It is almost taboo to discuss abortion in Uganda, yet some 300,000 women seek abortion in Uganda with about 85,000 receiving treatment from complications of unsafe abortions.
The Centre for Reproductive Rights (CRR) commissioned research to explain the existing law, and the results are carried in a report titled: A Technical Guide to Understanding the Legal and Policy Framework of Termination of Pregnancy in Uganda. Shifa Mwesigye talked to CRR's Africa Regional Director, Elisa Slattery, about their findings.
You have just compiled a report on the abortion law in Uganda. What are the key findings?
The report is a mapping and analysis of the legal and policy framework around abortion in Uganda. We decided to do the research because in many places in Commonwealth East Africa, abortion laws are interpreted as wholly restrictive, prohibiting abortion entirely. This is not the case, and so a lack of clarity around the abortion law is one of the main barriers to safe abortion services. We thought it would be important to get a clear picture of what the actual legal and policy framework is.
We found that while the laws are often confusing or a bit contradictory, they are much more expansive than people believe them to be and that there is a clear framework in which abortion is permitted - in cases of a threat to the life or physical and mental health of a pregnant woman, or in cases of sexual violence.
These are standards that are laid out and reflected in government statements and policies, as well as in case law, within the legal framework. The main point we want to make is that women are dying every day from unsafe abortion. This does not need to be happening.
Abortion is one of the safest medical procedures there is and safe abortion services would save women's lives. Unsafe abortion accounts for 26 per cent of maternal deaths in Uganda. As the government tries to reduce maternal mortality, this is one of the easiest ways to accomplish that.
Abortion in Uganda is illegal except to save a mother's life. Do you think it should be legalised?
What would be a very important first step is to publicise knowledge about the law so that women learn the conditions in which they can seek safe and legal abortion services. That would be a very important first step in keeping women from turning to unsafe abortions, because they mistakenly believe that abortion is prohibited.
The point is that it is already legal; the debate is less about taking it from an illegal status to a legal status [and more about] recognising what is permitted within the existing legal framework and ensuring that the government shares this information. Healthcare providers and women need to know what the law and policy say, and that [women] are able to seek safe abortion services.
How will this research benefit Ugandans?
What we really hope is that it will help clear out some of the existing misconceptions around what the law permits and that it will encourage more women to go to a safe abortion provider rather than turning to a back alley quack or trying to end the pregnancy themselves, which is often very painful and disastrous.
Abortion contributes half of maternal deaths in Uganda. What do you think can best bring down the rates of abortion?
I think that one of the things is to distinguish between safe and unsafe abortion. Unsafe abortion is one of the major contributors to maternal death and disabilities. Safe abortion is one of the safest medical procedures; and so, providing information, training service providers and providing services in a clean and compassionate environment can all take an immediate first step in reducing maternal mortality.
There are a number of steps in the big picture in terms of preventing unwanted pregnancy in the first place. Improving access to family planning, [providing] accurate information about family planning, and removing cost barriers and stock-outs of preferred contraception methods.
Even in that case, there will be [instances] where women will have unintended pregnancies; so, it will always be important to ensure that safe abortion services are available.
Controversy surrounds the question of providing teenagers with contraceptives, yet so many of them turn up pregnant and procure abortions. Should teenagers be allowed to use contraceptives?
It's very important that adolescents be provided with comprehensive family planning information and services. It's an unavoidable fact that at least some adolescents will engage in sexual activity. What's important is to make sure that they're able to make informed choices about when they engage in sex and how to protect themselves if they do.
This is a very important first step to preventing unwanted pregnancies among adolescents, many of whom would lack the necessary information or access to services.
Ugandan women continue to have unintended pregnancies - nearly half of pregnancies are unintended. What is the country not doing right?
One of the things that have been clear over the years is that the rate of contraceptive prevalence in Uganda has more or less stagnated. Women do not necessarily have access to family planning services as they would wish. It's clear they continue to have a number of unwanted and unplanned pregnancies.
In this case, as is with adolescents, it's very important that there is access to family planning information and services on a range of family planning methods. This involves ensuring that there is a range of methods available, that they're in stock, and that there aren't any unnecessary price barriers that keep women from accessing the services when they need them.
Women die because they do not seek post-abortion care. What does the law say?
I think the first thing that is important is that post- abortion care is a legal service, and one that the Ugandan government has affirmed its commitment to providing. So, post-abortion care is available [even though] many people don't realise they can seek the service or they're afraid they will be arrested or mistreated by a provider who might object to the fact that they have ended a pregnancy.
Often, cost can be a barrier. Many women feel a sense of stigma and shame, and [so] stay away from a healthcare facility.
How do you plan to make your findings known so that women know the correct information about the abortion law in Uganda?
We're trying to disseminate the findings as broadly as possible and we hope they'll be of use to national advocates who are working to address maternal mortality and the issue of safe abortion. They will be able to use these findings in their work and their advocacy.
Do you have anything more to add?
The main point would really be that the legal and policy framework as it exists recognises that there are situations when women need access to safe abortion. This legal and policy framework can be used to reduce maternal mortality to save women from tremendous suffering and fear when they have an unwanted pregnancy.
It's difficult to overestimate the fear that women have when they have an unwanted pregnancy and they don't know where to turn. There are provisions and government has recognised that this is important and that women should be able to have access to safe and legal services within the existing law.