamboga health center and had attended antenatal there. She said that during ANC she was given some free items called a Maama kit which helped her during labor and delivery. This made me also return to a government facility to access the free services there and to maybe get this kit too which can help me during labor and delivery and indeed it helped me to save a lot of money.” So I thank my friend for sharing with me the information on the free service of the Maama kit.
Join the ACCT in providing free Maama Kits in Uganda. $10 will provide one kit to support an expecting mother during delivery. Click here for more info!
* Names have been changed to protect privacy