How easy is it to abort AT a public facility?

It is 11am on a Thursday. I walk into Mulago National Referral Hospital casuality section. At the front desk, there are four people attending to patients. I look out for one with the least number of patients and line up there.
When I finally get to the inquiry window that is being operated by an elderly lady, she does not look at me but rather continues writing down some notes on a piece of paper as she asks me what I want.

I ask her where I can go to for an abortion. She swiftly raises her head, looks at me and immediately sends me to another woman (a nurse) seated at a bench in front of a big table at the entrance of the casuality section. When I ask the nurse the same question, she tells me, in a nice tone, that abortions are illegal and are therefore not conducted at Mulago.

But despite what she has told me, I am not ready to give up. Since I know the hospital well, I walk to the fifth floor, the obstetrics and gynaecological department.

I enter one of the offices and ask the woman at the desk where I can go to for an abortion. With disgust on her face, she says, “Enter that office and ask the women in there,” while pointing towards an open door close to where she is seated.
When I enter the office, I find two women, one a little elderly, the other younger. I greet them and ask if there is a doctor around who could conduct an abortion.

The elderly lady looks at me, frowns and goes back to her work. But the younger doctor smiles at me and asks, “Why do you want to have an abortion?” I explain that I am not the one who wants to have it but that I want to bring my 15-year-old sister for the operation.
Still with a smile, she says, “It is not necessary for her to have an abortion. I work with women and when I see how some of them suffer to get babies, I never encourage anyone to have an abortion.”
Standing my ground, I tell her I do not want my sister to have an unsafe abortion because she (my sister) was insisting on having one. So I thought the best services would be at Mulago.
But this doctor is also persistent as she tells me to encourage my sister to keep the baby. I try so hard to convince her into helping me but she stands by her word.

She says, “I am a doctor but I cannot perform an abortion because no matter what the reasons one has for going through with it, it is wrong. However, if you continue looking, evening will not come before you get a doctor who is willing to do it away from Mulago for some money.”

After saying this, she tells me to take my sister for a scan and hands me a piece of paper with her number while saying, “You can call me in case you need someone to talk to your sister about the dangers of having an abortion.”

Two days later, I walk into Mulago again. This time, I use the main entrance. As I walk towards the office, I see an old doctor. I politely stop him and ask if he could direct me to a place where I could get an abortion done around the hospital. He takes me to the side and asks for details. I tell him the same story.
He says, “You cannot get an abortion at Mulago. However, I can do it for you out of here at a price. When I ask how much, he says, “We shall discuss when you come. I am always on the fourth floor,” and walks away. I don’t meet him again.

Different facility
A week later, I walk into Kampala Capital City Authority Health centre in Namuwongo at 8am with the same story. The three nurses I find on duty gladly welcome me and ask how they can help me.

I tell them the same story. One walks away but the other two stay behind. One tells me that abortion is against Uganda’s laws and they do not conduct them at the health centre.
The other nurse tells me there is a doctor who even arrests both the patient and the doctor if found conducting an operation. The first nurse then asks me to bring my sister between Tuesday and Thursday for counselling.

She says, “There is no justification for abortion, all pregnancies should be carried to full term it does not matter whether they were as a result of rape. But I am sure that when we talk to your sister, she will change her mind.”

These experiences got me thinking that while government has failed to implement a number of programmes and laws, it deserves credit for having given health providers, mainly in public hospitals, a good scare since they don’t carry out abortions, not at the hospitals and health centres at least.

Seven things about abortion you never knew
Abortion is so abhorred that many believe it is a crime however, research by the Center for Reproductive Rights Uganda Chapter, reveals otherwise:

1. Abortion is not illegal according to our constitution. The Ugandan Constitution does not prohibit abortion. Article 22(2), which states that “No person has the right to terminate the life of an unborn child except as may be authorised by law,” does not preclude access to termination of pregnancy; it simply requires a legal framework to do so.

2. There is no absolute prohibition on termination of pregnancy in Uganda. It is permitted to preserve the life and health of the pregnant woman. Health is defined to include both physical and mental health.
This understanding was made clear in the widely recognised English case Rex v. Bourne (1938)—a case that has been affirmed effective to date as no other amendment or revision has been made to the constitution since the ruling of this case. It ruled that it was for the health of the woman, prudent to terminate the child, and thus Doctor Bourne was acquitted for murder.

3. The Ugandan Government has affirmed the importance of access to safe termination of pregnancy services and has issued guidelines specifying who can obtain these services.
The 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights provide for access to abortion services in cases of “severe maternal illnesses like severe cardiac disease, renal disease, severe pre-eclampsia and eclampsia, severe foetal abnormalities, cervical cancer and HIV-positive women requesting for termination.

4. Government policies permit abortion in cases of sexual violence—this has been policy for over a decade especially for cases of rape, incest and defilement.

5. There is no law, policy, regulation, or code of conduct in Uganda requiring that a health care provider consult with one or more other providers before performing a termination of pregnancy. Nor is this a legal requirement under common law.

6. Under the National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, mid-level providers can offer termination of pregnancy and post-abortion care services.

7. There is no law, policy or regulation requiring that a woman obtain her spouse’s consent before receiving reproductive health services, including a termination of pregnancy. The absence of a spousal consent requirement is reflected in the national policy guidelines and has no mention in the constitution hence making it void as a claim in court.

Joseph Lagen

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