MBALE – When Ms Agatha Negesa [Not her real name] 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.
She had a plan and target of having three children but also remaining at her workplace stable by the age of 35.
Everything went well according to her plan by the time she gave birth to her third born in February 2017.
Negesa is a Christian and given 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 ought to focus on responsible procreation and responsible parenting.
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.
“And also spacing of pregnancies is vital as it keeps mothers safe and reduces health risks,” said Negesa said.
Negesa had a good career as a social worker in the lower local government in the Sironko district and was 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 thirdborn, Negesa 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, Negesa 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,” Negesa said.
But even then she knew something was wrong because she had missed her periods for two months in a row. “I became very uneasy. My mind told me to take a test, but I was frightened. And I took a decision to wait for another month,” Negesa added.
Negesa 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,” Negesa said.
Negesa 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, Negesa 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 get pregnant again, I don’t want to carry a pregnancy I haven’t planned for,” Negesa says.
Her sentiments resonate with the experiences of many married women in Uganda procuring abortions today without the knowledge of their men.
According to the 2011 Uganda Demographic and Health Survey (DHS), more than four in 10 births are unplanned and figures from the 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.
The data adds that although it is easy to assume that majority of abortion cases are procured by unmarried women or helpless young girls, there are many married women who also 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 years 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, so they also opt for abortions.
Dr Julian Abeso [Mbale referral Hospital said 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 Abeso explained that some women think they have reached the menopause stage and engage in unprotected sex, but when they end up in an unwanted pregnancy, the only solution at their disposal is abortion.
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.
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 the Guttmacher institute report in 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 percent single, divorced, or separated (12 percent) while 4.4 percent are widowed.
A related study conducted by Marie Stopes and published in the journal Plos One in November last year 2019 shows that 24.4 percent of women in Kampala who procure abortions are married, partnered, or cohabiting.
Dr Muhammad Mulongo, a Gynecologist [Mbale regional hospital] says like Ms Negesa 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 but to end this, we must involve men in the family planning services,” said Dr Mulongo.
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 out 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.
Dr Abeso recommends that government should ensure that free or affordable public-sector family planning services reach all women—especially those who are poor and young—to reduce the 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.
Mr Moses Mulumba, the former executive director Centre for human rights and development [CEHURD] an local NGO advancing social justice and health rights in health systems in Uganda says 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 in 2019, the minister for Primary Healthcare then, Ms Sarah Opendi, said that before anyone talks about 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!”