By Our Reporter| Teso Advanced News.
The issue of maternal deaths stemming from complications related to abortion, particularly unsafe abortions, remains a pressing challenge in Uganda. Annually, around 168 women lose their lives due to these unsafe procedures.
Abortion – refers to the termination of a pregnancy; ending of a pregnancy before the fetus can survive outside the uterus.
While there has been a notable improvement in the maternal mortality ratio over the past five years—from 336 deaths per 100,000 live births in 2016 to 189 in 2022 (UDHS 2022)—the significant danger posed by complications from abortion persists.
This concern was emphasized by Dr. Simon Peter Kayondo, a prominent advocate for sexual and reproductive health and rights (SRHR) as well as a renowned expert in obstetrics and gynecology during a health café hosted by the Health Journalists Network in Uganda (HEJNU) at Café Javas in Kampala.
Esther Nakkazi, the founder of HEJNU, revealed that this important initiative is backed by a consortium known as IPAS Africa, based in Nairobi, Kenya. The focus of this project is on inclusivity and raising awareness about various rights, particularly concerning reproductive health, abortion care, reproductive justice, and the misinformation surrounding these topics.
Nakkazi explained that this café serves as an introductory gathering for conveners to grasp the broader implications of these issues. It is anticipated that these discussions will continue in regional cafés organized in different districts, with three sessions scheduled to take place in Kampala.
According to the Uganda Maternal and Perinatal Death Surveillance and Response (MPDSR) report for 2022/2023, unsafe abortions are a critical concern for maternal health, contributing approximately 6% to all maternal death cases. This translates to approximately 168 out of 2,800 annual maternal deaths occurring due to unsafe abortions.
The Guttmacher Institute reported in 2022 that around 297,000 induced abortions happen each year in Uganda, which amounts to about 54 per 1,000 women aged 15-49. Unfortunately, many of these abortions are unsafe, resulting in complications and fatalities.
While the law in Uganda permits abortion only under specific circumstances to protect a woman’s life, Dr. Kayondo highlights the necessity for lifesaving post-abortion care. This essential emergency care must be accessible at least from Health Centre III onward for all women, regardless of whether their abortion was induced or occurred spontaneously.
Proscovia Namusoke, a 45-year-old woman (name changed for privacy), shares her profound experience with abortion.
She recounted how she unintentionally ended up aborting her sixth child, influenced by her husband who did not want any more children.
Despite using family planning methods, she found herself pregnant and faced pressure from her husband to terminate the pregnancy.
When she sought help at a hospital, her request was denied because there were no medical complications to warrant an abortion.
Desperate, she turned to traditional herbal remedies, which led to severe blood loss and brought her to the brink of death.
This traumatic experience left her determined to never undergo an abortion again.
Now, she advocates for the government to relax restrictions surrounding abortion cases to support women in similar situations.
Can we stop Abortion entirely?
Dr. Kayondo argues that abortion itself is not the core issue, as spontaneous abortions can occur naturally and affect many women, sometimes leading to complications or even death. The focus should not be on preventing abortions, but rather on eliminating the complications and adverse effects associated with them.
In Uganda, the context surrounding sexual and reproductive rights remains fraught with challenges.
Numerous societal, legal, and service barriers restrict access to abortion and limit women’s ability to make informed decisions about their reproductive health.
Cultural norms and lack of comprehensive sexual education further complicate this situation, hindering progress toward improved sexual and reproductive health rights for women.
Barriers and Negative Indicators
Legal Limitations: In Uganda, the Penal Code restricts abortion access to situations where a woman’s life is at risk, leaving cases like rape, defilement, or incest unaddressed.
Access to Information: Numerous women and girls do not have access to thorough information regarding contraception and sexual health.
Teenage Pregnancy: The country faces high rates of teenage pregnancy, with figures stagnating around 24-25%. This is largely due to limited family planning services and inadequate sexual education.
Gender Inequality: Societal norms frequently restrict women’s ability to make decisions about their reproductive health.
Enforcement Challenges: Despite the existence of some progressive policies, challenges in their implementation arise from societal attitudes and a lack of widespread awareness.
Positive Progressive Aspects
Government Initiatives: The Ugandan government has introduced several policies designed to enhance access to sexual and reproductive health. These include national guidelines and various programs.
Among these initiatives is the recent launch of self-care guidelines for contraception and post-abortion care. Additionally, the post-abortion care guidelines have been integrated into the Essential Maternal and New-born Care guidelines. The introduction and distribution of Combipack for managing various abortion complications also marks a significant step forward.
A new Post Abortion Care (PAC) guideline has been developed, offering comprehensive guidance on preventing and managing abortion complications. This initiative is supported by the recently established PAC steering committee under the Ministry of Health.
Civil Society Engagement: Numerous NGOs and advocacy groups, such as the Ipas Africa Initiative and AOGU, are working diligently to raise awareness about sexual and reproductive rights and enhance the accessibility of necessary services.
What are the Root Causes of Unsafe Abortion
Limited access to contraception and family planning, coupled with financial pressures and unstable relationships, often drives women towards unsafe abortions due to a lack of information and support.
Cultural and religious beliefs, societal stigma, and the fear of disappointing parents can lead women to feel shame and resort to unsafe abortion practices in the face of unplanned pregnancies.
Legal and structural barriers, including restrictive laws, systemic failures in implementation, and challenges in conflict-affected areas, significantly limit women’s access to safe abortion services.
Unsafe abortions lead to various negative social consequences, particularly affecting young women, including intensified stigma, economic burdens, and detrimental impacts on family well-being, while also delaying critical medical care and perpetuating cycles of poverty and health crises.
The widespread occurrence of unsafe abortion leads to considerable social stigma, causing women and their families to encounter rejection, harassment, and isolation.
In discussing the issue of abortion in Uganda, Ruth Ajalo, a prominent lawyer based in Kampala, highlighted how sensitive the topic is from legal, social, and political perspectives.
Ajalo emphasized that while abortion is not entirely illegal, it does face significant restrictions. Post-Abortion Care (PAC) is legal, regardless of the circumstances surrounding the abortion. Healthcare professionals are authorized to provide treatment for complications, yet confusion and fear often prevent individuals from accessing the lawful care they need.
She cautioned the media against some common misconceptions, such as the notion that “abortion is completely illegal,” conflating abortion with post-abortion care, labeling women seeking PAC as criminals, and identifying or exposing patients or providers.
The 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights (SRHR) includes a specific section on PAC, affirming its legality in Uganda. This policy explicitly states that in certain circumstances, a woman or girl should be provided assistance to terminate a pregnancy. The guidelines were updated in 2012, which retained these provisions.
Moreover, the 2015 Standards and Guidelines aimed at reducing maternal morbidity and mortality due to unsafe abortion also reaffirmed these principles. Unfortunately, these guidelines have been put on hold by the Ministry of Health, limiting their current applicability.
