SIRONKO: Jane Nakumiza, 17, lives in Nabidoko village in Sironko district and takes care of her nephew. Her mother died almost seven years ago following complications from a botched abortion.
She had reportedly become pregnant in a terrible gang rape during the ‘Kadodi’ dancing procession at night.
“She told us that she saw five men rape her and then she lost consciousness. She was just quiet most of the time after the rape; she didn’t want the baby and tried to abort two times, “says Nakumiza.
She explained that her second time attempt proved catastrophic. “When she was about seven months pregnant, I was called by a neighbour saying my sister had fainted. She was taken to Budadiri Health centre IV, but she didn’t make it.
Nakumiza says her sister had taken a concoction of some local herbs from a Traditional Birth Attendant to kill the baby and force it out.
Unsafe abortion is a major public health crisis in Uganda. It is a leading cause of preventable death and illness among women and girls of reproductive age, and post-abortion care, including care for severe health consequences, consumes significant resources.
According to Dr Charles Kiggundu, a Gynaecologist and Obstetrician, lack of information on contraceptives, myths about side effects, stigma on abortion and limited control of contraceptive choice especially for young women are big blockades.
“And do you know that the national unmet need for contraception stands at 40 per cent, meaning that four in 10 people who would want to use contraception cannot,” said Dr Kiggundu.
The estimates from the Guttmacher Institute, an organisation that advances sexual and reproductive health and rights, show that 297,000 induced abortions occur each year in Uganda.
“And of those, about 85,000 are able to receive treatment for unsafe abortion-related complications, while about 65,000 women experience complications resulting from unsafe abortion but do not receive any treatment,” reads the report in part dated June 2016.
The National statistics show that only nine per cent of adolescents are using some form of contraception, implying that majority still put themselves at risk through unsafe sex.
Nakumiza’s sister is just but an example of the many adolescents who have lost life because of unsafe abortions carried out in the hands of TBA or unqualified or quack doctors.
Dr Kiggundu says in Uganda 850,000 women get unwanted pregnancies yearly, with many either dying or sustaining related health complications.
“When a woman gets pregnant, she has put one of her legs in the grave because there is a one-in-16 chance of dying in pregnancy currently. Unfortunately, for some, the second leg joins the first one in the grave totalling to 1500 deaths due to pregnancy or childbirth in a year,” said Dr Kiggundu.
He explained that the more we look away from safer ways of abortion, the more women run to unsafe ways and as a result there are many women and girls walking on the streets without uteruses because of unsafe abortions.
He said unsafe abortions are performed unsafely by women using herbs, coat hangers, spoons, knitting needles, crude needles, sticks and pens and harmful pharmaceuticals.
A Makerere University law don Prof Ben Twinomugisha says the legal obscurity has influenced how abortion is perceived, and has influenced decisions made by both providers, and girls and women seeking abortion services.
“And as many healthcare providers do not understand what services they legally can and cannot offer, majority do not offer any leaving girls to die in silence in the process of abortion,” said Prof Twinomugisha.
He explains that because many girls and women believe abortion is illegal in all cases, each year thousands seek out abortions in unregulated and unsafe environments, or attempt an abortion themselves using crude means.
The incidence of abortion in Uganda
The ministry of Health statistics for 2016/17 indicate that 343 per 100,000 women who go to give birth die in the process and that 26% of these are due to unsafe abortion.
According to Dr Kiggundu, over 10,000 abortions are handled every year at Mulago hospital where women who have terminated pregnancies are assessed and treated and that the biggest barrier to accessing abortion is access to the service itself.
The minister of state for primary health care Ms Sarah Opendi says to tackle unnecessary deaths arising out of terminating pregnancies, the ministry of health proposed to introduce Manual Vacuum Aspiration (MVA) a safe medical procedure where a woman can end a pregnancy up to 12 weeks this never came to pass.
She said abortion remains illegal according to the Ugandan laws but added that women who get pregnant as a result of rape, violence or incest are allowed to terminate it the pregnancy.
“And I think government has allowed this only from advise of a qualified medical doctor in hospitals,” said Ms Opendi.
Prof Anthony Mbonye, a former director health services at the Ministry of Health explained that attainment of the SDGs is being hampered by a multitude of community-related and health systems gaps indirectly leading to high fertility, maternal and infant morbidity, mortality and disability.
He explained that there are about 300,000 abortions happening in Uganda yearly with about 1500 girls dying and the “vast majority” are unsafe that make government lose more than Shs 5.7b annually on consequences of unsafe abortion.
Abortion is legal according to Ugandan laws
The constitution 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.
The Penal code Act [Cap. 120], as amended through the penal code [Amendment] Act, 2007 [Act No.8 of 2007], sections 141-143 and 212 all prohibit abortion but section 224 on surgical operation 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,”
A section of the Penal Code Act says abortion is permitted in order to save a woman’s life, but another section says clients who have abortions, and healthcare providers who perform them, are at risk of up to 14 years in prison.
The executive director of Centre for Health Human Rights & Development [CEHURD] Mr Moses Mulumba says in the 1995 constitution and Penal code, abortion is legal in limited circumstances, in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the woman is in danger.
Mr Mulumba says these advances have not translated into wider access to safe abortion and that there have been no efforts by the government to educate the public about when and where legal abortion is available.
Ms Mary Adong, a midwife at Mulago hospital says with the absence of clear guidance, some health providers are reluctant to offer abortions for fear of prosecution because the Penal Code includes criminal penalties for women who have undergone an abortion, with punishment of up to seven years in prison, and anyone who helps them get one, can be imprisoned for up to 14 years.
Ms Adong adds that she has spoken to many women and girls, including survivors of sexual violence, who told her they would not talk to health providers about abortions because they fear people will think that they are immoral.
He said without a clear law on abortion in place, focus should be put on prevention now that women can access free contraceptives at government hospitals and cheaply in private facilities.
Existing loopholes in the law
Article 22(2) says exceptions can be made under two circumstances; if the health of the mother is at risk and when the health of the child is at risk.
Mr Moses Mulumba, a lawyer says: “Even though the Constitution does not allow abortion, it leaves a loophole that allows the opinion of trained medical personnel as a justification. Now this poses a handicap because trained medical personnel can be anyone, including chemists and pharmacists to authorise the process.”
Quack doctors exploit the law
Ms Adong says majority of the girls and women are unable or afraid of seeking safe abortion services and prefer cheaper services from quack doctors.
“And because majority of young girls do not want to visit hospitals for the ‘criminal abortion’ because they are well aware that it is against the law, they seek unsafe abortions and the result as you can expect often end up severe medical complications,” said Ms Adong.
Give support to girls
The Ugandan government should publicly support women and girls’ right to unhindered access to voluntary safe abortion allowed by law, and ensures that post-abortion care is available for all abortion-related complications. It should also provide access to quality family planning information and services.