Gender equality and unsafe abortion in Uganda

11 March 2016

As part of our Mother’s Day and International Women’s Day blog series, HART Ambassador, Sophie Kleanthous writes on gender equality and unsafe abortion in Uganda. 

I was first made aware of the complicated abortion regulations and procedures in Africa when I was volunteering for my Amnesty International Society at my University. I was working on a campaign to end the abortion ban in El Salvador where girls as young as 5 who were sexually abused have been forced to give birth despite the serious health implications. I was shocked to find that in Uganda unsafe abortion procedures and after-care is killing many women and endangering their new-borns. Itis estimated that of the 297,000 abortions performed in Uganda every year, 85,000 women have been treated for complications as a result of poor sanitation and a general lack of sexual health education and family planning. At the moment, most of the severe complications as a result of the abortions lead to death.

The abortion laws in Uganda are very unclear. Though abortion is not completely illegal, doctors have to go through a very difficult and complicated process to help their patients and can only perform abortions if the mother’s life appears to be in danger. The long implementation process increases the risk of the mother’s health deteriorating, as they have to wait for their doctor’s application to go through a board of directors before anything can be done. In fact:

According to the Penal Code, a doctor who thinks that an abortion is justified to save the life of the mother, must write to the director general of medical services in the health ministry, seeking approval to terminate the pregnancy. Upon receipt of the letter, the director general is supposed to convene a medical board, composed of experts, to scrutinise the case and, if satisfied, appoint a specialist to carry out the procedure.”

The penal code also includes a prison sentence for anyone who has an abortion or is involved in the process. Consequently, a nurse or doctor can face a sentence from three to fourteen years in prison. The strong religious values in Uganda also cause trouble for women in need of an abortion, and anyone who is pro-choice may be cast aside from society.

This code just does not work in practise. For example, in emergency cases, going through this legal process would waste time and money, as well as risking lives. Many women are forced to look for other options, and in Uganda this means going to an illegal and unsafe clinic. This is where the high number of deaths from abortion originates from:

Abortion seekers usually go to illegal clinics, where procedures are performed under unhygienic conditions by under-trained practitioners. Such procedures usually lead to a high rate of death and severe complications, leading to diversion of substantial, scarce healthcare resources.”

 In the United Kingdom, abortions are legal up to 24 weeks under the Abortion Act 1967. It is done in a safe and sterile environment and forms a routine part of healthcare on the NHS. There is a clear need to prioritise sexual education and safer care services in many developing countries such as Uganda. So, why are millions of women dying from such a preventable cause?

Charles Akena/IRIN
Charles Akena/IRIN

Further Causes

According to Dr. Charles Kiggundu, a leading Gynaecologist and Obstetrician in Uganda, there are multiple causes for the high number of abortions every year. He argues that one of the main reasons is deteriorating contraceptive use; in Uganda only 26% of married women and 43% of sexually active unmarried women are recorded to be using birth control. In contrast, 75% of women aged 16-49 years use some type of contraception” in the UK. This shows that number of women in Uganda who are actually using contraception is incredibly low, and Dr Kiggundu notes that more needs to be done in Uganda to educate women and men to practise safe sex.

A recent study found that a woman in Uganda is much more likely to go through an unsafe abortion than go through the legal process of obtaining permission to undertake the procedure. As the study notes:

“There is an urgent need for programmes and policies that help address women’s reasons for obtaining unsafe abortion and diminish the consequences of such abortions, in particular through the provision of abortion services to the full extent of the law.”

The cost of abortion in Uganda is very high, with some women paying up to 59,600 Ugandan shillings for their abortion and this is before costs for extra days spent in hospital and treatments for any health complications during the abortion are added on. Many women and men in Uganda are living in abject poverty so these funds simply are not available to them. Furthermore, with the price of abortion increasing every year, more women will choose the unsafe method and risk the welfare of both their family and themselves. Therefore:

“In addition, concerted efforts must be made to reduce the overall costs associated with post-abortion care, so that women suffering from complications of unsafe abortion do not have to sacrifice the well-being of their families to receive treatment”.

However, there is some good news. At a family planning summit that took place in 2012, Museveni, the President of Uganda announced that the government would be investing in aftercare and family planning to “increase its annual expenditure on family planning supplies from $3.3 million to $5 million for the next five years.” Furthermore, The Ministry of Health in Uganda has proposed to set up a plan to ensure that there is universal access to family planning nationwide and improve upon the current maternal and prenatal services that are available to Ugandan women.  

After-care is very scarce as the hospitals simply do not have enough staff or resources to accommodate this, so this investment into family planning is a very positive and welcome change. In the short-term, many things can be done to increase awareness of this issue in Uganda, such as increasing provision of mental and sexual health education programmes, and introducing sexual consent workshops. If these initiatives are put in place I think more women will be aware of their rights and have a greater understanding of contraception. I believe this would help to significantly reduce the number of deaths associated with unsafe abortions.

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Disclaimer: This blog is a space for discussion and personal reflection. Any opinions expressed within the blog are those of the author and are not necessarily held by HART. Individual authors are responsible for the accuracy of statements made within the blog.

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