By Catherine Mwesigwa Kizza
Every year, about 1,500 girls in Uganda die from complications resulting from unsafe abortion contributing to the slow progress to reduce the number of women who die due to pregnancy-related complications.
“Abortion is hidden in the heamorrhage and sepsis figures but it is not captured. They hide it there because of the stigma,” says Dr Charles Kiggundu, the new president of the Association of Gynaecologists and obstetricians of Uganda.
He was speaking at a lawyers’ meeting organised by the Coalition to End Maternal Deaths Through Unsafe Abortion held at Kabira Country club in Kampala on Monday.
The meeting sought to explore the use of a Human Rights approach to unpack the legal and policy Framework on abortion.
Heamorrhage(excessive bleeding) and Sepsis (infection) are the leading causes of pregnancy-related deaths of women accounting for 26% and 22% of maternal deaths respectively. But 2008 Ministry of Health statistics estimated that abortion-related causes account for 26% of maternal deaths in the country.
“We cannot look at only bleeding, infections, malaria and HIV and expect to meet the Milleniumm Development Goal target to reduce maternal deaths by 75% by 2015 when abortion accounts for a third of maternal deaths,” said Dr Collins Tusingwire, the Ministry of Health Assistant Commissioner for Reproductive Health.
“If we ignore it (abortion) we shall not achieve what we intended to do,” he said.
Over 900,000 of Uganda’s annual 2.2million pregnancies are unintended and unplanned. About 400,000 of these end up in abortion.
A 2013 brief by the Guttmacher Institute states that Uganda’s abortion rates are higher than the 18% World Health Organisation’s estimates for the East African subregion and 13% of the world.
To compound the situation further, one in three married women are not using contraceptives even though they do not want to get pregnant.
Despite abstinence campaigns, premarital sex is common in Uganda with one in three never-married women aged 15 to 24 years admitting to have already had sex . These adolescents and young women are particularly at risk of unintended pregnancy, because they are reluctant to seek contraceptive services and counselling they need since premarital sex is not socially acceptable.
Sexual violence and coersive sex is also common. The Guttmacher Institute brief quotes a study among rural Ugandan secondary students that found that 43% of them said they had been very unwilling to have their first sexual experience.
These situations are breeding ground for unintended, unwanted pregnacies leading to high rates of unsafe abortion.
Abortion in Uganda is legal and permissible when a pregnancy endangers a woman’s life or her physical and mental health. However, sections of the Penal Code make unlawful abortion criminal.
“This makes providers of service to fear. Nobody wants to be punished, so you do not touch,” says Dr Kiggundu adding: “We need the law to be interpreted. We do not want to give a service and then end up in jail for 14 years.”
Making a case for the enactment of a law to authorise abortion in Uganda, Dennis Kibirige, a senior state attorney said that the legal regime on abortion has not changed since the new constitution.
He pointed out that the Odoki Constitutional Commission noted that the majority of Ugandans were against abortion and recommended that it must be punished though societies practice abortion where a mother’s life is endangered or in cases of rape and incest.
He explained that Article 22(2) of the Constitution attempted to strike a balance between the two scenarios but noted that since 1995, no law had been enacted to give effect to Article 22(2) of the Constitution.
“The problem with abortion is not in the constitution. It is with those charged with giving effect to Article 22(2),” he said.
He rhetorically asked whether the Ministry of Health guidelines on abortion were law and whether a person could rely on them and be legally protected.
Speaking on a panel at the meeting, Justice Damalie Lwanga emphasised that the issue was complex because there are legal, academic and practical arguments.
“Laws take precedence over guidelines unless guidelines are made in relation to the law,” she said.
She described the current arguments on abortion service as academic and not legal.
“Law is a very conservative subject. So attempting to go by the guidelines, your arguments may not be upheld that you did the right thing.”
She further added: “You cannot even be sure of what court will decide. Court decisions are unpredictable.”
Speaking from a lawyer’s perspective Busingye Kabumba stressed that there was another side to the Constitution’s Article 22(2) and that was the unborn child who cannot speak who depends on those able to speak.
He noted that both women and the life of an unborn child were valued in our society and emphasised that it was important to make the circumstances under which a pregnancy can be terminated clear so that, “we do not make it difficult for the woman to get what gives her dignity but we need to also clarify, should it be as easy as buying a condom or should it be as complicated as getting a panel to which she explains why she was raped?”
Professor Charles Ngwena from the Centre for Human Rights noted that Uganda’s experience in addressing unsafe abortion was similar to other countries like South Africa or America.
“There will never be consensus on such an issue,” he said adding that the Public health dimension on abortion was not creating the urgency among policy makers even though the public health evidence of loss of life due to abortion was there.
“You need to strike a balance that will save the 1,500 women who die from abortion related complications every year,’ he said.
Kiggundu urged for sensitisation of health providers on the law which he said apart from being unclear, its interpretation was being subjected to moral issues.
“When a person is shot in a robbery, we treat without thinking, but when it comes to abortion, the attitude changes,” Kiggundu said.
Ministry of Health using World Health Organisation standards has guidelines for Comprehensive Abortion Care which include prevention of unwanted pregnancy through Family planning, post abortion care and family planning for those who have had abortions.
The 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights provide for access to termination of pregnancy services in cases of:
• “severe maternal illnesses threatening the health of a pregnant woman e.g. severe cardiac
disease, renal disease, severe pre-eclampsia and eclampsia;
• severe foetal abnormalities which are not compatible with extra-uterine life e.g. molar
• cancer cervix;
• HIV-positive women requesting for termination;
• Rape, incest and defilement.”
Source NationaL Sexual and Reproductive heaLth Guidelines, Ministry of health, Management of sexual and Gender based vioLence survivors (Apr. 2007).
Uganda Constitution Article 22(2)
(2) No person has the right to terminate the life of an unborn child except as may be authorised by law.
The Penal Code Act
141. Attempts to procure abortion.
Any person who, with intent to procure the miscarriage of a woman whether she is or is not with child, unlawfully administers to her or causes her to take
any poison or other noxious thing, or uses any force of any kind, or uses any other means, commits a felony and is liable to imprisonment for fourteen years.
142. Procuring miscarriage.
Any woman who, being with child, with intent to procure her own miscarriage, unlawfully administers to herself any poison or other noxious thing, or uses any force of any kind, or uses any other means, or permits any such things or means to be administered to or used on her, commits a felony and is liable to imprisonment for seven years.
143. Supplying drugs, etc. to procure abortion.
Any person who unlawfully supplies to or procures for any person any thing, knowing that it is intended to be unlawfully used to procure the miscarriage of a woman, whether she is or is not with child, commits a felony and is liable to imprisonment for three years.