Despite large reductions in pregnancy related deaths in Uganda over the past two decades (the maternal mortality ratio dropped from 684 per 100,000 live births in 1995 to 343 per 100,000 in 2015 as per Ministry of Health records), the high number of maternal deaths remains a public health challenge.
Unsafe abortion continues to contribute significantly to maternal morbidity and mortality. A 2010 report by the Ministry of Health estimated that 8% of maternal deaths were due to unsafe abortion.
According to the senior programmes manager at Centre for Health, Human Rights and Development (CEHURD), Rose Wakikona, 52% of pregnancies in Uganda are unplanned and 25% of these end up being terminated.
In 2018, a study by researchers at the U.S. based Guttmacher Institute and Makerere University found that an estimated 57,000 abortions took place among Ugandan adolescents in 2013.
According to the World Health Organization, complications during pregnancy and childbirth are the second most common cause of death among 15 to 19 year-old girls and every year and approximately 3 million girls aged 15 to 19 undergo unsafe abortion.
“Unsafe abortions could lead to serious complications and even death. However, if it is done by a certified medical person, it’s 98% safe and there are 2% chances of having complications,” Diana Bisaso, a doctor at Sas Clinic Bombo said.
Post abortion treatment cost, a nightmare for the poor individuals
Marie Stopes, a private family planning and reproductive health organisation in Uganda, notes that unsafe abortions exert a huge economic burden on the public health system and the post abortion care cost is alarming considering the less privileged girls and women who might need it.
Faith Kyateka, the Head of Communication and Policy at Marie Stopes said that nursing complications resulting from unsafe abortions puts poor women at risk as they can’t afford the expenses.
“It costs a whopping Shs 7.5 billion yearly to treat complications related to unsafe abortions. The cost implication on procuring an abortion also prevents poor rural women from accessing the services,” Kyateka said.
Other sources reveal that in some big hospitals, the range of carrying out an abortion, although done illegally, can go from Shs 700,000 to 1 million.
Kyateka said that due to this, the poor women and those living in rural areas are at increased risk of carrying out unsafe abortions with 69-75% likely to experience complications, compared to the 17% of the non-poor, urban women.
“This is made worse by the fact that rural women often lack access to accurate reproductive health information and knowledge that can empower them to make the right choices and decisions to protect their lives,” she added.
Ugandan laws against abortion
Media reports and data from various health agencies indicate that abortion cases have been on the rise even when the Constitution of Uganda prohibits the procedure.
Article 22 (2) of the 1995 Constitution of Uganda notes that, “No person has the right to terminate the life of an unborn child except as may be authorised by law.”
The law also explicitly allows abortion to save a woman’s life. However, the 2012 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights permits abortion under additional circumstances, including in cases of fetal anomaly, rape and incest, or if the woman is HIV-positive.
“For many girls and young women who have no access to this information, coupled with the stigma that comes with the practice, unsafe abortion is an option they have taken, which in turn puts their lives in danger as they don’t get proper post abortion treatment,” Kyateka said.
More so, Kyateka explained, the lack of friendly sexual reproductive health services pushes the young adults away from the general health facilities for fear of being judged and ridiculed.