Police in Bududa district mid this year arrested two people for allegedly conniving to procure an illegal abortion.
It is alleged that a one Sarah, a friend of the girl (Oliver, 16) who aborted, led her to the traditional birth attendant and requested her to help terminate the four-month pregnancy, claiming that the man responsible had declined to provide assistance.
The police alleged that the TBA used quack chemicals prepared locally (Nanda) which had adverse effects on the teenager.
Ms Agatha Nafuna, a retired midwife says when the girl was brought to Bukigai health Centre IV, she was suffering from sepsis Gangrene and incomplete removal of the foetus from the womb. Police was tipped on the illegal abortion and arrested the TBA and Sarah.
The TBA and Sarah represent thousands of TBAs, medical workers and doctors who have been arrested in connection with procuring abortion and assisting young girls to procure abortion in circumstances beyond their control.
Many medical experts and NGOs say that such people are never apprehended because Uganda’s reproductive health laws and policies addressing abortion are unclear and difficult to apply.
Ms Nafuna says the causes of maternal deaths have long been known and majority of them are deemed preventable.
“In Uganda, about 16-20 women, majority of them in their teens and twenties, die daily while pregnant, having a baby or from complicatedabortion,” Ms Nafuna said.
According to teenagers who preferred anonymity, the stigma that youth suffer while accessing services on sexual reproductive health has made many adolescents shy away from asking questions about it.
“And once you find yourself pregnant and not ready to bring up a child, you just seek unsafe abortion from a TBA who wont ask you questions,” said Sarah, a youth who preferred anonymity.
She added that medical personnel usually ask so many questions which they cannot answer.
Laws on Abortion
The Uganda Police force spokesperson AIGP Asan Kasingye said: “Our constitution is clear in Article 22(2) that “No person has the right to terminate the life of an unborn child except as may be authorized by law.”
Mr Jacob Ojok, a lawyer based in Kampala, said under Section 143 of the penal code, any person who supplies anything knowing that it will be used unlawfully to terminate a pregnancy can be punished upon conviction with imprisonment for a period not exceeding three years.
Legal practioners say police rely on the colonial Penal code Act whose provisions on the legally permissible grounds for termination of pregnancy are vague and poorly understood, severely limiting access to safe, legal abortion and post-abortion care services and contributing to a high number of deaths and injuries from unsafe abortion.
Mr Yusuf Mutembuli, a legal practioners based in Mbale, says every woman and adolescent girl has a right to make informed decisions about their reproductive health but that the laws in Uganda are not clear about this.
“Uganda’s abortion law punishes women and girls who choose to end a pregnancy and criminalizes the health workers that offer them legal post-abortion care, which is wrong,” Mutembuli said.
He urged government to clarify its law and expand access to safe and legal abortion services in the country to save the lives of women dying because of illegal abortions.
The executive director of Center for Human Rights and Development [CEHURD] Mr Moses Mulumba said the Ugandan law allows abortion under some circumstances, but laws and policies on abortion are unclear and are often interpreted inconsistently, making it difficult for women and the medical community to understand what is legally permitted.
“The Ugandan Constitution states in article 22 on protection of life that no person has the right to terminate the life of an unborn child except as maybe authorized by law, this means that abortion is permitted if the procedure is authorised by law,” Mulumba said.
He revealed that under the 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, pregnancy termination is permissible in cases of fetal anomaly, rape and incest, or if the woman has HIV.
He said because the interpretations of the law are ambiguous, medical providers may be reluctant to perform an abortion for any reason for fear of legal consequences.
Prof Ben Twinomugisha, a lecturer at the School of Law, pointed out that the 1995 Constitution and the Penal code Act allow induced abortion in some circumstances but police ignore this provision.
“The continued arrests of those who carry out abortion reflect that police are ignorant of the law as provided in the Uganda Constitution Article 22(2) which gives conditions under which an abortion can be done,” Prof Twinomugisha said.
He criticised government for sticking to the law against abortion in the penal code which was enacted by colonialists, saying the current Penal Code police are using was passed in 1954 and the British that were using it have since repealed it.
He said police should consider the consequences of unsafe abortions and stop demonising the act and arresting those who carry out abortion with impunity.
Prof Twinomugisha also urged judicial officers and police to look beyond the criminal laws when trying reproductive health offences.
“Consider a young girl who has been raped by her father and tries to procure an abortion and is arrested and brought before the criminal justice system,” Prof Twinomugisha said.
“It’s time the government amended the abortion law and implemented health policies to ensure women and girls can get the health services they need and deserve,” Prof Twinomugisha added.
Dr Anthony Mbonye, the acting director general of health services at the Ministry of Health, said the ministry released a post-abortion management policy last year that aims at reducing the deaths caused by unsafe abortions done with the help of untrained professionals.
He said the policy provides useful guidance for the interpretation of the laws that provide for abortion and sets a standard in medical practice that should guide the provision of access to safe abortion services in the country.
Extent of Abortion in Uganda
Dr Charles Kiggundu, the vice president Association of Obstetrics and Gynecologists of Uganda, said an estimated 297,000 induced abortions occur in Uganda annually, with nearly 85,000 women receiving treatment for complications from unsafe abortion.
Dr Kiggundu added that about 65,000 women experience complications resulting from unsafe abortion but do not receive any treatment.
He said half of the two million pregnancies that occur annually in Uganda are unwanted and as a result , about 400,000 are aborted, with 90,000 of them resulting in severe complications, which most times lead to death.
Medical experts insist that the persistence of maternal mortality that currently stands at 438/100,000 live births is due to unsafe abortion.
They say if the trend persists, Uganda will not meet its commitment to achieve a reduction in maternal deaths to the set Sustainable Development Goals [SDGs] of 150/100,000 live births by 2030.
He said abortion is a silent killer of Ugandan mothers and has increased from 20 per cent in 2001 to about 32 per cent in 2014/2015.
Dr Kiggundu said the high rate of unsafe abortion is caused by multiple factors including persistent low contraceptive use with only 26% of married women and 43% of sexually active unmarried women said to be using at least one modern method.
Dr Kiggundu said this may not be the indicative of the actual rate “as abortion is commonly hidden in hemorrhage and sepsis figures due to stigma.
“And in 2013 maternal and perinatal death review found that unsafe abortion is the first or second highest contributor to preventable maternal mortality,” Dr Kiggundu said.
Ms Evelyne Opondo, the regional director for Africa at the Center for Reproductive Rights while releasing the report entitled; Stakes Are High: The Tragic Impact of Unsafe Abortion and Inadequate Access to Contraception in Uganda August 17, said although the country’s laws permit abortion for women not only to save a woman’s life but also on mental and physical health grounds, many people don’t understand the laws, including the implementers of the law.
She said due to unclear abortion laws in Uganda, women and adolescents continue seeking unsafe abortions and are vilified by their families and communities—even the doctors and health
“Abortion in Uganda is legal in limited circumstances, yet approximately 85,000 women each year receive treatment for complications from unsafe abortion and an additional 65,000 women experience complications but do not seek medical treatment due to fear and stigmatisation,” Ms Opondo said.
A report entitled; Facing Uganda’s Law on Abortion: Experiences from Women and Service Providers” a sexual and reproductive health advocacy publication highlighting experiences and perspectives of individuals who have been affected by or dealt with abortion says it is high time government made safe abortion legal to save women and young girls.
Another report from Uganda Human rights Commission reveals that the body is pushing for legal abortion in the country as a human right for every woman and girl to ensure that legal abortion is treated as a basic human rights issue.