‘Ugandan women needlessly dying from unsafe abortion’

By Ronald Musoke

The rate at which Ugandan women are dying from unsafe abortion is alarming, Dr. Charles Kiggundu, one of Uganda’s leading Gnaecologists and Obstetricians has said.

Kiggundu, a consultant at Mulago Hospital made the revelation at a meeting called by the Ministry of Health to update Ugandans on the status of unsafe abortion.

Speaking in Kampala on Feb.17 to a very well attended meeting of several civil society organizations under their umbrella body, the Coalition to Stop Maternal Mortality due to Unsafe Abortion as well as MPs, Kiggundu said unsafe abortions are devastating the country’s women and workforce.

“Unsafe abortion continues to kill many women and yet we know it is preventable,” he said, adding that abortion is now the second leading cause of maternal deaths in Uganda.

According to Kiggundu, half of the two million pregnancies that occur every year in Uganda are unwanted and as a result , about 400,000 are aborted, with 90,000 of them resulting in severe complications,  which most times lead to death.

Research shows that 54 abortions occur among every 1,000 women of reproductive age which are far higher than the average of 36 abortions per 1,000 women for East Africa.

Of the 6,000 deaths that occur every year due to pregnancy or childbirth, 1,200 women will die from unsafe abortion while about 40% of admissions for emergency obstetric care in Uganda are a result of the same condition.

Medical experts in the country insist that the persistence of the number of Ugandan mothers dying as a result of child-bearing related causes—currently estimated at 438/100,000 live births is due to unsafe abortion. They say if the trend persists, Uganda will not meet its commitment to achieve a reduction in maternal deaths to the set goal of 150/100,000 live births by 2015.

Kiggundu says the high rate of unsafe abortion is caused by multiple factors including persistent low contraceptive use with only 26% of married women and 43% of sexually active unmarried women said to be using at least one modern method.

With premarital sex very prevalent across the country, adolescents are particularly at risk for unintended pregnancies.  Kiggundu says more than one in three women aged 15-24 who have never married have already had sex.

However, although abortion is impacting on families and communities, the stakeholders too learnt that the practice is eating into both the women’s and government’s income.

According to a recent study done by the Guttmacher Institute entitled, “Documenting the Individual and Household-Level Cost of Unsafe Abortion in Uganda,” the majority of women treated for complications from an unsafe abortion experience some adverse economic effect.

For instance, of the women surveyed, 73% reported that they had lost wages, 60% said their children had had less to eat, were unable to attend school or both, and 34% experienced a decline in the economic stability of their household.

On average, Ugandan women pay Shs 59,600 (US$23) for their abortion procedure. However, those who receive treatment at a health facility for post-abortion complications spend an average of Shs 128,000 (US$ 49) for both the procedure and treatment of resulting complications.

For many women these expenditures are significant, given that Uganda has one of the lowest per capita incomes in the world and that a substantial proportion of Ugandans live in poverty.

For these women, the risks of experiencing a loss of earnings and of reporting negative consequences for their children were twice as high as those for women treated as outpatients, and the risk of experiencing some economic deterioration of the household was three times as high.

The proportion of women who reported that their children had suffered negative consequences was highest among teenagers (92%), followed by women in their 20s (62%) and older women (51%).

“These findings make [it] clear that more must be done to reduce unintended pregnancy by ensuring Ugandan women have access to family planning services,” said Moses Mulumba, the executive director of the Centre for Health, Human Rights and Development (CEHURD).

“Accurate information on contraception and high-quality services must be made available as a matter of constitutionally guaranteed rights to allow women to avoid an unwanted pregnancy. Young and poor women in particular need access to these services.”

According to the study, there is an urgent need for programmes and policies that help address women’s reasons for obtaining unsafe abortion and diminish the consequences of such abortions, in particular through the provision of abortion services to the full extent of the law.

In addition, concerted efforts must be made to reduce the overall costs associated with post-abortion care, so that women suffering from complications of unsafe abortion do not have to sacrifice the well being of their families to receive treatment.

Dr. Eunice Brookman-Amissah of the Nairobi-based Ipas Africa Alliance which has been working with regional governments to reduce maternal deaths noted that the African Union is coming up with a number of initiatives to compel member states reduce unsafe abortion on the continent.

She says it is important that Uganda works on a progressive law that will save women from dying unnecessarily.

“It is not true that when abortion is legalized, it will make women rush to procure the abortion. A lot of antipathy and opposition towards abortion is because of a lack of knowledge on the issue,” she said.

Sarah Opendi, the state minister for health in charge of Primary Health Care said she will remain an advocate of safe abortion in the country.

“If we don’t tackle the causes of unsafe abortion, we will not reduce unnecessary deaths of mothers,” she said.

“Even with the recent targeted investment by the government in the maternal health, this has not prevented mothers from dying unnecessarily.”

Opendi said Uganda spends about Shs 38 billion every year on post abortion care yet this money can be invested elsewhere.