Thursday, February 10, 2011

Being A Woman is Risky Business in Rural Uganda

by Ine Collins

Myth, stigma, and taboo shroud family planning efforts in many villages. At Buwaiswa, one of Uganda Village Project's targeted Healthy Villages communities, the shroud was particularly opaque. As a field officer, I was assisting with family planning workshops, bringing nurses and contraceptives to women in remote villages that otherwise would have limited access to such services. Women gathered around outside the empty room where we sat with nurses, wanting the information and contraception, but scared of who might see them, especially their husbands. We’ve found that most husbands are against contraception, yet in most cases it is not acceptable for the wife to refuse sex. So, we position ourselves near wells so that women can pretend to fetch water, or make whatever excuse they need to make to leave the house. Others simply sneak out when the sun goes down. This issue is one of the major challenges that Uganda Village Project faces in its family planning program, and we are currently working on an awareness-raising program for men using respected village leaders to speak out on how family planning has helped them.

A tall, handsome young woman with high cheekbones, big eyes, even inky skin, and a cropped afro came into the room. Her youngest child, less than a year old, was wrapped to her back with a kitengi cloth. She was my age, with four children. Despite the women outside gossiping about whoever was trying to get birth control, the woman was one of four others in four hours who ventured in to see us. After weighing her options, she opted for Depo Provera, like most women, because of its inconspicuous nature. The nurse handed her a pregnancy test. Positive. She didn’t miss a beat, smiled gracefully, and left. I was floored by the composure with which she took the news. The average woman my age who has even experienced a false alarm for an unplanned pregnancy sees her life flashing before her eyes.

At Nabitovu, there was no room for us. We held the workshop under a tree, as we commonly must do when working in these remote areas. The village was more receptive to family planning, so everyone was enjoying their neighbors’ company, giggling at the condom demonstration. As things began to wind down, an 18 year old mustered up the courage to walk over. Most of the women who come to us are in their 20s/30s, and married with multiple children.

She had an older boyfriend in town. She had no idea whether they used condoms or not. “I never look,” she explained.

I was horrified for her. My first experience trying to get birth control in America is etched in the stone of my memory.The doctor stared expectantly over his spectacles, ready to record the personal details of my sex life. Sitting in a cold room smelling of rubbing alcohol, I squirmed in my examination gown, mortified. I managed one-word answers. I’d sooner suffer in silence than relive that experience while a group of my mother’s friends and neighbors sat nearby, watching, listening, and judging.

A woman at another village in her early thirties with nine children came to us seeking birth control. Pregnancy test = positive. Her face betrayed her devastation. She grew desperate. “I can’t have another child. I have to stop this pregnancy. Please help me stop it.“ Abortion is illegal in Uganda. Post-abortion care is widely, and legally publicized through clinics, yet clandestine abortion contributes to approximately one-third of Uganda’s maternal mortality. I wondered - with her limited options, what would this woman do?

Looking at that woman, I thought of my grandmother who gave birth to nine children in Nigeria. Though she is a devout Catholic who once studied to be a nun, I wondered if she had ever wanted contraceptives or if she actually intended to spend over 5 years of her life pregnant.

The week before I arrived, a woman in labor arrived at a hospital where she ended up waiting for hours, only to be referred to a different hospital. Before reaching the next hospital, she was hemorrhaging, as someone encouraged her to push while riding the boda boda, a motorcycle taxi. At the hospital, the fetal heartbeat was gone. Nevertheless, she had to deliver the baby. After seeing her dead child, she fainted and died shortly thereafter. And to think she was one of the few women who could actually afford to pay for the 2,000 shillings (~1 dollar) taxi to the hospital so that she didn’t have to deliver at home on a bare floor.

I often joke half-seriously that being a woman is the worst decision I’ve ever made. Not only is there the ubiquitous cultural and institutional discrimination, but also sex, the source of life, is disproportionately risky for women, and childbirth carries a very real risk of death, with a lifetime risk of maternal mortality of 1 in 25. What’s more is that nothing I’ve said is really specific to Uganda. The stories would largely be the same, if not worse, if I were in rural Brazil, Nigeria, the Philippines, India, Afghanistan. Until access to healthcare improves across the world, it will remain dangerous to be a woman in these places.

Saturday, February 5, 2011

Sujal Parikh Memorial Symposium on Health & Social Justice: Mar 26th

Dear Friends, Family, Colleagues and Admirers of our friend, Sujal Parikh,

We are pleased to announce the inaugural Sujal Parikh Memorial Symposium on Health and Social Justice. Sujal, a University of Michigan medical student, passed away in October 2010 after a road accident in Uganda where he was conducting AIDS research as an NIH-Fogarty Clinical Research Scholar.  Sujal was an inspiring global health and social justice advocate and had held leadership positions in AMSA, UAEM, PHR, Uganda Village Project, and U-M Center for Global Health.  Read more about him here ( and here ( 

The goal of this event is to honor the life of Sujal Parikh and to carry on his vision by bringing together a community to advance health and social justice. This year’s theme is: The Social (Justice) Network.  See the below call for proposals for further details on presentations and content.

March 26th, 2011
University of Michigan, Ann Arbor, MI
The deadline for registration, which is free, is March 12, 2011.

For interested presenters:
We are currently soliciting presenters to discuss innovative ideas pertaining to one of the following themes that were important to Sujal: 

1) Curricula as an agent of social change: Education shapes future leaders’ views, values, and goals. In this way, curriculum can be a powerful tool for driving social change. Do you have an example of an innovative and effective curriculum related to health or social justice?
2) Defining health equity: A rigorous, vetted definition of this buzzword is critical for the next generation of leaders to advance meaningful change in global health.  How do we, as the millennial generation, define “health equity”? How can this definition guide practices and programs?
3) Innovations in global engagement: Global engagement is rife with controversy and ethical concerns, but these tensions can be negotiated with meaningful results. Are you pioneering a progressive global partnership? How can students and social justice advocates be sensitive to a community’s unique social context?

We hope to have a wide variety of speakers, from experts in their fields to students to community workers. Everyone is welcome to submit proposals!
-   Presentations should be no longer than 20 min. Please see for the style of talks we envision.
-   The deadline for presentation proposal submission is February 18th, 2011.
-   If you are unsure you can attend the symposium, please let us know if you would be interested in submitting a remote presentation! The logistics for this are currently being arranged.

For details and the online application, please visit:

We look forward to seeing you soon and sharing ideas about advancing health and social justice on March 26th!  

- Uganda Village Project