KAMPALA – 12th August is a day dedicated to the role young women and men play in bringing change in tackling global issues and achieving sustainable development. It also serves as an opportunity to raise awareness of challenges and problems facing the world’s youth.
In our society, one of the biggest challenges facing the youth has been Teenage pregnancies and unsafe abortion, among others.
The Covid 19 pandemic impacted all aspects of life in Uganda most especially disruptions in access to health and social services. No group has felt the effects of the pandemic more than adolescent girls. Today the high rates of teenage pregnancy can be attributed to disruption to programs that support access to sexual reproductive health services and information to school girls. The current economic hardships have led to some parents to marry off their daughters in order to make money to survive.
According to a recent study from the UN population fund, a total of 354,736 teenage pregnancies were registered in 2020, while 295,219 teenage pregnancies were registered between January to early September 2021. This implies that on average, over 32,000 teenage pregnancies are recorded per month.
This has unfortunately resulted in most teenagers dying while giving birth, something that contributes to the high maternal mortality rate every year.
According to a report published by UNFPA in January this year, If no action is taken to end teenage pregnancy, about 64% of teenage mothers will not complete primary education level; 60% of teenage mothers will end up in peasant agriculture work and annually more than 645 billion Uganda shillings an equivalent of 181.8 Million USD will be spent by Government of Uganda on healthcare for teen mothers and education of their children. From this report it is clear that if the teenagers do not attain higher but also meaningful education, they will become a huge burden to communities and the country at large because they will slide into the segment of the Ugandan population that cannot fend for themselves. Also important to note is that if steps are taken to protect girls to avoid early pregnancies and marriages, the country would be saving the 645 billion shillings that could be used to provide services to the population.
It is estimated that around 46,000 women die every year because of unsafe abortions and that as many as 5 million are either permanently or temporarily disabled because of abortion related complications. In addition, there are psychological responses that are more difficult to assess than physical detriments. Some reasons behind women’s choice to terminate a pregnancy are related to factors such as being very young and wishing to postpone childbirth, relationship problems, economic reasons, rape and/or social stigma related to being pregnant while unmarried. These are life circumstances influenced by gender inequalities and power relations between women and men in our society.
Uganda’s reproductive health indicators are poor. For instance, the maternal mortality ratio is 310/100,000 live births, or almost 5000 women dying annually of pregnancy-related causes. Unwanted pregnancies have been strongly linked to unsafe abortions, constituting nearly one third of maternal deaths among the country’s young people.
It should be noted that Ugandan law permits abortion under certain conditions, but laws and policies on abortion are imprecise and often interpreted incoherently. This makes it difficult for women as well as the medical community to comprehend what is legally permitted.
The 1995 Constitution of the Republic of Uganda is the supreme law of Uganda. Article 22(2) provides that, ‘No person has the right to terminate the life of an unborn child except as may be authorized by Law’.
While not speaking exclusively to abortion, it is obviously inclusive of abortion. This article does not, itself, indicate substantively the circumstances in which abortion is authorized. Rather, it merely serves a legitimizing role of giving constitutional legitimacy to legislative instruments and common law that regulate abortion but without providing explicit substantive content as a yardstick.
The legislative provisions of the Penal code of Uganda mainly provide for criminal sanctions to several aspects of abortion and a defence against prosecution for an offence relating to abortion.
Uganda’s National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights have expanded the circumstances under which an abortion could legally be carried out to include cases of severe fetal abnormalities; criminal circumstances such as rape, defilement and incest; and health circumstances affecting the mother, such as cervical cancer, HIV or renal or cardiac complications. But these do not have a legal backing.
Because interpretations of the law are unclear, medical providers might be hesitant to perform an abortion for fear of legal consequences. A national estimate of abortion incidence in Uganda reported an annual abortion rate of 53 abortions in every 1000 women, which is much higher than the average rate for Eastern Africa (36 abortions per 1000 women)
It has been estimated that about 297,000 illegal abortions are performed yearly in Uganda. A large proportion of these abortions are conducted under unsafe conditions by people without medical training, resulting in nearly 85,000 women treated annually for abortion related complications.
Almost all abortions in the country take place under clandestine settings and pose a serious threat to women’s health and wellbeing whereas the cost of treating complications of unsafe abortion drains already scarce resources from the national health system and places a heavy economic burden on women and their families.
As we commemorate this day, Let us be a progressive country that is alive to the needs of its population, with the following as recommendations
Policy makers and the relevant Government stakeholders like The Ministry of Health, let’s bring back progressive Standards and Guidelines to guide our professionals who are afraid of falling on the wrong side of the Law, Lets equip them with the tools to fully advocate for SRHR
Programs and policies are needed to help reduce recourse to unsafe abortion and lessen the negative consequences of such abortions. In particular, it is important that safe abortion services be provided to the full extent allowed by Law.
A concerted effort is needed to reduce the costs associated with post abortion care in order to reduce the economic burden it places on women, especially poor women and their families.
Women need accurate information on the availability of contraceptive services and greater efforts are needed to ensure that poor women in particular, are aware of and have access to these services.
We can all be the change we want to see.
The author, Nsiimenta Sauni Samantha is the Executive Director, The Advocates for Elimination of Discrimination Against Women (ADAW International)