In a quiet delivery room in rural Karamoja, a soft-spoken midwife holds the hand of a young mother, guiding her through the final moments of labor. For both women, this birth is more than a medical event—it’s a quiet act of resilience.
The mother, like many others in her community, has undergone female genital mutilation (FGM), a deeply rooted practice that endangers the health and lives of women and girls. But standing beside her is a midwife not only trained to manage the complex risks FGM poses during childbirth, but also committed to ending the cycle.
Across regions where FGM remains prevalent, midwives are becoming unlikely champions in the movement for change—providing compassionate care, advocating for abandonment, and empowering communities to protect the next generation.
Meet Paulina Chepkumu, aged 50. She works as a midwife at Loroo Health Centre III, Karita sub-county, Amudat district. While Chepkumu has spent nearly two decades delivering hope and new life to mothers and babies, what is unique about her is not the number of deliveries she has safely made, but rather her commitment to ensuring safe births for survivors of FGM.
“Those (women who have undergone FGM) are high -risk mothers because they are at risk of complications during pregnancy, child birth or postpartum. They need special attention and care,” Chepkumu says.
The midwife says while prevention interventions are thriving and community awareness is widespread, FGM is still happening in some villages and the health center receives some cases of expectant mothers facing complications delivering naturally due to FGM.
“Out of 10 deliveries every month at Loroo HCIII, among girls aged 14-16 years, six of them are found to be mutilated. (But) when delivery becomes complicated, we refer the mother to Amudat Hospital in an ambulance for better management,” she says.
She says Loroo HC III has two ambulances, one provided by Uganda's Ministry of Health and the other, Office of the Prime Minister.
“Those ambulances have really helped us a lot with referrals. It would be a different story if we did not have them here, “ she says pointing at the two ambulances parked in a shed.
According to Chepkumu, when a mother presents with FGM, she is provided her with health education so that she does not do the same to her children in the future.
“We also encourage them to take their children to school because, at school, they can learn about the dangers of FGM from their peers.”
At the Health Centre, Chepkumu has built collaboration with the members of the Male Action Group (MAGs), who are community champions advocating against FGM in the sub/county. Through the UNFPA-UNICEF Joint Programme for the Elimination of FGM, the MAGs are community-based groups composed of men and boys committed to promoting gender equality, challenging harmful social norms and advocating for the abandonment of FGM.
“The MAGs also help a lot. They go into the villages, identify cutters, and warn them of imprisonment through the law if they continue the practice.”
The health center also runs adolescent-friendly services on Tuesdays and Thursdays, where girls are educated about the dangers of FGM and menstrual Health Management, and young mothers are sensitized about family planning, and Paula leads on this.
Midwife Stella at the community dialogue in Tumbobi, an FGM hotspot in Kapchorwa district. She says some mothers who presented with FGM face severe complications and had to be retained for further management after delivery.
In neighbouring Bukwo distinct, 30-year-old Yeko Olive is another midwife working at Kapsarur Health Center II in Kyepkwatsa, Kongasis County to ensure mothers who have undergone FGM deliver safely. She says while cases of pregnant mothers presenting with FGM is rare, in most cases they are referred to Bukwo General Hospital for specialised care.
“When they (the mothers) come for antenatal, we ask about their FGM status in a non-judgmental manner and then attend to them, counsel them and advise them that when labour starts, they should go directly to the general hospital as we are not able to manage them at the health centre. These are high-risk mothers and we should give that level of care to ensure they have a safe delivery,” she says.
During a community dialogue organised by UNFPA in Kapchorwa district, Stella Cheptoek, a midwife at Tumboboi Health Center II is sensitising mothers on the dangers of FGM and child marriage. She reveals that 70 percent of mothers who attend first Antenatal Care at the health centre are below 19 years, posing a risk to their health.
“Some of them already mutilated and they face challenges at child birth, not only because of their age, but because of the scars caused by FGM,” she said.
Urging communities to reject harmful practices like female genital mutilation and child marriage, Cheptoek revealed that some of the mutilated mothers end up seeking futhur treatment after a complicated child birth.
“I have reached out to survivors of FGM who were mutilated three weeks ago. Some had experienced severe bleeding and are now seeking treatment at the health facility. We must stop this practice of cutting women and girls” she said.
While the national prevalence of FGM in Uganda has declined from 0.3 percent in 2016 to 0.2 percent by 2022, findings of Gender Based Violence (GBV) and Sexual Reproductive Health (SRHR) Community data collection conducted by the Uganda Bureau of Statistics (2022) indicated that in practicing communities, FGM prevalence is still high with Amudat district leading at 43 percent, leaving many mothers at risk of obstetric complications during child birth. But the motivation and commitment by midwives like Paulina Chepkumu, Stella Cheptek and Olive Yeko continue to ensure every mother delivers safely and is empowered to take control of her health and well-being.
* Written by Evelyn Matsamura Kiapi
