End Preventable Deaths and Disability From Unsafe Abortion

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The Association of Obstetricians and Gynaecologists of Uganda (AOGU), and their partners in the Uganda Safe Abortion Advocacy Coalition, mobilised on the 28th of September for International Safe Abortion Day to amplify its calls to end preventable maternal mortality and morbidity attributable to unsafe abortion.

Unsafe abortion is a significant public health problem in Uganda. The Uganda Demographic Health Survey 2016 states that the maternal mortality ratio is still high at 336 per 100,000 live births, and maternal deaths are estimated at 16-18 per day with 4-6 deaths attributed to unsafe abortion.  Unsafe abortion continues to be a leading cause of maternal death.

Uganda’s law explicitly allows for access to safe and legal abortion only to save a woman’s life (Article 224, Uganda Penal Code). However, the 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights (SRHR) go even further; permitting abortion under additional circumstances, including in cases of foetal anomaly, rape and incest, or if the woman is HIV-positive and/or has cancer of the cervix.

AOGU together with the Uganda Safe Abortion Advocacy Coalition organised a week of activities which highlighted the essential need for stronger access to sexual reproductive health services – that includes access to safe abortion, to the full extent of the law (and the 2006 national standards and policies on SRH services).

A media event kick-started the series of activities on the World Contraception day, 26th September 2020. The event identified the glaring gaps in the provision of SRHR services and abortion care in the country. AOGU, together with the advocacy coalition, also highlighted the impact of COVID-19 and how it has worsened critical access to SRHR services, directly impacting women and girl’s health.

Dr. Charles Kiggundu a consultant gynaecologist at Kawempe National Referral hospital said:

‘Unlike before where women would use herbal concoctions and devices such as wires and sticks, to procure abortions, a number of women now report inserting drugs they got over the counter, often used in high doses. Instead of having to deal with uterus repairs or removal, [we] are dealing a lot with over bleeding when providing post-abortion care.’

Dr. Kiggundu also shared the impact of Uganda’s restrictive abortion law on health workers:

‘Lives are lost when doctors are still weighing between helping victims because of the likely repercussions to them. Proper statistics on how many abortions could be happening annually remain scanty due to the fact it remains largely illegal, yet the legal aspects of it are not well understood. This is the reason why some doctors may not choose to document when they give post-abortion care.’

He added that:

 ‘What is documented for Kawempe [Hospital] alone shows that more than 800 women seek post-abortion services from the hospital when the situation is already out of hand and many of them show with advanced complications and can’t be saved.’

In addition, he noted the impact of the COVID-19 restrictions on access to contraceptives and abortion care services has worsened, which included placing already vulnerable groups such as teenage girls at higher risks to unsafe abortion.

To address the criminalisation of abortion that health practioners face, Dorothy Amuron, a lawyer working with the Center for Health, Human Rights and Development (CEHURD), shared the that CEHURD has devised  ‘a programme that helps doctors who are trapped in procuring abortion charges to access justice by providing them with legal aid.’

Various stakeholders working to strengthen SRHR were unified in urging the Ugandan government to address the public health problem of unsafe abortion. They called on the government to ensure a comprehensive provision of a Schools Sexuality Education framework, increasing access to contraceptives, and implementing the SRHR policy framework that includes critical guidance for health workers on when women and girls can access safe abortion services.

On International Safe Abortion Day, Dr Kiggundu appeared on Uganda’s mainstream TV channel, and reiterated the urgency to ensure women and girls have access to SRHR so that they are not forced to carry unwanted pregnancies that, as the evidence demonstrated, resulted in unsafe abortions and preventable maternal deaths and morbidity.

Additional activities were also conducted to mark the ISAD, where AOGU’s partners held vigils to remember women and girls who have lost their lives due to unsafe abortion, and a toll-free number was launched for women and girls to access evidence-based information regarding contraceptives and abortion care services. 

AOGU and their partners vow to continue advocating with and on behalf of women and girls to strengthen their SRHR and end unsafe abortions resulting in the preventable loss of lives.