Unsafe Abortion:Health advocates drag Uganda’s Parliament to Court

By Beatrice Nyangoma

Dr. Charles Kiggundu a Senior gynacologist at Mulago National Referral hospital sees atleast 15 women who have undergone unsafe abortion. These are as young as 9 and 15 years and as old as 40 years.

He says that these have various reasons why they decide to terminate pregnancies.

“I have a university student who has been impregnanted five times by her father and she has procured abortion five times. Many girls opt to terminate pregnancies that are as a result of incest and rape.”he says

He says that as much as this girl can afford to have a safe abortion, many of the others use rudimentsry means to terminate pregnancies.

Dr. Kiggundu emphasises that lack of a clear legislation in Uganda has led to many girls and women procuring unsafe abortion most of whom resulting into deaths.

“Unsafe Abortion continues to constitute a serious public health, human rights and social equity issue that affects millions of women in sub – Saharan Africa, and causes 29,000 deaths annually.”he says

“Women of all social standings seek abortion services, but it is mostly young women and poor women who die or suffer long term consequences from unsafe abortion due to the severe socio-economic deprivation they encounter. Providing access to safe abortion is a critical step towards reducing the unacceptably high rates of maternal death in Africa.” Kiggundu notes  

According to World Health Organisation, of the 6.4 million abortions in Africa carried out in 2008, only 3% were safe. One quarter of unsafe abortions occurred among adolescents aged 15-19, and 60% were among women under age 25. Additionally, unsafe abortion accounts for 13% of global maternal deaths and up to 40% of maternal mortality in African countries.  

Meanwhile, Uganda has one of the highest rates of unsafe abortion in Eastern Africa. It is a leading cause of maternal morbidity and mortality in the country, contributing to approximately 26% of the estimated 6,000 maternal deaths every year, and the estimated 40% of admissions for emergency obstetric care. Unsafe abortion places a huge cost on the public health system; approximately Ushs 7.5 billion are spent annually to treat complications.

A national abortion incidence study found that 15 out of every 1,000 Ugandan women of reproductive age were treated for abortion complications in 2003. Poor, rural women are at increased risk of unsafe abortion, 68–75% experienced complications, compared with the 17% complication rate for non-poor urban women.

According to Kiggundu, Uganda’s restrictive abortion laws permits abortion only to save the life of a pregnant woman. However, conflicting and restrictive interpretations of the abortion provisions under the 1995 Constitution of Uganda, the Penal Code Act and National Reproductive Health Policies have created confusion about the correct legal status of abortion.

According to a study conducted by Human Rights Awareness and Promotion Forum- HRAPF between 2011 and 2015, in seven main police station in Kampala, atleast four people were arrested every year in relation to abortion. Linette du Toit, the Research and Advocacy Officer at HRAPF says that nationally 182 arrests were made on abortion charges noting that few of the health workers are arrested.

Its a gainst this background, that  Prof. Ben Twinomujuni a Law don at Makerere University together with Center for Human Rights and Development-CEHURD filed a petitioned seeking that the constitutional court  orders the Executive and Legislative arms of government to pass a law  regulating termination of pregnancies to reduce maternal mortality rates that arise from  unsafe abortions.

The law dons in their petition filed on March 3 2017, contend that the existing legislation only permits abortion in exceptional circumstances such as a life of a mother at risk, but doesn’t protect young girls and married women who may get unwanted pregnancies hence resorting to unsafe abortion methods.

The petitioners argue that other African countries like Kenya, Rwanda, Ethiopia, Ghana and Tunisia, which are similar in social and economic circumstances as Uganda, deliberately developed laws to protect the rights of women by prescribing circumstances under which a woman is allowed to terminate her pregnancy.

“We do not see any reason as to why Uganda should not borrow a leaf from its neighbours and take an essential step to   protect the lives of women who continue dying day by day due to unsafe abortions,” reads part of the petition.

“Because the government has not operationalized Article 22(2) of the 1995 constitution of Uganda as a way of clarifying the parameters for legal abortion, healthcare providers are unable to provide safe and legal abortion services, while law enforcement officials and judicial officers do not effectively enforce or implement laws that permit abortion thus denying women and girls access to safe and legal abortion services.”Twinomujuni notes

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How lower health centers struggle to operate:A case of Njeru Health Center III

By Beatrice Nyangoma

On a rainy Tuesday morning, Agnes Kirabo braved the cold and by 8am, she was in the queue for her third antenatal check-up from Njeru health center III located in Namwezi village, Njeru West of Buikwe district.

She is expecting her third child and she was the 31st patient to register at maternity ward of the facility.

 Kirabo says that she has to spend at least four hours before she is attended to because the queue is always long .

But the most worrying thing for Kirabo is the fact that she will have to deliver her baby from another hospital.

“I have to save money for transport to Jinja Regional Referral hospital at the time of delivery because Njeru health centre does not admit patients. I always have to spend over 100,000 Shillings whenever I go to another hospital to deliver.”she says

Sarah Nakigozi , an enrolled nurse at the health center says that the facility records close to 200 patients everyday and yet its premises were constructed in 1973 for not more than 30 patients as a private health centre.

She however notes that the facility was not expanded when government took it over in 2001.The government’s take over of the facility was after the residents raised concerns about lack of a health centre III in the area.

She however adds that even the patients are in most cases turned away because the unit rarely has drugs in stock. She says that National Medical Stores-NMS supplies drugs every after two months. She however notes that the drugs supplied are less compared to the number of patients adding that some times the drugs are consumed within just one week.

Nakigozi adds that most HIV/AIDS and TB patients are referred to St. Francis hospital, a non governmental facility where free services are offered while others are referred to Jinja and Kawolo hospitals.

 She also notes that the facility has staff shortage of six people. She adds that the eight people at the facility are very few and yet the number of patients is overwhelming.

The centre is also in toilet crisis since they filled up two years ago. Nakigozi says that the health unit administration decided to close down the toilets after they failed to get money maintain  them. She however adds that the toilet crisis endangers the lives of the workers and patients.

Margret Hashasha, the deputy speaker for Njeru Town Council notes that efforts by the council to secure funds to buy land to relocate the centre have been futile because of the limited budgets. She however notes that the council has secured 20 million to construct a waterborne toilet this financial year. 

She says that the facility records a huge number of patients because the district lacks a district hospital and yet Njeru health centre is located on the highway. She adds that the centre is bridging the distance between Kawolo and Jinja hospitals which would be the other options. Most of the patients come from Najjembe, Lugazi, Wakisi and Njeru municipality.

Hashasha also told that the council has started on the process of elevating the facility to a health centre IV or constructing one in another area to ease the burden on Njeru health centre. She however adds that this the council is yet to find funds for this transition.

She says the facility serves a number of patients but the challenges it has need to be urgently addressed.

Between 2000 and 2015, Uganda has reduced the maternal mortality ration from 560 to 368 per 100,000 and under five mortality from 687 to 343 per 1000rate albeit at a slow pace.

Health advocates have attributed the slow progress to shortages in human resources for health, persistent stockout of drugs inclusive of family planning and reproductive health commodities and poor infrastructure, among others.

beatricenyangoma@gmail.com