How Unsafe Abortions Undermine Maternal Healthcare in Uganda

  • Illustration by Gideon Artpro

By Kigezi News Agency Team

On September 3, 2021, Kasese district was plunged into shock when a young lady, Brenda Biira, died after a self-induced abortion went awry.

Biira was formerly married but then separated from herooo first husband following a misunderstanding.

Eventually, she fell in love with a primary school teacher, Deus Bitswatswa, who impregnated Birra while she was still at her parents’ home.

After the incident, Bitswatswa never took full responsibility to support Biira. Faced with a potential situation of having to look after a child single-handedly during the Covid-19 pandemic, Biira decided to terminate the pregnancy.

However, it was a risk that ended with Biira losing her own life from Kagando hospital in Kasese district where her parents had desperately rushed her for post-abortion care.

She was buried after her second fiancé paid the dowry in fulfillment of a tradition that satisfies custom rather than saves a life.

Agnes Mbambu, the Kasese district Health Educator says the demise of Biira was regrettable and strongly condemns the archaic acts of self-induced abortions.

The law on abortion

Uganda’s laws ban abortion except under very strict situations where the mother’s life is threatened by the pregnancy.

These include health risks like severe malaria, anemia, sexually transmitted diseases, and uterus tract infections among others.

An attempt to procure an unlawful abortion is punishable by imprisonment for up to seven years according to Section 142 of the Penal Code Act and anyone who aids a woman in performing the unlawful abortion can be imprisoned for up to three years as per Section 143 of the same law.

Mbambu says based on this law, the Ministry of Health does not recommend abortion in situations like that of Biira and as health workers, they are forbidden from conducting abortions in health facilities that could be why she decided to do it on her own.

However, Biira’s case was just a tip of a giant iceberg that is claiming lives of promising young Ugandan women at an alarming rate that Guttmacher Institute in 2013 put at 310 to 438 maternal deaths.

As health workers fear possible prosecution in case they are caught participating in illegal abortion or aiding it, this limits women who view abortion as inevitable to resort to crude methods.

Crude methods of abortion

In Arua city, Philip Atidra, the branch manager for Reproductive Health Uganda (RHU) revealed that the number of unsafe abortions during the period of lockdown has been overwhelming.

Phillip Atidra, the Arua Reproductive Health Uganda Manager

The statistics at RHU branch in Arua for the first six months of the lockdown indicate that 3,293 women received post-abortion care from the center, double the number for the six months period before the Covid-19 pandemic hit Uganda.

The most affected age group is young girls aged between 18 and 24 years, according to RHU records.

Atidra says as schools were shut down, it allowed more time for idle girls to hobnob with idle men and indulge in unprotected casual sex (at times including with relatives) resulting in unwanted early pregnancies.

The health expert says in order to terminate the pregnancy, the girls adopt crude methods of unsafe abortion which involve the use of drugs and herbs to induce the expulsion of the fetus while others insert sticks or bicycle or motorcycle spokes into their private parts.

Grim situation

It is the same grim situation everywhere in Uganda according to Samuel Balamaga, the youth, and key populations manager at Marie Stopes Uganda (MSU).

Citing the Guttmacher Institute, he says the state of unsafe abortions in Uganda is very bad with an average 314,000 abortions registered annually.

Balamaga says that abortion rate in Uganda is higher than the estimated rate for the East African region, standing at 34% among the women aged 15-19 years.

Those Adolescents, he pointed, have the highest rate of abortions which are frequently unsafe.

According to the Population Media Centre, adolescents bear a disproportionate burden of sexual and reproductive health risk compared to any other age group in Uganda.

The nonprofit organization reports that 25% of girls aged 15-19 have begun childbearing with nearly half reporting these pregnancies as un-timed or unwanted.

These findings are similar to those contained in the Ministry of Health annual reports on maternal death which showed that abortion or abortion related complications had increased from 5% in 2018/19 financial year to 10% in half of 2019/20.

In the reporting year, the Ministry of Health says 1,192 maternal deaths were reported which means 110 young mothers died because of abortions or abortion-related complications.

Treatment rate for complications from unsafe abortion had reduced by 3% in ten years from 15% per 1,000 women in 2003 to 12% per 1,000 women in 2013.

This translates into 93,300 women that were treated for complications from unsafe abortion according to the Guttmacher Institute.

Hon Jane Ruth Aceng, the Minister of Health, in her forward for the Annual Health sector performance report 2019/2020, did not address the issue of abortion or post-abortion complications but generally said Covid-19 had affected the health of people.

Health Minister, Dr Jane Ruth Aceng

In a follow-up interview with www.westniletodaynews.com Dr Aceng insisted that the government has always had a plan of educating young girls and young boys on the side effects of unsafe abortion and that it is continuing to educate them.

She appealed to the media to also join the government in educating the masses on the negative effects of the vice more especially during this time of the lockdown.

Still, the Wakiso district council sat in August for an extraordinary meeting to deliberate on the Ministry of Health report that showed abortions or abortion complications were the leading cause of death of mothers in the district.

Bonny Natukunda Elubu, Wakiso’s senior health educator, says following the council’s deliberations on the report they have intensified information sharing using media and outreaches by village health teams (VHTs).

“Young girls must be safeguarded at home when they have the right information so that we don’t lose others,” he says.

Samuel Musoke, the Kumi district health educator, says 270 unsafe abortion complications were registered at Kumi Health Center IV during the first year of the Covid-19 pandemic.

“Most of the girls got complications when trying to abort,” said Musoke.

In Arua, Dourine Byaba, in-charge maternity ward Oli health center IV discloses that in the last quarter (April – June 2021) the health center registered 20 mothers who have undergone unsafe abortions.

Dourine Byaba, in-charge Oli Health Centre Maternity Ward

At Biiso health centre IV in Buliisa district, medics were fearful of discussing issues related to abortion with journalists.

Many of them would simply state that “abortion is illegal, we don’t do it” and walk away.

Nonetheless, one health worker who said he wanted to speak off-record disclosed that so far this year, they received three cases of young women seeking post-abortion care.

He said that the women were referred to either Buliisa general hospital or Hoima regional referral hospital for better management.

The driving factor

An annual report 2020 released by Marie Stopes Uganda indicates that the driving factor behind the grim situation of abortions and abortion-related deaths has been the difficulty in accessing family planning commodities by the young girls, especially in the rural areas.

Faith Kyateka, the Marrie Stopes head of communications observes that many adolescents faced challenges of transport during the lockdown when they were out of school and lacked information on sexual reproductive health rights.

She says this is due to the non-fulfillment of family planning stock orders or quantities by the government to the health center IIs and IIIs across the country.

However, a ministry of a health update on family planning has shown that a number of doses of family planning commodities have been expiring at health facilities unused.

In July 2021 alone, health facilities from 16 districts spread across the country reported a cumulative total of 16,323 doses of family planning commodities that expired.

Kyaketa maintains that as outreach teams limited their movements across the country, the young girls found it very hard to access information on reproductive health, yet their parents could not openly talk to them about sexuality.

She says also a number of activities targeted for the adolescents on family planning were unmet because of social norms, stigma, and limited urgency in making decisions about sexual misconduct among adolescents.

Some of the abortions, she added, are done due to peer influence while others are a result of domestic violence.

Though up-to-date information on abortions arising as a result of domestic violence during the pandemic is lacking, a compilation of cases of abortion due to domestic violence between November 2018 and November 2019 by the Uganda Bureau of Statistics sourced from the ministry of health indicates that a total of 29,171 cases of abortion were recorded in the outpatient departments across the country.

The remedy

To contain the situation, the health experts have recommended a raft of remedies ranging from escalating sensitization on reproductive health, risks of unsafe abortions to availability of contraceptives and condoms.

Atidra says as reproductive health Uganda, they have been sensitizing the community against the dangers of unsafe abortion and how the community can prevent girls from going for it.

He however notes that it is not easy to come out with a message on abortion that RHU has been packaging its messages in a manner that is accepted in the community where women involved in abortion are frowned at.

Oli health centre’s Byaba says they have scheduled every Wednesday as a clinic day for the young mothers from the age of 10- 24 years who feel embarrassed to speak among the elderly women.

This gives them ample time to speak about sexual reproductive health and unsafe abortions when they are in the company of their peers.

In down-town Wakiso, Musoke says they are teaching girls to use safe contraceptives if they are sexually active to avoid unwanted pregnancies that often lead to unsafe abortions.

Kasese’s Mbambu says where as it is very rare to get requests that need the district to recommend safe abortion, they do give such recommendations when the requests are genuine to save the lives of the mothers.

Reporting by Alex Baluku, Patrick Onzima, George Emuron, Alex Galeku, Innocent Atuganyira, Richard Drasimaku and Goodluck Musinguzi

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