Abortion: The face behind the veil
Dec 05, 2006
MARY Mutesi, 38, has seven children and is pregnant. She thought she was done with giving birth when she discovered she was four months pregnant.<br>“I did not want another child, but now I am pregnant and cannot afford an abortion,†she says.
By Irene Nabusoba
MARY Mutesi, 38, has seven children and is pregnant. She thought she was done with giving birth when she discovered she was four months pregnant.
“I did not want another child, but now I am pregnant and cannot afford an abortion,†she says.
Mutesi says the seven children are already a handful and she cannot adequately provide for them. Her husband is a casual labourer at a construction site and she is just a housewife.
“He is going to kill me if he finds out I am pregnant but what can I do?†she ponders.
Mutesi’s situation is not uncommon. Of the estimated 1.2 million pregnancies recorded in Uganda annually, 775,000 are unintended, according to a recent study.
Obstetricians and gynaecologists at the Guttmacher Institute in New York, in collaboration with Dr. Florence Mirembe, a senior gynaecologist and obstetrician at Mulago Hospital and Charles Kiggundu, a gynaecologist
from Mulago Medical School, conducted a study that revealed that four in 10 pregnancies in Uganda are unintended.
The 2005 study: Unintended Pregnancy And Induced Abortion In Uganda; Causes and Consequences, says 16% of these pregnancies end up in abortions.
During dissemination of the research findings at the Grand Imperial Hotel in Kampala recently, Kiggundu said about 297,000 induced abortions are performed each year in Uganda, which translates to an annual abortion rate of 54 per 1,000 women aged 15-49 or approximately one for every 19 women in this age group.
“We know the cases could even be higher because abortion is illegal in Uganda and there is a strong social stigma surrounding the practice. Its clandestine nature makes it difficult to measure abortion incidences as most cases go unreported,†Kiggundu says.
According to the 2006 United Nations Family Planning Association state of world population report, Uganda’s fertility rate is 7.11%, the highest in the world. Yet the maternal mortality ratio is estimated at 505
maternal deaths per every 100,000 live births, with unsafe abortion accounting for 13%.
Abortion presents serious health consequences common among them, haemorrhage, infection or damage to the
uterus, infertility, urinary incontinence, and prolonged or permanent infections to the pelvis.
But an estimated 65,000 women (one fifth of all women who obtain abortions) each year experience complications but receive no treatment because of their inability to pay for post-abortion care, fear of revealing that they procured the abortion, and concern that they will receive hostile or judgmental treatment from the medical staff. The findings reveal that health care providers treated about 85,000 Ugandan women for complications of induced abortions in 2003. “This is just a visible tip of the iceberg. We estimate that for each of the women known to receive post-abortion care, an additional 2.5 women either had abortions free of complications, had complete or incomplete abortions for which they did not receive care, or received care outside the formal health system,†Kiggundu said during a seminar. He says only 58% of the abortions are conducted by medically trained providers like doctors, nurses or midwives, who rely primarily on Dilation and Curettage (D&C), where an instrument is inserted into the vagina to enlarge the neck of the womb as the doctor breaks the waters and sucks the foetus remains out. Medical personnel also use manual vacuum aspiration, where a pump is used to terminate the pregnancy.
“But not all abortions done by trained providers are safe,†Kiggundu warns.
Some health workers such as nurses and midwives, may not have adequate skills to conduct an abortion. Besides, most health centres do not have the medical supplies and sufficiently trainned health professionals
to provide proper post abortion care.
He says many abortions are conducted by pharmacists, traditional healers or women themselves using crude methods like insertion of catheters or sharp objects into the uterus, herbal remedies, medications, hormonal
drugs, and drinks made from detergents or other caustic substances.
A woman is more likely to have a ‘safe’ abortion if she can afford the services of a medically trained professional. But the more trained the practitioner, the more costly the procedure.
The findings reveal that, on average, physicians charge more for abortions (sh40,000-140,000) than nurses and midwives (sh22,000-50,000) or traditional healers, herbalists and lay practitioners (sh19,000-54,000). Fees for the pharmacist range between sh8,000-22,000.
Why an abortion anyway?
The study says the primary reason that women worldwide seek abortions is unintended pregnancies. A small proportion of pregnancy terminations are carried out for health or other reasons.
“The woman and her partner may believe that they already have too many children or that they are too poor to support a new child, the woman may be in school, in poor health or pregnant as a result of rape or
incest,†the study says. “She may also have simply conceived at a wrong time or could be a cause of a poor marital relationship.â€
Jotham Musinguzi, the director of Population Secretariat, says this has been worsened by the fact that many Ugandan women of childbearing age who do not want to get pregnant are not using a modern contraceptive method.
“The unmet need for contraception in Uganda is very high, for instance women who want to use contraception but cannot access it. It is at 35%. For women who live in rural areas, with little schooling or who are poor, this unmet need is even as high as 38%,†Musinguzi says.
He says distrust of modern methods of contraception because of the associated side effects, failure of male involvement and religion are the main cause of the unmet need. Besides, pregnant HIV-infected women are very ambivalent about having children because of the fear of infecting their unborn babies and are very likely
to abort them.
Recommendations
The study recommends that a broader public discussion about unsafe abortion is essential, standards of post-abortion care must be raised and coverage expanded.
It also recommends improvement in access to family planning services and provision of accurate information about contraception.
While launching the findings, Dr. Emmanuel Otaala, the Minister of State for Health (primary health care) said, “Not much has been done to study this area, considered a no-go area because abortion is illegal. But these findings give us a very grave picture. We must not only treat the patients but prevent the phenomenon.â€
“This takes us back to the high unmet need of family planning. We need to do more in terms of providing family planning services and raising awareness because the acceptance rate is very low.
MARY Mutesi, 38, has seven children and is pregnant. She thought she was done with giving birth when she discovered she was four months pregnant.
“I did not want another child, but now I am pregnant and cannot afford an abortion,†she says.
Mutesi says the seven children are already a handful and she cannot adequately provide for them. Her husband is a casual labourer at a construction site and she is just a housewife.
“He is going to kill me if he finds out I am pregnant but what can I do?†she ponders.
Mutesi’s situation is not uncommon. Of the estimated 1.2 million pregnancies recorded in Uganda annually, 775,000 are unintended, according to a recent study.
Obstetricians and gynaecologists at the Guttmacher Institute in New York, in collaboration with Dr. Florence Mirembe, a senior gynaecologist and obstetrician at Mulago Hospital and Charles Kiggundu, a gynaecologist
from Mulago Medical School, conducted a study that revealed that four in 10 pregnancies in Uganda are unintended.
The 2005 study: Unintended Pregnancy And Induced Abortion In Uganda; Causes and Consequences, says 16% of these pregnancies end up in abortions.
During dissemination of the research findings at the Grand Imperial Hotel in Kampala recently, Kiggundu said about 297,000 induced abortions are performed each year in Uganda, which translates to an annual abortion rate of 54 per 1,000 women aged 15-49 or approximately one for every 19 women in this age group.
“We know the cases could even be higher because abortion is illegal in Uganda and there is a strong social stigma surrounding the practice. Its clandestine nature makes it difficult to measure abortion incidences as most cases go unreported,†Kiggundu says.
According to the 2006 United Nations Family Planning Association state of world population report, Uganda’s fertility rate is 7.11%, the highest in the world. Yet the maternal mortality ratio is estimated at 505
maternal deaths per every 100,000 live births, with unsafe abortion accounting for 13%.
Abortion presents serious health consequences common among them, haemorrhage, infection or damage to the
uterus, infertility, urinary incontinence, and prolonged or permanent infections to the pelvis.
But an estimated 65,000 women (one fifth of all women who obtain abortions) each year experience complications but receive no treatment because of their inability to pay for post-abortion care, fear of revealing that they procured the abortion, and concern that they will receive hostile or judgmental treatment from the medical staff. The findings reveal that health care providers treated about 85,000 Ugandan women for complications of induced abortions in 2003. “This is just a visible tip of the iceberg. We estimate that for each of the women known to receive post-abortion care, an additional 2.5 women either had abortions free of complications, had complete or incomplete abortions for which they did not receive care, or received care outside the formal health system,†Kiggundu said during a seminar. He says only 58% of the abortions are conducted by medically trained providers like doctors, nurses or midwives, who rely primarily on Dilation and Curettage (D&C), where an instrument is inserted into the vagina to enlarge the neck of the womb as the doctor breaks the waters and sucks the foetus remains out. Medical personnel also use manual vacuum aspiration, where a pump is used to terminate the pregnancy.
“But not all abortions done by trained providers are safe,†Kiggundu warns.
Some health workers such as nurses and midwives, may not have adequate skills to conduct an abortion. Besides, most health centres do not have the medical supplies and sufficiently trainned health professionals
to provide proper post abortion care.
He says many abortions are conducted by pharmacists, traditional healers or women themselves using crude methods like insertion of catheters or sharp objects into the uterus, herbal remedies, medications, hormonal
drugs, and drinks made from detergents or other caustic substances.
A woman is more likely to have a ‘safe’ abortion if she can afford the services of a medically trained professional. But the more trained the practitioner, the more costly the procedure.
The findings reveal that, on average, physicians charge more for abortions (sh40,000-140,000) than nurses and midwives (sh22,000-50,000) or traditional healers, herbalists and lay practitioners (sh19,000-54,000). Fees for the pharmacist range between sh8,000-22,000.
Why an abortion anyway?
The study says the primary reason that women worldwide seek abortions is unintended pregnancies. A small proportion of pregnancy terminations are carried out for health or other reasons.
“The woman and her partner may believe that they already have too many children or that they are too poor to support a new child, the woman may be in school, in poor health or pregnant as a result of rape or
incest,†the study says. “She may also have simply conceived at a wrong time or could be a cause of a poor marital relationship.â€
Jotham Musinguzi, the director of Population Secretariat, says this has been worsened by the fact that many Ugandan women of childbearing age who do not want to get pregnant are not using a modern contraceptive method.
“The unmet need for contraception in Uganda is very high, for instance women who want to use contraception but cannot access it. It is at 35%. For women who live in rural areas, with little schooling or who are poor, this unmet need is even as high as 38%,†Musinguzi says.
He says distrust of modern methods of contraception because of the associated side effects, failure of male involvement and religion are the main cause of the unmet need. Besides, pregnant HIV-infected women are very ambivalent about having children because of the fear of infecting their unborn babies and are very likely
to abort them.
Recommendations
The study recommends that a broader public discussion about unsafe abortion is essential, standards of post-abortion care must be raised and coverage expanded.
It also recommends improvement in access to family planning services and provision of accurate information about contraception.
While launching the findings, Dr. Emmanuel Otaala, the Minister of State for Health (primary health care) said, “Not much has been done to study this area, considered a no-go area because abortion is illegal. But these findings give us a very grave picture. We must not only treat the patients but prevent the phenomenon.â€
“This takes us back to the high unmet need of family planning. We need to do more in terms of providing family planning services and raising awareness because the acceptance rate is very low.