Uganda - Campaign to End Fistula

298.0 KEY INFORMANT INTERVIEWSAn in-depth interview was conducted among 24 persons who included the DistrictDirector of Health Services, the District Nursing Officer or District Public HealthNurse/Visitor. These were selected because of their experience and work which requirethem to interact with grassroot people at rural health units and have access to all datacollected from the whole district. They are also involved in district planning andimplementing policy and projects in their district. The senior staff of the Ministry ofHealth headquarters and heads of development partners were similarly interviewed.8.1 Attitudes and beliefs of families and communitiesPregnancy and ChildbirthThis is a source of joy among stable couples or family but could be a source of miserywhen untimely like among the Bakiga “a curse to the girl if she conceived outsidemarriage”.A normal woman is expected to have a normal vaginal delivery and women who fail toconceive or deliver are inferior in society or have been bewitched. They will spend timeand money to get a child at any cost, as infertile women are denied family privileges.Operative Abdominal Delivery (Caesarian Section)Most women and communities are scared of abdominal operative delivery. It is neverwelcome and remains for weak women who cannot prove their womanhood. Everythingwill be done to avoid caesarian section and this would include going to hospital late wheneverything has failed. Many women believe if one goes early to hospital it can lead toher being operated early because “the health workers are impatient and do not wait forlong enough”. In Kabarole district among the Batooro, a woman in labour should bebrave and make no noise regardless of the severity of pain in order not to alarm people athome. She can be hidden in a banana plantation or bush to keep her away from people.Among the Banyankole if a mother is in labour in the hospital she must remain quietotherwise any “noise made during labour in a hospital alerts health workers to ‘cut’her”. Delivery is a private affair only close female relatives like her mother or motherin-laware supposed to be near and see her private parts unlike in hospital where privateparts are exposed for every one to see and later narrate stories.A lady from Kamwezi said that even if it meant “Kushatuka akahago” i.e. to rupture herbladder, she would never go to hospital to expose her private parts as health workerswould later talk about her natural anatomy of her genitalia.A few women deliver in health units in Mbarara district because they fear unnecessaryexposure of their private parts in hospital, a midwife at Kabuyanda said. Lying in supineposition during childbirth is not acceptable. They prefer to stand or squat while clothesare hanging and this reduces exposure of private parts as opposed to lithotomy or supine positionsimposed in health units.