In Summary

Respecting privacy. The proposal to arrest nurses and midwives will violate the right to expect and demand adequate antenatal services by underage women given that healthcare providers will not fulfil their mandate in fear of breaching the professional codes of conduct in regards to respecting privacy and confidentiality of the people they serve.

Let’s imagine a young woman in the district of Bundibugyo who goes to government- run health centre to seek antenatal care. Prior to her visit, the district makes a by-law that requires health facilities to declare the health status of their patients for reasons of planning and budgeting for major health problems.

Due to the fear of the district accessing her medical records, the young woman declines the new invasive nature of the antenatal care and when the time to deliver comes, she seeks the help of the old woman next door, who is well known to have delivered nearly half of the village adults. This traditional birth attendant this time, unfortunately, fails to save both the young woman’s life and that of the baby. It is of no doubt that when Bundibugyo District made this by-law, it did not think about issues of privacy and confidentiality in access to treatment and how it would work in reverse against the intended purpose of “proper planning”.

This could be the outcome if the recent pronouncement by state minister for Youth and Children Affairs about the intention to arrest midwives who do not register child mothers (see Daily Monitor, August 30). The minister declared that government will start arresting midwives who do not report to police underage mothers who seek antenatal care at health centres. While on the surface, she might seem to make a good point of curbing defilement, which leads to underage mothers, the move fails at different fronts such as privacy and confidentiality in access to treatment, thereby threatening to violate the rights of women and girls.

Such a suggestion is blind to the professional ethics requirement for nurses and midwives about the duty not to disclose patients’ information unless when required by law or court order. Should we then assume the government has failed to find a solution to defilement? Hinging on healthcare in this fashion would mean a violation of Article 42 of our constitution that speaks to the right to just and fair treatment in administrative decisions.

Last year, data from the Uganda Demographic and Health Survey 2016 (UDHS) conducted by the Uganda Bureau of Statistics, showed that between June 12 and December 18, 2016 there was 1 per cent increase in teenage pregnancy from 24 per cent in 2011 to 25 per cent in 2016. Inspector General of Police Okoth Ochola said police records show that 120,707 girls below the age of 18 years were defiled in Uganda in the last five years between 2011-2016.

Recently released police report shows that defilement cases reported are at 14,985. All these statistics have real people behind and this sexual predatory and violence have long lasting impact on a girl’s life beyond pregnancy. Pregnancy is one of the leading causes of school drop out rates for girls.

According to the Uganda Aids Commission, the country registers 227 infections per day - that is nine infections per hour. Young people, especially young women and girls, are disproportionately affected. The commission says “about 60 per cent of the deaths are as a result of HIV due to their poor health seeking behaviour. The men then transmit the HIV infections to young girls. In 2015, it was estimated that 567 young Ugandans aged between 15 and 24 years get infected with HIV every week and of these, 363 are girls!

The drivers of teenage pregnancies and defilement are well researched by different government agencies. It will be a shock to the nation if minister Kiyingi and her supporters in government manage to go through with this ridiculous expectation put on health workers. Health workers are already overburdened with huge workload and Uganda still loses 13 women daily due to childbirth complications, young mothers facing a bigger risk as their bodies have not fully developed and largely lack financial backing to seek better healthcare.

The move will be a complete violation of the right to health yet the State has a duty to ensure that all citizens have an equal chance to live a long and healthy life. The proposal to arrest nurses and midwives will violate the right to expect and demand adequate antenatal services by underage women given that healthcare providers will not fulfill their mandate in fear of breaching the professional codes of conduct in regards to respecting privacy and confidentiality of the people they serve.
On top of their gross inequality and disadvantages society piles on young girls, this means that underage girls will be denied the opportunity of living with respect and dignity and their demand for basic needs such as antenatal care will be curtailed.
Our Constitution guarantees the right of Ugandans to enjoy access to health services. We must remind minister Kiyingi and the State she represents that Article 33(3) of the Constitution calls upon the State to protect women and their rights, taking into account their unique status and natural maternal functions. Such directive will also violate the girl-child and further their discrimination.

Every person in need of medical care is entitled to impartial access to treatment in accordance with regulations, conditions and arrangements obtaining at any given time in the government health system. The Patients’ Rights Charter equally reminds us that patients have the right to privacy in the course of consultation and treatment, and information concerning anyone’s health may only be disclosed with informed consent, except when required by law or on court order. There is no law or any provision that allows for legitimising a pronouncement like that of minister Kiyingi.

In this debate, therefore, Uganda needs to seriously think through the likely outcomes of this move and how many lives we might lose due to maternal mortality and general denial of sexual and reproductive health information.

For Uganda’s change grim figures of teenage pregnancy, defilement and HIV rates among young people, there has to be greater moves to guarantee more rights to young people, especially girls. Girls should be provided with adequate sexual and reproductive health and rights information, access to contraception and protection under the law. Also we have to move to ensure more families are lifted out of poverty.

Mr Jjuuko is a researcher at the Center for Health, Human Rights and Development.