MBALE – Hanna Namutosi, 19, was raped by a mentally ill man while walking alone in a bushy village path in Bududa district.
And when she missed her first period, she thought nothing of it. Her periods had always been irregular.
But after some time, she started vomiting in the morning and got nauseous whenever she the smelt eggs or mandazi or anything being fried.
Along the way pregnant and desperate, Namutosi faced a stark choice: risk her life by having a secret abortion, or risk her life bearing a child with a mentally ill person.
In the end, she opted for an abortion, something more than an estimated 840 girls and women undergo in Uganda and where on average five die as a result. Annually, unsafe abortions lead to more than 1,500 deaths.
One morning, she headed to a native doctor to get an abortion who asked her when she last had her periods while she pounded some purple and yellow leaves together with something that looked like the bark of a tree.
She added water to the mixture to form dark liquid which she instructed drink up the mixture and the next four days were hell for Namutosi.
Namutosi suffered excruciating cramps that rendered her bedridden. She bled profusely, losing both her strength and the pregnancy and eventually Namutosi passed on after over bleeding.
Namutosi is not alone, due to the illegal status of abortion in Uganda, the young who get pregnant against their choice [unwanted pregnancy] go for abortions even though some fear the risks associated with the procedure; whether safe of backstreet, cheap or expensive, they are willing to take a chance in this noxious act.
It is clear that the Ugandan law allows abortion to save a woman’s life and national guidelines permit abortion under additional circumstances—including in cases of fetal anomaly, rape and incest, and if the woman is HIV-positive, but safe and legal abortion is difficult to obtain.
As a result, many women resort to unsafe abortion, which accounts for more than 10% of all maternal deaths in Uganda according to the Centre for Health, Human Rights and Development, a Kampala-based research and advocacy organization.
According to Dr. Charles Kiggundu, a Consultant Obstetrician Gynaecologist at Mulago National Referral Hospital, 10,000 abortions are handled every year at the hospital where women and girls who have terminated pregnancies are assessed and treated.
He explained that although Uganda’s law permits induced abortion only to save a woman’s life, many women and girls obtain abortions often under unhygienic conditions because of fear and stigmatisation.
Mr Moses Mulumba the Executive director at CEHURD says each day an estimated 840 girls and women have an abortion in Uganda and on average five die as a result and that annually, unsafe abortion leads to more than 1,500 deaths.
He explained that the poor and rural girls and women whose access to skilled providers is limited by financial constraints and geographic distance, often result to abortions performed by untrained providers using unsafe methods or attempt to self-induce an abortion.
“And some of them try to induce abortion themselves using highly dangerous methods, while others purchase abortion-inducing drugs from pharmacists or other vendors and some reportedly drink gasoline or take untested combinations of herbs and drugs to induce an abortion and eventually die in the process,” said Mr Mulumba.
He said the case of Namutosi and other young girls have died because the laws and policies on abortion are unclear in Uganda and are often interpreted inconsistently, making it difficult for women and the medical community to understand what is legally permitted.
“For example the Uganda 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 explained that 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 because the interpretations of the law is ambiguous adding that medical providers may be reluctant to perform an abortion for any reason for fear of legal consequences.
A research by U.S based Guttmacher Institute and Makerere University, also says at least 57,000 abortions took place among Ugandan adolescents in 2013 and that an estimated 314,300 abortions occurred in Uganda in 2013 among all age-groups, and more than 93,000 women were hospitalized for complications from unsafe abortion.
The World Health Organisation and the Population Division of the United Nations Department of Economic and Social Affairs, 2017 says that Women, including adolescents, with unwanted pregnancies often resort to unsafe abortion when they cannot access safe abortion.
And according to WHO around 22 million unsafe abortions are estimated to take place worldwide each year adding that each year between 4.7 percent and 13.2 percent of maternal deaths can be attributed to unsafe abortion
The Guttmacher Institute and Makerere University 2010 report says that in addition to a range of other factors, restrictive laws are a barrier to accessing safe abortion.
Abortion is allowed in Uganda when if the health of the mother is in danger or once authorised by medical personnel But many doctors invoke their religious faith and refuse to carry them out.
As a result, some women abort illegally and authorities largely turn a blind eye to the situation or arrest the medical personnel who carries it out to save a mother.
According to doctors, many young girls prefer a method called ingesting Misoprostol, an over-the-counter drug used to treat ulcers, which causes the expulsion of the embryo but that it can also cause serious complications for the mother.
Ms. Agatha Nafuna, a retired midwife, however, counsels those who use the drugs to use them safely and to seek emergency or professional treatment at established health centres.
The law and punishment in Uganda
Article 22(2) of the Constitution says: “No person has the right to terminate the life of an unborn child except as may be authorised by law.”
Section 141 of the Penal Code states punishment for any person who abets abortion in any form, it says: “Any person who, with intent to procure the miscarriage of a woman whether she is or is not with child, unlawfully administers to her or causes her to take any poison or other noxious thing, or uses any force of any kind, or uses any other means, commits a felony and is liable to imprisonment for fourteen years.”
The same Penal Code Section 142 says a woman who procures her own miscarriage commits a felony and is liable to imprisonment of up to seven years.
The District Health Officer for Bulambuli Dr. Muhammad Mulongo says although he supports the law, there is a religious and cultural clash on the issue.
He added that medical research suggests that in low-income countries like Uganda, procuring safe abortion saves lives, improves choices and empowers women.
The dilemma is the cultural, religious and ethical arguments.
UN stand on abortion
Last year, World Health Organisation and the Population Division of the United Nations Department of Economic and Social Affairs launched a new, open-access database of laws, policies and health standards on abortion in countries worldwide.
The database aims to promote greater transparency of abortion laws and policies, as well as to improve countries’ accountability for the protection of women and girls’ health and human rights.
They said Women, including adolescents; with unwanted pregnancies often resort to unsafe abortion when they cannot access safe abortion. According to them, around 22 million unsafe abortions are estimated to take place worldwide each year.
Each year between 4.7 percent and 13.2 percent of maternal deaths can be attributed to unsafe abortion, they said. In addition to a range of other factors, restrictive laws are a barrier to accessing safe abortion.
The authors of an article about the new Global Abortion Policies Database, stated: ‘According to an analysis by the UN, the average rate of unsafe abortion is estimated to be more than four times higher in countries with more restrictive abortion laws than in countries with less restrictive laws.”
The database includes information on a broad range of policy areas. These include; legal grounds and related gestational limits, authorisation and service-delivery requirements, policies about who can provide abortion and where, when and how abortion services are permitted, and criminal penalties for women, girls, health-care providers and others.
In addition to data on specific abortion policies, individual country profiles include sexual and reproductive health indicators, links to ratified human rights treaties, and links to UN Treaty Monitoring Body Concluding Observations and Special Procedure Reports, which address abortion.
Honest discussions are needed urgently on abortion to save women, girls
Mr Mulumba says abortion has been controversial in religious spheres, not just in Uganda alone, but also in many other African countries.
He added that but given the risks that many women and girls are facing in Uganda at the hands of quack doctors and sexually abusive individuals, it might be time to have an honest discussion around these divisive issues in order to save lives and reduce teenage pregnancies.
“Blaming the explosion of abortion and teenage pregnancies on moral decay and then doing nothing to correct it is akin to burying our heads in the sand and hoping for miracles. Teenage pregnancies are clearly not of miracle conception and the solution lies with society,” Mr Mulumba says.
–Inability to get pregnant due to infection or complication from an operation.
-A possible hysterectomy as a result of complication or injury during the procedure.
-Hemorrhage (heavy bleeding).
-Incomplete removal of the unborn child, placenta, or contents of the uterus requiring an additional operation
-A hole in the uterus (uterine perforation) or other damage to the uterus.
-Injury to the bowel or bladder.
-A cut or torn cervix (cervical laceration).
-Complications from anesthesia, such as respiratory problems, nausea and vomiting, headaches, or drug reactions.
-Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.