By Alege G. Stephen
Despite restrictive abortion laws, recent estimates by the ministry of health indicate that over 175 out of every one thousand women who die due to child birth related complications are due to unsafe abortions. This proportion is double the World Health Organisation’s estimate for Eastern Africa which stands at 95 women. This is in addition to the many women who are injured and hospitalised as a result of unsafe abortions related complications.
Ugandan women, on average, give birth to nearly two children more than they want which is one of the highest levels of excess fertility in Sub-Saharan Africa. Almost four in 10 of the unintended pregnancy result into an abortion.
Uganda has restrictive laws on abortion that are often interpreted inconsistently, making it difficult for women and the medical community to understand what is legally permitted. Ugandan law allows abortion under some circumstances, but these laws and policies on abortion are unclear and are often interpreted inconsistently, making it difficult for women and the medical community to understand what is legally permitted. The Ugandan Constitution states that abortion is permitted if the procedure is authorised by law. Under the Penal Code of June 15, 1950, a person who conducts an abortion faces imprisonment for 14 years while a pregnant woman who undertakes the same act or consents to its performance is subject to seven years imprisonment. This ambiguity and fear of punishment makes medical providers reluctant to perform safe medical abortions.
As a result, women who decide to abort often resort to untrained and usually unskilled practitioners who practice in illegal and hidden clinics. These clinics provide unsafe abortion procedures that result in a high rate of complications and sometimes death. Due to the restrictive laws, even skilled providers work in clandestine environments, which often compromise the safety of the procedures they perform and leads them to charge expensively for their services. This situation is worsened by the delay of women to seek care for post abortion complications due to judgmental or abusive treatment from health care providers. A study in 2011 found unsafe abortion induction and care costs averaged sh400,000 resulting in over sh170b spent annually.
While preventing unintended pregnancy through the use of family planning will contribute to the reduction in the number of unsafe abortions, the use of modern family planning methods remains low. According to the Uganda demographic survey 2011, one in three married women wanted to space or stop childbearing but were not using any method of contraception. This situation often leads them to take a risk and undergo an unsafe abortion.
Therefore, revising the restrictive laws on abortion will benefit women’s health by enabling women to easily access safe medical abortions services and confront the community stigma that is currently associated with abortions. This will further open the way for improvement in the quality of post abortion care services, including the equipping of the health care providers with appropriate skills to provide safe abortion services in legally permitted circumstances. This should be done alongside awareness creation interventions among the general public of the scope of Uganda’s abortion law. This will result in a reduction in injury, death and the cost currently associated with unsafe abortions.
The writer is a Makerere University School of Public Health-CDC Fellow