MBALE – When Ms Sarah Nambozo got married, she had her family life planned out well.
This is because she did not want to produce too early, too soon, too often and too late.
Her plan and target was to have three children and remain at her workplace stable by the age of 35.
And everything had gone according to the plan by the time she gave birth to her third born in February 2017.
With her staunch Christian background, she believed in the natural family planning paradigm to ensure that children are conceived with a reason and that human beings must focus on responsible procreation and responsible parenting.
“And you know that spacing of pregnancies is vital as it keeps mothers safe and reduces health risks,” said Nambozo
She said families who space births are in a better position to meet the needs of their children; “Responsible and reasonable spacing of children also contributes to ensuring education for all and promotes women empowerment,” she said.
She had a good career as a social worker in the lower local government in Sironko district and married to a Senior assistant secretary [Sub-county chief] with two children aged nine and six years.
And about seven months after the birth of her third born, Nambozo started taking birth control pills.
“The pills were my most favourable option because I was not ready to use an intrauterine coil. I had also ruled out other methods of family planning like the implant because of previous heavy menses,” she said.
Having taken her pills religiously, Nambozo was shocked when she started to miss her periods a year later.
“I was not worried at first because I had taken my pills religiously well and there is no way I could have gotten pregnant,” Nambozo said.
But even then she knew something was wrong because she had missed her periods for the two month in a row. “I became very unease. My mind told me to take a test, but I was frightened. And I took a decision to wait for another month,” Nambozo added.
Nambozo took a test and the test was positive. “I was shocked and angry because I had not planned to have another baby,”
She decided to keep her pregnancy away from her husband as she contemplated what to do. “I had to act fast before any pregnancy signs could emerge; I decided to procure an abortion,”
“I shared my options with a close friend who is a doctor and got a trustable referral to get rid of this pregnancy,” Nambozo said.
Nambozo took a day off work and went for her secret abortion. “I took a surgical abortion using a suction method and the procedure lasted less than 15 minutes,” she added.
Currently, Nambozo is using long-acting reversible contraception as her preferred family planning method.
“I don’t regret to have aborted because conception is a choice and a right for every woman. And I can still go for another abortion if I got pregnant again, I don’t want to carry a pregnancy I haven’t planned for,” Nambozo says.
Her sentiments resonate with experiences of many married women in Uganda procuring abortions today.
According to the 2011 Uganda Demographic and Health Survey (DHS), more than four in 10 births are unplanned and that figures from Uganda Bureau of Statistics (UBOS) show that Ugandan women, on average, give birth to nearly two children more than they want (5.4 vs. 4.2).
The demographic and health survey adds that a significant number of women who procure abortion for the first time are likely to do it again.
It would be easy to assume the majority of abortion cases are procured by unmarried women or helpless, young girls. But, there are many married women who procure abortions in Uganda.
Dr. Charles Kiggundu, a consultant senior gynecologist attached to Mulago national referral says women above 40 years [married] are increasingly accessing abortion services in the country
Dr Kiggundu explained that this trend has taken the medical world by surprise since it’s usually abortions among teenagers that are common.
“We are receiving women above the age of 40 seeking to procure abortion services. About four out of 10 women who come to Mulago to procure abortion are 40 and above. The trend is increasing and as medics, we are wondering what could be the cause,” Dr Kiggundu said during the two-day dialogue on the role of religion and culture in promoting and regulating sexual reproductive health and rights.
He said further that some of the major reasons married women opt for abortion are failure to use contraceptives, failed and untimed contraceptives and that it is hard to estimate the numbers of married women who abort because the terminations are done silently behind closed doors.
Reports from medical personnel from the ministry of health also suggest that some women could be widows and when they engage in sexual activities and end up getting pregnant, they fear their in-laws would rebuke and shun them.
Dr Kiggundu also stated that some women may engage in extramarital affairs and may feel like not getting another child from a different clan, hence resorting to abortion.
Dr Kiggundu explained that some women think they have reached the menopause stage and when they engage in unprotected sex, they end up getting an unwanted pregnancy.
Menopause is a natural biological process that happens to every woman and is a time that marks the end of a woman’s monthly menstrual cycles. This situation is diagnosed after a woman has spent at least a year without experiencing her monthly menstrual periods. Menopause usually occurs in women between their 40s and 50s.
“These women try as much as possible to conceal the act because they do not want the society to lash out at them,” he added.
According to the 2011 Uganda Demographic and Health Survey, more than four in 10 births (43%) are unplanned. The proportion of births that are unplanned is higher among rural, poor and less educated women than among their urban, wealthier and better-educated counterparts.
Data from Guttmacher institute report February 2017, titled Abortion and Post Abortion Care in Uganda, adds abortion rate for Uganda is slightly higher than the estimated rate for the East Africa region as a whole, which was 34 per 1,000 women during 2010–2014.
The 2017 data also reveals that within Uganda, abortion rates vary widely by region, from 18 per 1,000 women in the Western region to 77 per 1,000 in Kampala.
The report notes that nearly two-thirds of women who seek post-abortion care services are married, 22 per cent single, divorced or separated (12 per cent) while 4.4 per cent are widowed.
A related study conducted by Marie Stopes and published in the journal Plos One in November last year shows 24.4 per cent of women in Kampala who procure abortions are married, partnered or cohabiting.
Dr Muhammad Mulongo, a Gynecologist at Mbale hospital says when an educated woman or one pursuing studies falls pregnant out of her plans, they see abortion as the perfect solution to stop her career and academic plan from crumbling.
“Having a baby is not as easy as it sounds. It takes sacrifice and commitment,” Dr Mulongo says adding that many women out there also opt for abortion because they do not want to have any children at all.
It is true that the procurement of abortion reflects the conception of unwanted pregnancies in Uganda.
According to a 2013 report by the Centre for Reproductive Health Uganda titled; A Technical Guide to Understanding the Legal and Policy Framework on Termination of Pregnancy in Uganda, abortion in Uganda is a widespread problem and alarming because of complications from the procedure.
The report reveals that every 60 minutes, slightly over 33 women will have had an abortion and that by the end of the day, a whopping 800 abortions will have been carried in Uganda, translating to 292,000 abortions annually, out of these 1,500 will die.
Dr. Kiggundu says that half of the two million pregnancies that occur every year 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.
He said the high rate of unsafe abortion is caused by multiple factors including persistent low contraceptive use with only 26 percent of married women and 43 percent of sexually active unmarried women said to be using at least one modern method.
Medical experts in the country insist that the persistence of the number of Ugandan mothers dying as a result of child-bearing related causes—currently estimated at 438/100,000 live births is due to unsafe abortion and that if the trend persists, Uganda will not meet its commitment to achieve a reduction in maternal deaths to the set goal of 150/100,000 live births.
The medical experts recommend that the government should ensure that free or affordable public-sector family planning services reach all women—especially those who are poor and young—to reduce unmet need for contraception and lower the incidence of unintended pregnancy.
Dr Jonathan Wangisi, the DHO Mbale says that health programs should offer comprehensive family planning services—including counseling and a wide range of contraceptive methods—to enable women to choose the best methods for them, to use methods effectively and to switch methods when desired.
Dr Mulongo says that there is need to expand and improve the quality of post-abortion care services to treat the often serious health complications resulting from unsafe abortion and that health authorities should allocate greater resources to post-abortion care and prioritize incorporating counseling and provision of contraceptives into this care.
But Mr Moses Mulumba, the executive director Centre for human rights and development [CEHURD] an local NGO advancing social justice and health rights in health systems in Uganda wants the government to clarify Uganda’s abortion law and policies, and raise awareness of the content and scope of Uganda’s abortion law among the medical community, the judicial system and women.
Mr Mulumba thinks that for Uganda to overcome unsafe abortions done in hiding under unqualified personnel, it needs to put into practice the Maputo Protocol which it signed with other 52 African Union states.
“This agreement advocates licensing abortion and specifies under which conditions a mother should have an abortion. In the long run, it aims at saving the mother’s life,” he said.
But during a university dialogue on sexual rights organised by reproductive health late last year, the minister for Primary Healthcare, Ms Sarah Opendi, said that before anyone talks abortion, they should put emphasis on family planning.
“Yes, this will prevent the consequences of any unwanted pregnancies. However, what happens when a woman is faced with no option after the pregnancy happens anyway, what happens?” she wondered. “Also, abortion is not a pleasant thing that you go around doing, it is not at all!”