Access to sexual and reproductive health education and services is related to multiple human rights, and is essential for achieving gender equality. Yet, in Uganda, lack of sexual health information and services is a significant challenge, leaving vulnerable adolescent girls and young women (AGYW) at risk of early sexual debut, unplanned pregnancy, violence and disproportionately high HIV infection rates. According to 2018 research from the Guttmacher Institute, approximately half of all pregnancies among women aged 15-19 in Uganda are unintended, with the overwhelming majority of these (88%) occurring among AGYW with an unmet need for modern contraception. What’s more, Uganda still has a high maternal mortality rate, with 336 deaths per 100,000 births.
With the majority of midwives based in hospitals, sexual health information and support can be difficult to access, particularly for those living in rural communities. Midwife Harriet Nayiga is committed to changing that.
Nayiga is the founder and director of Midwife-led Community Transformation (MILCOT), a charity that aims to bridge the gap between midwives and communities in Uganda. The midwives at MILCOT are, in the organization’s own words, “educators, counselors, researchers, leaders and advocates,” supporting vulnerable households and families, adolescents and youth groups, community and religious leaders, elders and Village Health teams. Currently operating in the Nansana Municipality, Nayiga wants to expand MILCOT across the entire country with the goal of shifting the focus from responsive to preventative healthcare.
Falling in love with midwifery
Education is deeply important to Nayiga. Inspired by nursing from a young age (“My mother used to tell stories about how nurses care for people—and their smart uniforms!”), when she finished school Nayiga applied for a scholarship to study midwifery at the Mulago School of Nursing and Midwifery. She loved working in the clinic during her studies, caring for mothers and newborn babies. “It was so exciting to see a woman smile because of how I have treated her.” When Nayiga graduated in 2013, she received the Best Practical Midwife of the Year award and was offered a job at Wakisa Ministries, a non-profit organization that cares for teenage girls with crisis pregnancies.
It wasn’t an easy role. As well as providing physical healthcare, Nayiga supported the girls as they battled external prejudice. “The girls I was working with had gone through a lot. They had been rejected by their communities. Some of them had been raped. It was a really tough situation. I would take them to hospital for their antenatal visits and they would cling to me as the other mothers stared at them. I was a safe space for them.”
Learning new skills
Nayiga’s work at Wakisa Ministries showed her the scale of the challenge in sexual and reproductive health in Uganda, and made her determined to do something about it. But first, she had to return to school.
“I applied to Aga Khan University School of Nursing and Midwifery, for a Bachelor of Science in Midwifery, but I knew tuition would be a challenge,” she says. “Luckily Johnson & Johnson Foundation provided funding to see me through university. That allowed me to meet my objectives, gain more knowledge and skills, and better serve the women and girls who need my help.”
Johnson & Johnson Foundation began partnering with AKU School of Nursing and Midwifery (AKU-SONAM) in 2001 to offer financial support to its nursing and midwifery students in countries across East Africa. AKU-SONAM operates across Kenya, Uganda and Tanzania, and the partnership has enabled 2,388 graduates to become innovative, qualified working nurses and midwives. The school aims to improve nursing and midwifery education, policy, practice and research to improve patient care in East Africa.
While at AKU-SONAM, Nayiga connected with Dr Grace Edwards, a Professor at the School who became her mentor. “She listened to my goals—the challenges I saw and how I was positioning myself to solve them. She always offered support and helped me to build my reputation.” Edwards recommended Nayiga for a profile by a local publisher, which then led to more features, including an interview with Her Royal Highness the Duchess of Cambridge. Shortly after graduating in 2018, Nayiga was selected by Nursing Now as a young midwife innovator, attended the World Health Assembly, and became a young midwife leader with the International Confederation of Midwives.
Since graduating from AKU-SONAM, Nayiga has continued to push herself, participating in the Young Midwifery Leadership course and other leadership programs, with additional support from the Johnson & Johnson Foundation and from the Ugandan Government.
Adjusting for COVID-19
Now at the helm of MILCOT, Nayiga leads a team of midwives, counseling psychologists, programming officers, and social workers, providing sexual and reproductive health and rights (SRHR) information, counseling, psychotherapy, and vocational skills. “We hope that the support we give can help individuals make informed health decisions and thrive on safe sources of livelihood,” she says.
On a day-to-day basis, Nayiga balances her work in the community with administrative tasks, as well as monitoring vocational skills classes within the center. There is nothing she won’t do for the people she serves, from picking up and dropping off clients, to giving up her house for the community to use as a meeting center.
When COVID-19 reached Uganda, MILCOT had to change its approach to ensure that AGYWs could still access information, counseling and vocational skills training. “Lockdown brought a lot of gender-based violence and teenage pregnancies,” says Nayiga, “so we had to make sure we kept a connection by calling the girls regularly.” During the second lockdown, with support from SIA, MILCOT provided food, sanitary pads and soap to the beneficiaries within 75 households. Nayiga got a permit so that she could visit clients in their homes and provide home-based counseling and medical care, and refer those who needed it to hospital.
With support from the Burdett Trust for Nursing, Nayiga and her team are implementing the Nursing Now Challenge project that aims to build the resilience of nurses and midwives in leadership and empower them with the knowledge and skills to provide adolescent-friendly sexual reproductive health services. Due to Nayiga’s outstanding work in the community, MILCOT was recently awarded the excellence prize in advancing maternal and child healthcare, given by the Ministry of Health at the Heroes in Health Awards 2021.
Focusing on the future
Despite the intense nature of her work, Nayiga is full of optimism. She is passionate about bringing more visibility to her work—not just to promote MILCOT but to inspire others to follow in her footsteps. “The impact of our work makes me smile. And I keep going by thinking about the people who most need my help, as well as by having my own strong support system. I share my story so that my colleagues can also become problem solvers and tackle the health challenges of this century.”
While nursing and midwifery is still seen as a ‘last resort’ profession by some in Uganda, Nayiga is determined to change its reputation by standing as an example. “Many people think of us as less qualified than doctors. They don’t realize that nursing and midwifery is its own, highly-skilled profession. Our contribution to healthcare has been underestimated over the years, even though we are on the front lines.”
Nayiga advocates for increased investment into nursing and midwifery, as well as calling upon stakeholders to prioritize supporting innovations within the profession. “Without financial, physical and emotional support, we cannot do our jobs. When I was supported, I was able to build on my vision and now I am impacting lives. That is why investing in us is so important.”