The major causes of maternal mortality and morbidity in Uganda are well known. But action to address unsafe abortion –one of the four major direct causes of maternal mortality has been at the centre of debate in the recent weeks.
The Ministry of Health officials last month came under fire from religious leaders after releasing a post-abortion management policy detailing the circumstances under which medical workers can perform abortions, in hospitals.
Dr Anthony Mbonye, Director Health services (clinical and community), while releasing the new policy said it was intended to provide for a comprehensive management of post abortion complications and reduce death.
“There are a lot of women coming to hospitals with complications, they report with infections and punctured uteri every day, this policy will provide a better picture on how, when and in what circumstances a safe abortion can be performed,” Dr Mbonye said adding that about 30,000 women die annually as a result of unsafe abortions.
The health ministry’s policy caused uproar amongst religious leaders.
Church of Uganda Archbishop Stanley Ntagali termed such a policy as propagating “murder’’ and condemned it in the strongest terms.
“We are hearing a rumour about legalising abortion in this country. As a Church, we strongly condemn this, its murder, killing, nobody has a right to take way life, it’s ungodly,” said Archbishop Ntagali.
The Mufti of Uganda, Sheikh Shaban Mubajje also warned government and advocates of the proposed law on abortion arguing that termination of pregnancy is unacceptable and amounts to murder.
“In our culture abortion is bad. We cannot begin referring to other countries because their culture is different and besides there are challenges we are facing as a country like poverty and corruption right from families which we have to fight than focusing on ungodly,” he said.
But who is right on abortion?
According to the Population Secretariat, of the 1.2 million pregnancies recorded in Uganda annually, 25 per cent are teenage pregnancies.
This figure is undoubtedly disturbing considering that majority of these teenage pregnancies belong to at least the dormant religions-Islam, Catholic, Pentecostals Seventh Day Adventists and traditionalists are increasing in number.
The 2014 National Population and Housing Census indicate that Muslims stand at 13.7 per cent in 2014, Pentecostals occupy 11.1 per cent, Anglicans 32.0 per cent (over 11 million) and traditionalists to 1.7 per cent.
The fact that these religions have failed to tame in the first place these pregnancies, Dr Charles Kiggundu, a consultant gynaecologist and obstetrician at Mulago National Referral hospital says any woman who doesn’t want to have a baby should be allowed to carry out abortion whenever they want.
“If we leave it [illegalising abortion] the way it is; it won’t abolish abortion, but if we provide a safe window [for abortion] it would cut off the cost including humanitarian waste,” warns Dr Kiggundu .
The former president of the Association of Obstetricians and Gynaecologists of Uganda says legalising safe abortion would even be cheaper given the country spends about Shs7.5bn on treating unsafe abortion complications.
“It would only cost one tenth of the money used for treating abortion complications,” he adds that Uganda will not be the first country to legalise abortion saying that it has nothing to do with increasing sexual immorality.
In any case, Dr Kiggundu says, many young girls continue to carry out abortion either using herbalists or unqualified personnel which puts their lives in danger.
“By exploring the circumstances under which they [women] conceive such as rape and incest, its unjust to force a woman to carry a baby which they don’t want,” he adds.
His argument is sustained by the country’s inadequate essential commodity supplies required to ensure that healthy reproductive care is made possible for individuals to have a right to choose, obtain and use contraceptives to avoid unintended pregnancies.
Uganda, according to the Uganda Demographic Health Survey 2011, has the highest unmet need for family planning in the world with 54.2 per cent of urban and 73.1 percent of rural women are not using any method of contraception.
Yet at the time, the country has one of the highest fertility rates in the region at 6.2 children per woman putting the total fertility rate for women in urban areas at 3.8 compared to 6.8 for rural women, the report says.
Jail for abortion
As a result, both teenagers and married women end up getting unwanted pregnancies which they at one point stealthily try to get rid of as abortion is illegal in Uganda and only permissible when saving a woman’s life.
The Penal Code Act 120 prescribes a prison sentence, ranging from three to 14 years, for procuring, assisting or supplying drugs to aid abortion despite the red tape surrounding the legal process.
However, the use of crude methods has led to rampant cases of unsafe abortions and the subsequent post abortion complications which among others include maternal mortality.
A total of 292,000 abortions are carried out annually in Uganda while abortion-related cases account for 26 per cent of maternal deaths, according to Ministry of Health.
The Uganda 2003 national abortion incidence study also indicates that 15 out of every 1,000 Ugandan women of reproductive age were treated for abortion complications that year.
Current records from the Mulago obstetrics and gynaecology department which has since been shifted to Kawempe general hospital, a total of 8,520 abortion cases have been handled between January and September this year.
Out of theses, 2,545 cases are post abortion cases which include both incomplete and septic abortions.
With such stunning figures in a period of nine months from just one facility, the activists’ camp claims that the church, by its obstinacy, is fuelling maternal mortality and morbidity caused by unsafe abortions in Uganda.
The Centre for Human Rights and Development executive director, Mr Moses Mulumba, argues that the church should instead step up to defend the neglected women rights saying that the latter are well placed to hold government accountable where it has failed to provide safe abortion services.
“Religious leaders should know that in about 160 countries where legislation allows abortion on broad indications, there is a lower incidence of unsafe abortion and much lower mortality from unsafe abortions, as compared to legislation that greatly restricts abortion like in Uganda,” Mulumba says
A comprehensive global collaboration study between scientists from the World Health Organisation(WHO) in Geneva and the Guttmacher Institute in New York, a reproductive rights group concluded that abortion rates are similar in countries where it is legal and those where it is not, suggesting that outlawing the procedure does little to deter women seeking it.
The 2007 report also found that abortion was safe in countries where it was legal but dangerous in countries where it was outlawed and performed clandestinely.
Globally, abortion accounts for 13 percent of women’s deaths during pregnancy and childbirth, and there are 31 abortions for every 100 live births, the study said.