21 February 2006

Uganda: 297,000 Unsafe Abortions

Nairobi — THE HIGH INCIDENCE OF unsafe abortions is a leading cause of maternal morbidity and mortality, which hampers Uganda's aim of attaining the fifth Millennium Development Goal (MDG).

The goal requires countries to improve maternal health by reducing by three-quarters the maternal mortality ratio.

A recent study shows that an estimated 297,000 induced abortions - 54 for every 1,000 women - occur every year. This reflects one in every five pregnancies.

Health officials warn that at this rate, half of all Ugandan women will require treatment for complications related to abortion in their lifetime.

The 2002 Uganda Population and Housing census says although the country's population is 26.8 million, it is growing at 3.4 per cent and is expected to double in 20 years. The gender ratio stands at 95 males to 100 females.

"Because women seeking abortions rely primarily on untrained personnel using unsafe methods, a total of 85,000, or 15 out of 1,000-women, are treated for abortion-related health complications each year and unsafe abortion is the country's leading cause of maternal death," said the study, titled The incidence of induced abortion in Uganda.

Women with abortion complications may require several days of hospitalisation, treatment with expensive antibiotics or blood transfusions and, in the long run, some suffer from long-term consequences such as infertility.ÊÊ

The study, published in December 2005, was done in 313 health facilities that treat women with post-abortion complications. It also involved 53 professionals knowledgeable about abortion. The study found that the abortion rate is higher than average - at 62 per 1,000 women - in the central region of the country's most economically developed area. But it is much higher in the northern region, at 70 per 1,000. The national average stands at 54 per 1,000.

The abortion rate is particularly high in the north, reflecting in part the increased difficulties faced by women seeking healthcare because of the civil unrest that has prevailed in the region since 1986, says the study.

"Security issues have forced health facilities to close down and created gaps in delivery of contraceptive supplies," said the study co-author Prof Florence Mirembe, lecturer in obstetrics and gynaecology at Makerere University in Kampala.

"In addition, women in areas of conflict are often widowed, may have to resort to commercial sex work to support their children, and face an increased risk of rape and physical abuse - situations in which they may seek abortion if they become pregnant."

Ugandan law forbids abortion and induced abortion is allowed only when the pregnancy endangers a woman's life. Legal abortions are rare, and are almost impossible given the detailed process for obtaining approval - where providers require certification from three doctors; many healthcare providers and women are unaware of the provisions of the law.

PROF MIREMBE SAYS THE only way out is to help women obtain contraceptives that can reduce the number of abortions. "Healthcare providers, advocates, professional associations, government and communities all have a role to play in ensuring women's access to the contraceptive services they need, she says.

The study points out that about half of all pregnancies in the country are unintended, 51 per cent of married women aged 15 to 49 and 12 per cent of unmarried women have an unmet need for effective contraceptives.

Data from the Ministry of Health shows that contraceptive use increased slightly between 1995 and 2000; the gap between the number of children a woman wants and the number she has rose slightly over the same period.

On average, Ugandan women have two more children than they plan for and the desired family size declined from 6.5 children in 1988 to 4.8 in 2001. However, access to contraceptives for both married and unmarried women remains low.

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