maternal health in uganda maternal health in uganda like many developing countries, uganda has high maternal mortality ratio at 343 per 100,000 live births. according to the world health organization (who), a maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. in situations where attribution of the cause of death is inadequate, another definition, pregnancy-related death was coined by the us centers for disease control (cdc), defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. a maternal health nurse in karamoja uganda is an african country within the sub-saharan african region. when comparing the rates of uganda to the region uganda has a much lower maternal mortality ratio, 430 versus 619 deaths per 100,000. sub-saharan africa fertility rate is 119 per 1,000 – which is significantly less than uganda. this is suggesting that when compared to other nations in the same region, uganda has more teen pregnancies and births. however, the region averages only 19 seats in parliament, which is much lower than uganda. 22.2% of women in the region have at least a secondary education. this is significantly higher than uganda suggesting that higher education for women is more difficult to achieve in uganda compared to the average number in the region. 62.9% of women in sub-saharan africa are actively participating in the labor force. uganda seems to have greater participation from women than the region's average. uganda is the average when it comes to contraceptive use in the region suggesting this is an issue of that entire region. 73.6% of women attend at least one antenatal care visit in the region. uganda's is higher, suggesting more uganda women take advantage of healthcare services than other women in the region. uganda is also the average for the region in percent of births done with the aid of a skilled attendant also suggesting this is a regional issue. the fertility rate in sub-saharan africa is 4.8, which is a lot lower than the fertility rate in uganda. multiple factors may be attributable to this high mmr in uganda, for example, mmr is often a reflection of access to health care services. even when health care services are available, healthcare worker under-staffing is common often with low medical supplies such as essential medication which can also have an effect. the health of a mother impacts the family and even the entire community. her ability and access to receive necessary healthcare largely determines health outcomes for herself and her baby. traditionally, ugandan women seek to handle birth on their own as it is a time when they can use their own power and make their own decisions which can also be a factor in such a high maternal mortality rate. many women report mistreatment from healthcare personnel as an additional reason to avoid seeking professional care during pregnancy and labor. a study also found that a majority of ugandan women lack health literacy and in turn seek care in more traditional or homeopathic ways. malaria is also a substantial issue. pregnant women and their newborn babies are particularly susceptible to complications related to malaria, which is endemic in uganda. this is also an issue that needs to be addressed in order to improve maternal mortality in uganda. maternal health as a capability and why it matters a nurse in uganda monitoring a patient's heart rate with a pinard horn stethoscope. the who defines health as the enjoyment of the highest attainable standard of health and is one of the fundamental rights of every human being. amartya k. sen, a feminist economist, adds to that as he said that health is among the most important conditions of human life and a critically significant constituent of human capabilities which we have reason to value. it has been found that healthier nations, or those with a greater life expectancy and lower infant mortality, see greater economic growth and prosperity. the argument has also been made the other way that economic growth contributes to healthier nations. it is not just the overall availability of resources that improves health, but access by the public to those resources. sen argues that health only improves during economic prosperity if there is a shift in resource allocation towards health and education, equitable distribution of income, and extensive employment programs to decrease the unemployment rate. sen writes, "the factors that can contribute to health achievements and failures go well beyond health care, and include many influences of very different kinds, varying from (genetic) propensities, individual incomes, food habits and lifestyle, on the one hand, to the epidemiological environment and work conditions, on the other...we have to go well beyond the delivery and distribution of health care to get an adequate understanding of health achievement and capability." unicef found that healthy children need healthy mothers. a woman in sub-saharan africa has a 1 in 16 chance of dying in childbirth. the report found that at least 20% of the burden of disease in children below the age of 5 is related to poor maternal health and nutrition, as well as the quality of care at delivery and during the newborn period. yearly, 8 million babies die before or during delivery or in the first week of life. further, many children are tragically left motherless each year. these children are 10 times more likely to die within two years of their mothers' death. it has also been found that the health of the mother vastly affects the health of all of her children. the health of our mothers vastly impacts the health and success of our future generations. maternal mortality and morbidity the world health organization (who) defines maternal health as the health of women during pregnancy, childbirth and the postpartum period. according to estimates from uganda bureau of statistics (ubos), uganda’s maternal mortality ratio, the annual number of deaths of women from pregnancy-related causes per 100,000 live births stands at 343 after allowing for adjustments. women die as a result of complications during and following pregnancy and childbirth and the major complications include severe bleeding, infections, unsafe abortion and obstructed labor. uganda is slow in its progress in the fifth goal of improving maternal health in its millennium development goals. with the 2015 target for maternal mortality ratio at 131 per 100,000 births and proportion of births attended by skilled health personnel set at 100%, uganda has a long battle in reaching its intended goals. moreover, the methodology used and the sample sizes implemented by the uganda demographic health survey (udhs) do not allow for precise estimates of maternal mortality. this suggests that the estimates collated are erroneous and it is conceivable that the actual rates could be much higher than those reported. uganda has over the years had a decline in infant and under-five mortality. the most common causes of under-five mortality are pneumonia (16 per cent), malaria (13 per cent), diarrhea (10 per cent) and hiv and aids (7 per cent). child mortality is differently across the country. karamojia, southwest, west nile and the western regions have the highest mortality. although there is a decline in mortality, 1 out of 11 children dies before they turn five years old. although the maternal mortality has increased from 435 in 1990 to 438 in 2011 per 1000 child, the neonatal mortality has dropped from 29 in 1990 to 27 in 2001 per 1000 child. high maternal mortality rates persist in uganda due to an overall low use of contraceptives, limited capacity of health facilities to manage abortion/miscarriage complications and prevalence of hiv/aids among pregnant women. despite malaria being one of the leading causes of morbidity in pregnant women, prevention and prophylaxis services are not well established. human development report 2011 the human development report ranked 183 countries based on a variety of criteria. uganda ranked 161 out of 183 countries. its high ranking puts it under the low human development category. the human development index (hdi) is a composite index that measures the achievement of countries in three basic dimensions of human development-a long and healthy life, knowledge, and a decent standard of living. uganda received a value of 0.446. the closer the number is to one, the better the country is in regards to human development. norway is ranked at number one with a hdi of 0.943. the next variable that was taken into consideration is life expectancy at birth in years. uganda's life expectancy is 54.1 years. the mean number of years in school is the average number of years of education received by people ages 25 and older. in uganda the mean is only 4.7. expected years of schooling is the number of years of schooling that a child of school entrance can expect to receive if prevailing patterns of age-specific enrollment rates persist throughout the child's life. i uganda, the expected years of schooling is 10.8. the gross national income (gni) is the aggregate income of an economy generated by its production and its ownership of factors of production, less the incomes paid for the use of factors of production owned by the rest of the world, converted to international dollars using purchasing power parity rates divided by the midyear population. in uganda the gni is $1,124.00. the gni per capita rank minus the hdi rank: difference in ranking by gni per capita and by the hdi. in uganda this measure is 7. the last measure is the nonincome hdi, which is the value of the hdi computed from the life expectancy and education indicators only. in uganda this measure is 0.506. the gender inequality index (gdi) is a composite measure that reflects inequality in achievements between women and men in three categories: reproductive health, empowerment, and the labor market. out of 183 countries, uganda ranks 11th and the maternal mortality is 343 per 100,000 live births. the fertility rate adolescents (ages 15–19) is 149.9 per 1,000. women currently hold 37.2 seats in parliament. only a meager 9.1% of the female population has a secondary education or higher. 78.3% of women are participating in the labor force. only 24% of women who are in their childbearing years use some sort of contraceptive method. 94% of women are receiving at least 1 antenatal visit, but only 42% are giving birth with the aid of a skilled attendant. the fertility rate in uganda is 5.59 children per female. based on the information given in these tables there appears to be a correlation between the high maternal mortality ratio and high fertility rate which could be associated with low contraceptive use. the low percentage of women giving birth with a skilled birth attendant could also be associated with a high maternal mortality ratio. low secondary education rates, low access to health care services, low use of contraceptives coupled with high fertility rates is contributing to a high percentage of maternal mortality in uganda. however, we do see a high labor force participation which could potentially lead increase empowerment for women and an increase in monetary gain to spend on health services. however, currently the high labor force participation does not seem to be aiding uganda women in regards to maternal health. uganda's extremely low percentage of women with at least a secondary education could also be attributed to a higher fertility rate and less desirable birth outcomes, as education affects health literacy and identifying the need for assistance from a skilled birth attendant. studies have shown how the poor health of women can have a negative impact on economic achievement for the country as a whole. low economic development then constrains the capability of women to achieve better health. poor quality of healthcare services almost all women in developing countries have at least four antenatal care visits, are attended to by a skilled health worker during childbirth, and receive postpartum care. in contrast, only 47% of ugandan women receive antenatal care coverage and only 42% of births are attended by skilled health personnel. among the poorest 20% of the population, the share of births attended by skilled