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The social organization of maternity care and birth in Amuru sub-county, northern Uganda Rudrum, Sarah Elizabeth Ellen


High maternal mortality rates throughout sub-Saharan Africa attest to the critical importance of comprehending barriers to health care during pregnancy and birth. This study examines how maternity care and birth are socially organized in Amuru sub-county, northern Uganda, a rural setting recovering from two decades of conflict. To conduct this study, I spent seven months undertaking fieldwork in Amuru, northern Uganda. In addition to observations, I interviewed and held focus groups with childbearing women, and in a second study stage spoke with health care providers and health care administrators. My research methods draw from institutional ethnography. The challenging context for maternity care and childbirth in Amuru was exacerbated by poor infrastructure and ongoing social distress in the aftermath of the protracted conflict between the Lord’s Resistance Army (LRA) and government forces that ended in 2006. Findings drawn from the data illustrated that approaches to care and birth among participants were shaped by everyday challenges associated with poverty and lack of infrastructure, the most prominent of which were accessing transportation, avoiding arduous physical work while pregnant, and ensuring adequate nutrition. Couples’ HIV testing, which was positioned as compulsory and wherein women were responsible for husbands’ participation, also challenged participants access to antenatal and delivery care. Childbearing women’s approaches to maternity care were also shaped by the mama kit project (distribution of a non-profit ‘gift’ of baby-care basics to mothers), and its associated discourses of deservingness, scarcity, and uncertainty. Imbued with power, all these factors affected access to care. This dissertation contributes to scholarship on the social constitution of maternity care and childbirth in northern Uganda.

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