In Conversation With Winfred Ongom

Winfred Ongom is a sexual and reproductive health and rights advocate working with the White Ribbon Alliance in Uganda. She tells us about the challenges she faces as a young woman speaking up on issues many would rather keep quiet about – including convincing her mother that her brothers should learn about condoms!

“It took her some time – we still have those fights – but at least there is some progress and she understands the need for them to protect themselves.”

By improving laws, staying open-minded and focusing on human rights-based approaches, Winfred is hopeful that future generations won’t face the stigma, mis-information and discrimination holding young people back today.

“Maybe the children I’ll have will have a better life, where their sexuality is open and they’re free to talk about it.”

This video was made possible through a generous grant from SayItForward.org in support of women’s advocacy messages.

Why Men’s Involvement in Safeguarding Maternal Health Is Critical!

This post was written by Elman Nsinda, journalist and maternal health advocate, White Ribbon Alliance Uganda (nsindae (at ) gmail.com)

In Uganda, 17 women and 106 newborns die every day due to complications related to pregnancy and child birth. Unfortunately, the causes of these deaths are clearly known and could be averted if each of the parties responsible played their part. The causes of death include: Severe bleeding, sepsis, obstructed labor, Hypertensive Disorders among others, exacerbated by delays at both community and at facility levels.

Pregnancy comes as a result of a moment of enjoyment by a couple; man and woman. This means therefore that the two are equally responsible for the outcome and the results whether negative or positive, should be equally shared by the two. The death of a woman as result of complications related to pregnancy and child birth, leaving the husband to remarry, will justifiably show injustice to the woman.
ewec-sun-event-photo-by-%c2%ac-2016-perry-bindelglass-228I am a father of two, and during pregnancy for the two children, I provided good food for the mother’s nutrition, planned transport to take her to the health facility and accompanied her to hospital for antenatal care and delivery for both of our children. I also saved money to plan for emergencies.
During this process, I witnessed mothers lying on the floor, midwives backing at women, delays and other ill treatment. Mine did not face any of those because it was me leading the way for her. We were given priority because I was around; other women without husbands accompanying them were looking on when we were by-passing them!
The experience gave me a sense of being an active participant in my wife’s pregnancy and birth. My wife also felt safe and cared for. No wonder why she delivered normally to healthy, thriving babies.

In Uganda, it’s known that every pregnant woman with a husband accompanying her is catered for fast. In fact, some women who can afford to hire other men to accompany them, do so in order to get first priority and good health care. Reports show that after women become pregnant, many men keep watching as the pregnancy gestation matures, claiming ownership but doing nothing to support the woman go through the process safely to have a healthy thriving baby! As we encourage men to take more active roles as fathers during pregnancy and childbirth, we also need to strive to change the social norms that place women in a position where they need to be accompanied by men to receive proper healthcare and treatment.

img_2537In sub-Saharan Africa, pregnancy and childbirth is looked at as a responsibility of the woman. Therefore, it is rare to see men accompany women to antenatal care and be present at delivery. When they see fellow men doing it, they consider them to be idle, perhaps unemployed and having a lot of extra time. Even with positive examples they miss, and abdicate their responsibilities.

But men can have a tremendously important role during pregnancy and childbirth for example through proving good nutrition to the pregnant woman, responding to complications, seeking medical help, paying for transport, and providing household needs. Birth preparedness! However, these roles are often overlooked and neglected. Almost all causes of maternal deaths are preventable. By taking more active roles as partners and fathers, men could do their part in preventing unnecessary maternal and newborn deaths in countries like Uganda.

In many nations, men also still make most decisions about family planning, such as when to have a child, how many children are to be born, where to give birth from (home or facility), among other vital decisions. We need to work towards changing this, and ensuring that women have control over their own reproductive decisions and their bodies – and decisions about children are made jointly by men and women, as equal partners and parents.

It’s the responsibility of all of us – you and me – to raise awareness about these critical roles in our societies so that men can understand how important their active participation is and play their part in helping women receive the quality care they deserve. Through this, men can help women ultimately survive childbirth, thrive as women and mothers and transform their lives and the lives of their families. This will remarkably impact on maternal health indicators and eventually contribute to the attainment of the Sustainable Goals, because healthy mothers make for a healthy world.

screen-shot-2016-09-20-at-9-52-24-pmA journalist and advocate for women’s and children’s health and rights, Elman Nsinda has been involved in safe motherhood advocacy campaigns across the Uganda to ensure that needless deaths of mothers and newborns are prevented. Elman is a trained White Ribbon Alliance citizen journalist and volunteer.

Featured image: A couple after birth of their child at Barr Health Center in Lira district, northern Uganda. The midwives at the health center encourage pregnant women to go with their husbands for ANC and delivery. Photo by Denis Okwir/WRA Citizen Journalist.

White Ribbon Alliance: Passionate Citizens Changing Communities

Girls’ Globe bloggers have had the opportunity to meet with and speak to Midwives and Citizen Journalists from Uganda, Malawi and Zimbabwe, who are working with White Ribbon Alliance to strengthen the rights and health of women and children, and to change communities so that they thrive.

Caroline Maposhere, Zimbabwe

Caroline Maposhere is a Registered Nurse, nurse midwife and a public health nurse with Bachelor of Theology and Master of Science in Counseling studies. She has extensive experience working in reproductive health including counseling young people, parents and religious leaders on sexual diversity and training health care providers on how to be sensitive to the needs of LGBTI people.

Caroline has vast training experience including being US Peace Corps Pre service Technical Trainer in more than 10 countries. She is well-known as “Aunty” on radio, TV and church programs for sexual and reproductive health in Zimbabwe and is a member of the Board of Trustees for White Ribbon Alliance Zimbabwe.

Elman Nsinda, Uganda

A journalist and advocate for women’s and children’s health and rights, Elman Nsinda has been involved in safe motherhood advocacy campaigns across the Uganda to ensure that needless deaths of mothers and newborns are prevented. Elman is a trained White Ribbon Alliance citizen journalist and volunteer.

George Nkhoma, Malawi

George Nkhoma is a passionate midwife and manager at Chitipa District Hospital in Malawi. His interest in midwifery grew from personal experience in that his mother lost her life giving birth to him.

Throughout his career, George has demonstrated strong leadership. In 2014, he was voted the best midwife manager for the district, and regional coordinator (north) for the Association of Malawian Midwives (AMAMI). In 2015, AMAMI nominated him to attend a reproductive health and rights advocacy meeting in Kampala, Uganda. Later that year, he was nominated by Commonwealth to attend the Heads of Governments meeting in Malta following recognition of his efforts in advocating against child, early and forced marriages.

 

Midwife By Choice, Not By Chance

This post was written by George Nkhoma.

My name is George Nkhomo and I work as a nurse and midwife in the rural district of Chitipa in Malawi.  I grew up as a house boy, not knowing my real family. Then, after searching for my roots I learned that my mother died while giving birth to me. At that point I knew I wanted to do something to help other mothers and ultimately decided to become a midwife. I have been committed to make a difference for other mothers and babies ever since.

Malawian Midwives are among the most passionate and hardworking midwives in the world. In my District, most health centres operate with one midwife per facility. Most of these are dual qualified, which means they single handedly deliver all nursing and midwifery services to the whole catchment population. This means that providing services day and night, all month round, all year round is entirely his or her call. I am yet to know of another profession – in Malawi or beyond – that serves the population this much.

However, it is shocking how much our profession is understaffed. According to a 2016 survey by White Ribbon Alliance for Safe Motherhood Malawi (WRA Malawi), the country has only 3,233 bedside midwives serving a population of over 15 million. That means only one midwife per 1,200 women of child-bearing age, even as the World Health Organization recommends one midwife for every 175 women. While we often hear about the failure to achieve maternal, newborn MDGs and other subsequent goals, we hear less about the numbers of midwives we will need to achieve those targets.

Being one of those 3,233 bedside midwives, I have discovered throughout my practice that the current crop of professional midwives is determined to achieve results, however we work in a frighteningly poor environment.

We often work several 24-hour shifts for days in a row without a break. Recent government cuts have left midwives and patients without food. Our pay, the equivalent of $250 a month for those with advanced degrees like myself, doesn’t cover our basic living expenses so many midwives also have to farm or run small shops. We do not have the most basic supplies like sterile gloves; we lack fuel which can mean working in the dark or by mobile phone torch light.

The result of these working conditions is that women in our maternity wards give birth untended while midwives, often the only health worker on shift, rush between one life-threatening emergency and another.

It’s clear that Malawi has a critical shortage of all health workers. Yet while it is well known that we need doctors, clinical technicians, and nurses, the extent of the shortage of midwives is only now emerging.

If Malawi is to achieve its Sustainable Development Goals, this needs to be well looked into at the planning phase. Our government needs understand that we are not the same as nurses, and to train and employ more midwives.

Malawi did well in achieving some of the MDGs, including the reduction of child mortality, much of which was due to immunisations. However child mortality includes newborns as well as babies and children under five. Thirty percent of all child deaths globally are amongst newborns. Premature births in Malawi remain among the highest in the world at 18.1% according to the World Health Organization (WHO), and neonatal mortality remains unacceptably high. It is the skills of midwives which can prevent these deaths. Midwives can also prevent the needless deaths of far too many Malawian mothers who continue to die while giving birth.

Midwifery is the face of the health sector in any country, deserving of the utmost attention, not the status quo. The health indicators it drives are determinants of health for any nation. Yet with such low numbers of midwives, poor motivation and working conditions, limited openings for professional growth and declining supply of resources, the future of my profession remains uncertain. The pressures we go through, the dilemmas we encounter, the commitment we give, the good work we do is all unacknowledged and seemingly unappreciated by society. These conditions make it hard to give mothers and newborns the quality, respectful care they deserve. But we are doing our best, and we are making a difference.

There are regrettably a few midwives who are misplaced in this dear profession and who have given us a bad name. This is typical of individuals in every profession, but the wonder is – why has their behavior resulted in such negative generalizations about the whole of midwifery? There is an old Malawian saying; nsomba ikawola imodzi zose zawola, which means ‘one bad fish means all are bad’. But we are not fish, we are midwives, and all but a very few are highly admirable professionals.

At the pace we are going, we are unlikely to achieve Malawi’s national safe motherhood targets: to ensure that all pregnant women deliver at a health facility; no woman dies in childbirth; no newborn or child under dies; that all pregnant women attend antenatal care as early as they recognize they are pregnant. But the negative stories so often published in our newspapers are pulling against our efforts.

Instead, the media should be highlighting the need for our government to invest in midwifery. They should also promote health seeking behaviour in our people, and show how the best practices of midwives keep people healthy. Better to do this than to magnify one mistake made by one midwife and tarnish our whole profession. 

This and more is why I recently took part in a workshop by White Ribbon Alliance, graduating as one of the first ever midwife Citizen Journalists in Africa. I am working to change the image of midwives by writing and speaking about the true state of my profession.

I am a midwife by choice, not by chance, and I am proud of my profession.

georgeGeorge Nkhoma is a passionate midwife and manager at Chitipa District Hospital in Malawi. His interest in midwifery grew from personal experience in that his mother lost her life giving birth to him. 

George graduated from Mzuzu University in 2013 and joined Chitipa district hospital in May 2013, where he also serves as the maternity department unit manager and safe motherhood coordinator.

Featured image: Hospital in Malawi. Copyright White Ribbon Alliance 

From Despair to Hope

Midwife and citizen journalist Philomena Okello from Uganda’s Lira District describes her journey as an advocate with White Ribbon Alliance.

I have grown up seeing pregnant mothers and newborns being ‘sentenced to death’ for reasons that could have been prevented. The pain of seeing pregnant women and newborns die became a thorn in my flesh and deep inside me, I felt there should be some contribution I can make to humanity to prevent this.”

This was worsened by the fact that I have seen so many pregnant women coming to the hospital to give birth, expecting to go back with bouncing babies. But instead they end up in a coffin, or if the mother happens to survive, too often she goes back home with her dead baby.

On one occasion, a woman died leaving her three-day old baby for me to care for. She had no hope for living, having been rejected by her husband, family members and the community. All that was because it was revealed that she was HIV positive.

Enough was enough. I prayed to God; what could I do to help prevent such horrific situations? The answer was given to me in 2011 when I attended the International Scientific Conference for nurses and midwives in Moroto, Karamoja District. The then commissioner of nurses in Uganda talked about White Ribbon Alliance (WRA), its vision, mission, goal, principles and values. I immediately joined White Ribbon Alliance. Since then, I have been a very active member, championing improved healthcare for mothers and newborns.

Philo talks to women at a rural health facility in Lira
Philo talks to women at a rural health facility in Lira

I feel so much joy when I see pregnant mothers and newborns receive the care they deserve in their homes, in the community and health facilities. This motivates me to work harder and mobilize the community to ensure mothers get the care they have a right to.

Women in my community are marginalized and feel they can not openly speak for themselves. I am happy to be a voice for them, sharing their challenges so that they can receive better heath care. As a representative of WRA in Lira, I’m empowering the community to speak up and hold their leaders accountable for their promises of health services.

Last September, I was chosen to represent my community in New York during the 70th Session of the United Nations General Assembly. I spoke to an audience of 200 leaders from around the world. The audience was clearly moved when I told them in the past 2 years I had witnessed more positive change due to the social accountability initiative of White Ribbon Alliance Uganda than I had seen in the previous 40 years of my midwifery career!

Recently, the citizens in Lira District petitioned the Member of Parliament (MP) about our poor maternal and newborn health services. The MP has presented this petition in Parliament and we are hopeful the Government of Uganda will support our campaign – ACT NOW TO SAVE MOTHERS.

#1 – The Global State of Maternal Health

In this first episode of The Mom Pod, hosted by Girls’ Globe Founder and President Julia Wiklander, you will be given an in-depth introduction to the global state of maternal health.

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Julia interviews Brigid McConville, Director of White Ribbon Alliance UK, who shares her expertise in the field of maternal health around the world. She tells stories of progress, speaks about what more needs to be done and what we can do. Brigid is a journalist and an award-winning author. She recently released her book On Becoming a Mother – Welcoming your new baby and your new life with wisdom from around the world. 

Julia also calls Emma Saloranta, Co-Founder of The Mom Pod, who is based in Tanzania to speak about expectations, hopes and more!

What do you want The Mom Pod to cover? Do you have unanswered questions you want an expert to tackle or are you curious about motherhood in other parts of the world? Record your voice message here or send us a written note.

Cover Photo Credit: UNICEF Ethiopia/ Tesfaye, Creative Commons on Flickr.