The 28th of September is observed as the International Safe Abortion Day yet many young women continue to die due to unsafe abortions in Uganda.
The figures are so alarming with an estimation of 297,000 induced abortions with nearly 85,000 receiving treatment for complications of unsafe abortions while about 65,000 of those who experience complications aren’t even able to access any treatment.
Approximately one in five pregnancies in Uganda ends in an induced abortion which is very significant given the high incidence of unsafe abortions.
Most young women are forced in to unsafe abortion because they are left with no choice and decide to take matters into their own hands by self-administering substances or objects that result in either grave injuries or death.
The Uganda Demographic Health Survey 2016 states that the maternal mortality ratio is still high at 336 per 100,000 live births, and maternal deaths are estimated at 16-18 per day with 4-6 deaths attributed to unsafe abortion. Unsafe abortion continues to be a leading cause of maternal death.
Uganda’s law explicitly allows for access to safe and legal abortion only to save a woman’s life (Article 224, Uganda Penal Code).
Unlike before where women would use herbal concoctions and devices such as wires and sticks, to procure abortions, a number of women now report inserting drugs they got over the counter, often used in high doses. Instead of having to deal with uterus repairs or removal, now doctors are dealing a lot with over bleeding when providing post-abortion care.
The late Dr. Charles Kiggundu who was a consultant gynecologist at Kawempe National Referral hospital and always advocated for safe abortion always stressed that Uganda’s restrictive abortion law on health workers had far grave impact and costing lives:
“Lives are lost when doctors are still weighing between helping victims because of the likely repercussions to them. Proper statistics on how many abortions could be happening annually remain scanty due to the fact it remains largely illegal, yet the legal aspects of it are not well understood. This is the reason why some doctors may not choose to document when they give post-abortion care.” He intimated during a media campaign in 2020 shortly before he passed on during due to Covid-19.
He added that at the time ‘What was documented for Kawempe [Hospital] alone showed that more than 800 women sought post-abortion services from the hospital when the situation was already out of hand and many of them showed with advanced complications and couldn’t be saved.
According to Dr, Kavuma Ronnie the project officer Tusitukirewamu group Bwaise, better reproductive health, better communities project the very first gap they identified was a lack of sanitation for the young women and then set out to help them have access to appropriate information on preventing unintended pregnancy and access to quality post abortion care, FP and other SRH services through increasing community awareness on availability of high quality post abortion care, FP and other SRH services through community mobilization and sensitization, as a way of preventing unsafe.
The girls who seek post abortion care services revealed that Safe abortion is perceived as a religious and cultural taboo which pushes them in to unsafe means while others fear that they would disappoint their parents and guardians and still wish to pursue their education.
Beginning April 2018, Tusitukirewamu in partnership with International Planned Parenthood Federation (IPPF) – Safe Abortion Action Fund Grant started implementing a three- year Better Reproductive Health, Better Communities Projectwhose goal is to ensure that women of child bearing age have access to information on preventing any unsafe abortions, unintended pregnancy and to have better access to high quality post abortion care, FP and other SRH services.
Specifically the project aims at increasing knowledge on prevention of unsafe abortions, unintended pregnancies and access to post abortion care services, emergency contraception and family planning amongst women of reproductive age living in the 8 urban slums of Bwaise I,II and III, Kawempe I, Kazo Angola, Makerere II and III and Wandegeya.
Dr. Kavuma says they have reached out to over 4000 young women in need of post abortion care and have managed to re direct them to always seeking safe abortion care.
Nakirya Hadijah an 18 year old from Kawempe Mbogo says she was referred to Tusitukire wamu group by a friend who is a student at Makerere University when she conceived accidently and had to find ways to terminate it. “I reached out to the peer educators who took me through counselling sessions and were able to save my life”. She said.
Elizabeth Mbatudde, 32 used to be a medical officer at Mulago Hospital, which also provides PAC. She was surprised to one day hear that her own Gera sister was at the hospital and had severe pains. When Gera told the nurses about her pain, and the fact that she once had an abortion, the nurses assumed that she had had an illegal and unsafe abortion and practically abandoned her in the reception area where she breathed her last.
This is when Mbatudde realized how serious the problem was, prompting her to do something extra to help reach out to other young women who had the same unfortunate fate as her own sister never made it.
When Mbatudde started her outreach programmes, she met another victim who also worked tirelessly to sensitize young women about the grave consequences of unsafe abortions offering medical support, psych social support and counseling.
Joyce Nassali still remembers the unsafe abortion and deafening silence that ultimately took her friend’s life. She says her friend was a senior six vacist waiting to join university when she solicited for an abortion with a quack doctor who ruptured her uterus. “She died days later and that is when it occurred to us that she had an abortion without confiding in any of us (her friends).”
Sara Kwagala a university students says she feared to tell anyone and kept quiet due to fear of stigmatization and being abandoned by her family but when the peer educators came to her hostel for a training session, she talked to Mbatudde who offered her the support she needed ultimately saving her life.
“I used to hear stories of drinking too concentrated tea, using a hanger to pull out the fetus, drinking Jik or Omo and many other means but it didn’t sound safe, however I almost took up one of those options but the peer educators were right in time to save my life” Sara says.
“When my friends mention anything about conceiving accidently, I am always quick to share Mbatudde’s number because I know, they would be saved”. She adds
Nassali on the other hand take pride in how greatly she has impacted the lives of many young women in the slums of Bwaise anad kawempe as well as young university students who reside in areas of Bwaise, Makerere Kikoni and Wandegeya. “Most of these girls used to take pills that they obtain over the counter in pharmacies but they now seek safe abortion services and post abortion care. They can now openly talk about their predicament unlike before”. She notes.
She notes that her office attends to an average of 5 girls on a daily basis. The abortion rates in Kampala stand at 77 per 1000.
Dr. Kavuma’s group has worked with over40 peer educators (Community Volunteers) and outreach workers to reach out to these young women.
These volunteers are the first point of contact but are always available to link clients to service providers in a very expeditious manner.
Young people including food vendors, boda boda riders, mechanics, carpenters and sex workers were identified as the first target groups with messages through Social media and mobile outreach,using mobile phones and social media platforms like Whatsapp, Facebook and Twitter, to reach 4000 young people with information about safe and Post Abortion Care, Family Planning and other Sexual Reproductive Health services.
He notes that after identifying the gaps they worked on increasing the quality of post abortion care, FP and other SRH services by equipping health service providers with skills on modern technologies of post abortion care for young and vulnerable women in and out of schools including sex workers by December 31st 2021.
He however notes they are constrained by finances since Tusitukirewamu project is donor funded. “Projects have timelines, yet the number of clients we serve keeps growing, there are usually increases in cist of drugs we use to treat clients basing also on dollar rates in forex markets.”
The other issue that is most challenging is that of self medication by clients which creates more complications which require expensive regiments for treatment.
Dr. Kavuma also hopes that the project will be widened to reach out to other areas with in Kampala and probably in other districts.
He expresses concern over Uganda’s law on abortion which prohibits several acts and omissions relating to abortion and sets out to punish women and health workers who perform any of the prohibited acts.
He calls on legislators and policy formulators to put this right before to ensure a safe environment for women and enable them exercise their full reproductive and maternal functions.
A report by the Center for Reproductive Rights, CEHURD, abortion affects girls, women, health workers, lawyers, police, and communities, with victims being particularly stigmatized thus calling for a need for access to safe abortion services in Uganda.
It is unfortunate that no effort has been made to take advantage of the opportunity that is presented by Article 22 (2) of the Constitution to create a law that provides specific instances in which an abortion is permitted. Despite the significant progress in the policies that relate to access to safe abortion services, the law has barely moved an inch since the Constitution of Uganda came into force. CEHURD now works towards complementing efforts to realize a safe legal environment for women to access safe abortion and post aborting