Abortions: The silent killer of girls in Uganda

Bududa.
With an emaciated body, Ms Jane Nakuti turns slowly in her bed, the grimace betraying the pain she is enduring. As Ms Nakuti squeaks she is careful not to disconnect the sterile bag containing isotonic saline connected to the intravenous delivering blood to her body.

She has been here, in Bududa District Referral Hospital, for the last six months and the ailment has taken a toll on her. The youngster has lost weight and her hitherto light complexion is fading. The only energy left in her is muted responses to questions by medical staff and wishes of quick recovery from her numerous visitors.

With her prominent cheekbones and sunken eyes, Ms Nakuti appears badly undernourished. This is a big contrast to the picture of her taken on the day before she had an abortion.

The nurse in charge, Ms Caroline Achom, and her attendant say before she was brought to hospital, she had been secluded at home barely able to speak. She had developed wounds behind her back and on the buttocks because she has been in bed for long.

“She is suffering from Sepsis Gangrene, pyometia, obstetric fistula, incomplete cervix and incomplete removal of products and could stay in this hospital a bit longer,” said Ms Achom.

Ms Nakuti is inconsolable! She speaks of shattered innocence and a blighted future, regretting why she had opted for an abortion when she conceived. “I have seen all of my dreams being destroyed. I have been ostracised by my family. They point at me saying, ‘you are a disgrace.’ I don’t understand what pushed me into an abortion,” said Ms Nakuti
Her face changes, she blinks as she narrates the ordeal. She flinches as she tells of the huge amount of blood loss and the pain. Ms Nakuti is not alone, there are many girls who are victims of unsafe abortions in the remote Bududa District, on the slopes of Mountain Elgon.

Ms Nakuti was hardly more than two months in a relationship with her equally juvenile boyfriend when she realised that she was pregnant. “I was only 16 and I wasn’t ready to have a baby then. I just had a voice tell me “take a test.” When I took the test the results were positive. When I told my boyfriend he told me he was not responsible and asked me to look for the man responsible,” she recalls.

“I was in Senior Three then, I could not tell my parents, I thought about committing suicide, then abortion, then chose the latter to abort in order to continue with my studies,” said Ms Nakuti as she constantly would be taken up in deep thoughts, tears would roll then she would recover then shortly keep quiet for some time before resuming to narrate. She told Daily Monitor that she chose to have an abortion locally.

“I then moved to a traditional birth attendant to seek advice and she gave me a mixture of herbs in a mug to take at about 7.00pm, she urged me to take a mug of this mixture of very many things I did not understand and I took,” said Ms Nakuti.

“Nothing came out, I bent on the floor as if to ease myself, I was heavy, the bleeding eventually started, for the moment I remained alone but then later I called my mother when the pain intensified,” she says.
“And when my mother walked in, she found me in a pool of blood and without speaking a word, she called our neighbours who put me on a local stretcher and took me to the Budadiri health Centre III,” she says.
She said she lay unconscious in bed and that when she woke up, it was difficult to know what exactly had happened.

“I was treated for a ruptured uterus, spleen and some stomach complications. My body has healed, but my psychological scars will take longer to mend. And I am constantly struggling with depression, I can’t imagine dealing with such intense emotions whenever I recall what I went through as a teenager,” says Ms Nakuti.

She said after treatment, the doctor then pronounced before her mother that she might never have a baby because the uterus was ruptured then my mother turned to me and said “It is up to you, I have played my part as a parent”

Ms Nakuti’s case however is just among the many cases of many abortions done in rural areas by quacks and wrongly by medical workers not supposed to perform abortions in clinics.

Dr Seggane Musisi of the Department of Psychiatry School of Medicine at Makerere University says every year about one million teenagers get pregnant and 40 per cent of these abort because they did not plan to have the children.

Unregistered abortions
He revealed that although this is the number which is recorded in the health facilities, there are many cases that undergo abortions and have died in the villages silently because they fear to be stigmatised and victimised by the colonial law that condemns abortion.

“Moral condemnation and intimidation makes taking a decision to abort very difficult for a woman. And unsafe abortions are very much linked to laws prohibiting abortion in Uganda,” said Dr Musisi.

He revealed that Ms Nakuti was a victim of quack methods of chemicals prepared by TBA [Nanda] which very many girls have fallen prey to because the qualified medical workers shy away from doing for fear of being arrested.

Dr Musisi said many young girls are suffering sepsis Gangrene, pyometia, pelvic inflammatory diseases, infertility, obstetric fistula, embolism, ectopic pregnancy, incomplete cervix and incomplete removal of products just because government has failed to legalise abortion to be performed in hospitals by qualified medical workers.

Dr Charles Kiggundu, a consultant Gynecologist/Obstetrician at Makerere University Medical School says it has been observed in Uganda that six women suffer severe morbidities- anaemia, infertility, pelvic pain and obstetric fistulas that lead to ill health caused partly by deliveries and unsafe abortions carried out in rural areas.

“Unplanned pregnancy is the root cause of most abortions. Preventing unintended pregnancy, and thereby the abortions that often follow, would eliminate nearly all injury and death resulting from unsafe abortion,” said Dr Kiggundu.

He says recent studies have shown that the cost to the healthcare system of treating complications from unsafe abortion is $130 (Shs330,000) per patient.

Maternal mortality dropping
He revealed that Maternal Mortality Rates in Uganda have moved down from 506 to 438/100,000 live births, abortion has become the silent killer of Ugandan mothers that has moved from 20 per cent in 2001 to about 31 per cent in 2012/2013 posing a great obstacle to achieve MDGs Two by 2015 that stands at 143/100,000 live births.

“One thing government should know is that post abortion care is estimated to cost nearly $14 million (Shs36b)annually in Uganda. And two-thirds of this amount, or $9.5 million (Shs24b), is spent on non medical costs (overhead and infrastructure), and the remaining third, $4.4 million (Shs11b) is spent on drugs, supplies, labour, hospitalisation and outpatient fees, which far expensive than procuring an abortion itself.
The question here is why government doesn’t legalise abortion to save mothers and save money budgeted for and spent every year on post abortion complications treatment,” said Dr Kiggundu.

He said most costs of post abortion care arise from treating incomplete abortion and a significant proportion is spent treating more serious complications, such as sepsis, shock, lacerations and perforations and yet an abortion would cost about Shs200,000 or even less.

The abortion law and policy in Uganda
The executive director of Center for Human Rights and Development [CEHURD] Mr Moses Mulumba said the Ugandan law allows abortion under some circumstances, but laws and policies on abortion are unclear and are often interpreted inconsistently, making it difficult for women and the medical community to understand what is legally permitted.

“The Ugandan Constitution states in article 22 on protection of life that no person has the right to terminate the life of an unborn child except as maybe authorized by law, this means that abortion is permitted if the procedure is authorised by law, but many of the medical workers cannot perform abortions because of failure to interpret the law,” said Mr Mulumba.

He revealed that under the 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, pregnancy termination is permissible in cases of fetal anomaly, rape and incest, or if the woman has HIV.

He said because the interpretations of the law are ambiguous, medical providers may be reluctant to perform an abortion for any reason for fear of legal consequences.