BY ANNE MUGISA
A 15-YEAR-OLD girl lies on the thin thread between life and death in Mulago Hospital. She was rushed to the hospital after she became unconscious. She had attempted an abortion using a crude method and it turned disastrous. She had allegedly been made pregnant by the husband of her twin sister.
When they tried to terminate the pregnacy in vain, her brother-in-law delivered her to Mulago and disappeared. Medics say such a problem is not isolated. It is not a story we should be telling when, in a few days, Christians will be commemorating the birth of Jesus Christ, who famously proclaimed: “I have come so that they may have life and have it abundantly!” Even as we celebrate Christmas, the birth of a healthy baby under challenging circumstances, many Ugandans will be in hospital ill, dying or dead due to unsafe abortions.
According to the Ministry of Health, unsafe abortion is the third biggest killer of mothers in Uganda, after over bleeding and sepsis. It accounts for 26% of the 438 deaths, out of the 100,000 that occur among pregnant women annually. This translates into about 500 mothers dying every month due to complications arising from abortion.
According to the health ministry, 800 abortions take place daily in Uganda. And even then, these are the ones that are known in the medical circles because many women doo not go to the clinics or die before they can make it there. This translates to an average of 292,000 abortions a year and, according to the primary health care minister, Sarah Opendi, many of those who survive suffer disastrous consequences, including disability.
Three NGOs; the Centre for Reproductive Rights, O’neill Institute and the International Women’s Human Rights Clinic carried out a study on the impact of unsafe abortions and inadequate access to contraception in Uganda. Their report, The Stakes Are High, said it was tragic for communities to look on as young, energetic and productive women perished due to circumstances that are preventable. “The values, attitudes and morals of society must change to make the woman and her wellbeing the centre of discussion,” the report added.
Over 900,000 of Uganda’s annual 2.2million pregnancies are unintended and unplanned. About 400,000 of these are aborted. 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 sub-region and 13% of the world. To compound the situation, 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 since premarital sex is not socially acceptable.
Sexual violence and coersive sex is also common. The Guttmacher Institute brief quotes a study among rural secondary school students that found that 43% of them said they had been unwilling to have their first sexual experience. These situations are breeding ground for unintended and unwanted pregnacies, leading to high rates of unsafe abortion. THE FINDINGS
The study found out that many of those who abort were married women, who were forced into the practice by their husbands, who wanted sex and not the child. This dispelled the notion that abortion is for irresponsible promiscuous women and girls, who should suffer the consequences.
As Dr. Charles Kiggundu, a consultant gynaecologist at Mulago Hospital puts it, the problem persists because none of the men responsible for Dr. the pregnancies has ever died or got maimed from pregnancy-related complications. The male-dominated world may not appreciate it when women continue to pay with their lives and health. They only come up after incidences of incest, with fathers molesting and impregnating their daughters, leaving them to suffer with the consequences, to connive to conceal the evidence.
The study, whose results were launched last month, suggests that the primary cause of abortions is unwanted pregnancies, usually because women had no access to family planning services. Uganda has the second-highest unmet need of contraception in the world, after Niger, according to the report.
This unmet need of 40.6% is also responsible for the soaring population growth. Over 60% of the population in Uganda are youth, a productive age group, which contributes greatly to maternal deaths and morbidity. The report reveals that half of the pregnancies in Uganda are unwanted. And a quarter of all pregnancies end up in unsafe abortions. And two out of every three pregnancies are risk pregnancies.
Sickness and deaths as a result of abortion rob the country of manpower and resources. The money that should be used to treat other diseases is channelled into dealing with the consequences of risky pregnancies at resource-constrained health centres. Opendi says the Ministry of Health sinks sh38b in treating complications of unsafe abortions annually, and is still losing the battle because more cases keep surfacing.
The consequences include death, loss of fertility and fistula. Fistula is a condition where the affected woman leaks of urine, faeces or both. In Uganda, 200,000 women are living with fistula. When a mother dies, there are grave implications on the family. Lives of dependent children are disrupted and worse, the survival of those under five years, who are regarded as most vulnerable, is not guaranteed. Because women are care-givers, their death affects the livelihood and health of families.
According to Lucy Shillingi, the country director or Path Finder, a non-governmental organisation, the answer is in preventing unwanted pregnancies by availing family planning services. “What we see now is sh38b sank downstream (when women are already pregnant), yet little money is put upstream (to prevent the pregnancies). We need to take preventive measures like sex education,” Shillingi says.
The report recommends several solutions. One is that Government should publicise the law and policy guidelines on abortion because few people know that it is allowed in the country. This will help healthcaregivers, law enforcement and women realise that they can procure an abortion safely, and legally, without risking with crude methods. The Government is also called upon to take steps to address the stigma attached to abortion. Health workers should be sensitised to help the women in need of services without hostility. But this needs an adequate access to family planning and removal of barriers like having to consult husbands for permission.
People should be educated about the availability of emergency contraception, contraception and access to comprehensive sexuality education should be improved. The report calls for postabortion care, in addition to sensitisation of the population on abortion laws and policies because that would save the lives of mothers and ensure survival of the wouldbe orphaned children.
The common cry is lack of money to implement such recommendations. However, Rugunda says the Government is trying to address the issue of capacity. “Family planning requires sensitisation and mobilisation, including involving husbands and community leaders,” he said. The public health specialist and medical coordinator at Reproductive Health, Demeter Namuyobo, calls for the need to address the myths and misconceptions that cause resistance to family planning methods. “We have a low contraceptive rate and very high maternal mortality rate.
We need to create demand for the services. “About 90% of the population lives in rural areas and we need to reach them, using the village health teams (VHTs) It has worked in Ethiopia, where in one year, they increased family planning usage from 7.9% to 29%. The VHTs need to be motivated,” Namuyobo explained
What is the Government doing?
Health minister Dr. Ruhakana Rugunda says the Government is aware of the problem. “We are aware of the enormity of the problem and that is why we have decided to step up maternal and reproductive health services, which should reduce unwanted pregnancies.” He says, however, that abortion should not been seen in isolation. “The issue is maternal services and family planning. We need to do much more to address the unmet need,” he said.
Currently, the country is struggling to reduce pregnancy-related deaths, with a target of at most 131 per 100,000 mothers by 2015. This is the year by which the Millennium Development Goals on maternal and child health should be realised. The MDGs required the child deaths to have been reduced to below 50 per 1,000 and those of mothers to have been slashed by 75% by 2015. At that time, maternal deaths stood at 505/100,000