Back door abortions thriving in Kampala

In a competitive environment, how you present yourself to customers determines your business survival. And that’s exactly what ‘Dr Gift’, despite advertising an illegal service – which he called legal – did.
I was taking a walk in the city centre when I came across a bold advert on A4 size paper. It stood out from the other black and white adverts because it was written in red, capital letters. The poster proclaims how ‘Dr Gift’ provides “legal abortion and free cleaning”.
I take the number and make a call. The male voice asks how he could be of help. Once I tell him why I have called, he confirms – in a shaky voice – that he is indeed the doctor.
Throughout our conversation, ‘Dr Gift’ uses colloquial language and street slang. He asks for my name and permission to save my number so as to send me a text message with the details.
“We have different systems and each system has its cost. Let me send you the details,” he says before hanging up.
I got two other people to call him at different times using different numbers, asking him to send the cost details by text. We all received different figures.
His first quotation had “Pills Shs176,500, injection Shs202,000 vacuum Shs275,000. All services include free cleaning.”
The next day on a different number, his quotation is: “Pills Shs226,500, injection Shs264,500 and vacuum system Shs325,000.”
Four days later, the quotation on yet another number comes with different details: “There is an injection method at Shs234,000 and takes only 35 minutes, pills Shs196,500 (works in one hour) and a vacuum at Shs285,000 and takes not more than 15 minutes once the machine has loaded.”
When I call him to provide details of the costs, he says he has a professional team. When asked about the safety of the service, he is quick to reassure me: “Trust me this is our profession. I promise you a good professional service and care.”
He asks how old the pregnancy we want to terminate is and when he is told it’s 12 weeks, he responds with authority but the stammering and the use of street language pokes holes in his expertise.
“One to three months period, there is nothing much; that is just blood. That’s a very minor job for us. There is nothing serious that can make her weak or what, what. Afterwards it’s very okay on her side,” he says.
Because he does not want to reveal his real name, we decide to check the name under which the phone number he uses is registered. We found out the number is registered in the names of a female.

Vague
Also, his operation location is kept vague. The directions are sent via text but then in a telephone conversation, he admits to having several centres within the city centre and its suburbs. The location address given is also ambiguous.
“We are located at Nakasero near Hardware city opposite Zaneth Plaza along Entebbe road Office number S52A second floor,” he says.
He further explains: “We are open weekly from 8:30-17:30, Saturday and Sunday only by appointments.”
He, however, does not specify the exact building on which they are located.
We set up three different appointments but he does not give specific location and prefers that we wait for him around hardware city building from where he would pick us up and take us to the clinic where the abortion is to be carried out.
At the meeting venue, a rather youngish boy of less than 30 years comes and separately tells us (on three occasions) that “the doctor is coming to pick you up and take you to the clinic”.
One day he asks us to meet him at a clinic in Makindye near Calendar Guest House where he is attending to a client.
From the way he operates, ‘Dr Gift’ seems to be an agent of the different clinics where the people he calls professionals are operating from. During the first phone call each of us made, he would be so eager to know where we were calling from so that he directs us to a clinic closest to our location.
“We have clinics in Seguku, Rubaga, Kawempe, Makindye, City Centre and other places. Monday and Tuesday [I’m] in Gulu where we have just opened our operations,” he explains.
Having told him I was a married man who impregnated a student and I’m afraid of my family finding out about the pregnancy, he assures me that they do a professional job. They not only stop at removing the foetus but also help with the cleaning.
“Cleaning is part of the package, it’s very important in any abortion process. If not cleaned well the remaining particles can result into wounds leading to cancer. When you test again the results turn to be positive [even] when you are not pregnant and sometimes you may lose the uterus as a result of poor cleaning,” he says.
I insist that the client is a young girl and this was her first pregnancy so her safety is key. “Listen to me,” he says, adding: “This is our job; we are professionals. More than 80 per cent of our clients are young girls removing their first pregnancy [so] trust me we know what we are doing; there will be no side effects no matter the method used.”
The female undercover client
To find out how their system works, I call a potential client called Betty who has been referred by one of his former patients. A male voice on the line identifies himself as Dr Gift.
He does not sound confident as he explained the procedure I have to go through.
He asks a few questions to know how best to serve me. He asks to know how old the pregnancy is, whether I have used contraceptives before.
Through stammers and coughs, Dr Gift explains the procedure and gives me an identification code. I am to identify myself as Betty 9. Details on the costs are to be sent by phone text.
It is my time to ask questions mostly about the safety of his method since it is my first pregnancy.
He says: “Don’t worry; young people are my main clientele so you are safe. Abortion is better carried out when the pregnancy is in its early stages preferably at three months as a mature one can be dangerous to tamper with.”
After explaining the different methods they use Dr Gift assures me that “there are no side effects apart from minimal pain of two to three days.”
From what he tells me, this must be a cartel carrying out abortions in different parts of the city and country.
“We are a big team and everyone is an expert, even if I don’t work on you, I will recommend a very professional doctor who will give you good service. He then reminds me to make an appointment when I’m ready and also asks me whether I prefer a government or a private clinic.
“Is it okay going to a public clinic or one of our private branches in Seguku, Mityana, Makindye or the new branch in Gulu where I operate on Monday and Tuesday?” he asks.
With an appointment secured for a Thursday when he is in Kampala, we agree that since I come from Natete, he takes me to one of their centres in Rubaga.
Our meeting point is at a petrol station on Wakaliga Road where he appears with another man who he talks to in private before turning to me that he has a patient waiting for him in Makindye and this other man he was with is to take me to the clinic where the doctor is already waiting for me.
Knowing I am not pregnant, my excuse to escape is having forgotten the money at home. I request the man who was supposed to take me to the clinic to wait for me as I go back home to get the money. He is very furious that I wasted his time and refused to pick my subsequent calls.

An agent
Dr Gift seems to be an agent for various backdoor abortion clinics given the way he operates. He prefers to be met on the street and to be paid on the street as well.
He acts too busy, always in a hurry delivering clients to the various clinics. It is evident that these clinics in different parts of Kampala cannot be run by the same person.

The law and punishment
Article 22(2) of the Constitution says: “No person has the right to terminate the life of an unborn child except as may be authorised by law.”
Section 141 of the Penal Code states punishment for any person who abets abortion in any form, it says: “Any person who, with intent to procure the miscarriage of a woman whether she is or is not with child, unlawfully administers to her or causes her to take any poison or other noxious thing, or uses any force of any kind, or uses any other means, commits a felony and is liable to imprisonment for fourteen years.”
The same Penal Code Section 142 says a woman who procures her own miscarriage commits a felony and is liable to imprisonment of up to seven years.
However, the president of the Uganda Medical Association, Dr Ekwaro Obuku, says though their association, they support the law and there is a religious and cultural clash on the issue, research suggests that in low income countries like Uganda, procuring safe abortion saves lives, improves choices and empowers women.
The dilemma is the cultural, religious and ethical arguments.

UN stand on abortion
Last year, World Health Organisation and the Population Division of the United Nations Department of Economic and Social Affairs launched a new, open-access database of laws, policies and health standards on abortion in countries worldwide.
The database aims to promote greater transparency of abortion laws and policies, as well as to improve countries’ accountability for the protection of women and girls’ health and human rights.
They said Women, including adolescents, with unwanted pregnancies often resort to unsafe abortion when they cannot access safe abortion. According to them, around 22 million unsafe abortions are estimated to take place worldwide each year.
Each year between 4.7 per cent and 13.2 per cent of maternal deaths can be attributed unsafe abortion, they said. In addition to a range of other factors, restrictive laws are a barrier to accessing safe abortion.
The authors of an article about the new Global Abortion Policies Database, stated: ‘According to an analysis by the UN, the average rate of unsafe abortion is estimated to be more than four times higher in countries with more restrictive abortion laws than in countries with less restrictive laws.”
The database includes information on a broad range of policy areas. These include; legal grounds and related gestational limits, authorisation and service-delivery requirements, policies about who can provide abortion and where, when and how abortion services are permitted, and criminal penalties for women, girls, health-care providers and others.
In addition to data on specific abortion policies, individual country profiles include sexual and reproductive health indicators, links to ratified human rights treaties, and links to UN Treaty Monitoring Body Concluding Observations and Special Procedure Reports, which address abortion.

Abortion risks

Below is a description of the immediate abortion risks:
>A hole in the uterus (uterine perforation) or other damage to the uterus.
>Injury to the bowel or bladder.
>A cut or torn cervix (cervical laceration).
>Incomplete removal of the unborn child, placenta, or contents of the uterus requiring an additional operation.
>Complications from anesthesia, such as respiratory problems, nausea and vomiting, headaches, or drug reactions.
>Inability to get pregnant due to infection or complication from an operation.
>A possible hysterectomy as a result of complication or injury during the procedure.
>Hemorrhage (heavy bleeding).
Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.
Source: www.ramahinternational.org