Health workers have called for amendments to the laws on abortion, to save some 1,500 would-be mothers annually.
The call came on Monday, as health workers and legal experts met at Kabira Country Club, Kampala, to discuss the law on abortion. The president of the Association of Gynaecologists and Obstetricians of Uganda (AOGU), Dr Charles Kiggundu, said most of the 1,500 women were dying after procuring unsafe abortions.
"Out of every 100 pregnant women, 20 will get abortions and eight of these will need emergency post-abortion care but might not access it because of the stigma society and health workers attach to abortion," Kiggundu said.
Most of the victims are the youth. They use crude methods, including smoking cow dung, drinking laundry detergents, bleach or petrol and insertion of a catheter, clothes hanger, sticks or pieces of cassava into the vagina.
Kiggundu says two million pregnancies occur annually in Uganda, with 400,000 ending up in unsafe abortions.
Some 90,000 of these women later develop complications such as haemorrhages that require emergency obstetric care, available in only 15 per cent of the health facilities across the country.
Unpacking the law
According to Moses Mulumba, the Executive Director of the Centre for Health, Human Rights and Development (CEHURD), abortion is permitted under some circumstances. But the relevant laws (Section 140-2 of the Penal Code) are often interpreted inconsistently, making it difficult for both women and the medical community to understand their options.
Consequently, he says, most health workers avoid overt abortion practices. Mulumba was backed by Dr Collins Tusingwire, the acting head for Reproductive Health Services in the ministry of Health.
"Because abortion is an offence under this law, it is being carried out secretively in un safe dark places, using unsafe instruments so that the giver and receiver of the service are not penalised. This has worsened the situation," Tusingwire said.
The 1995 Constitution slightly improved abortion legislation, providing, in article 22 (2), that "no person has the right to terminate the life of an unborn child except as may be authorised by law."
"However, since 1995 there is no law that has been enacted to give effect to article 22(2) of the Constitution," said Senior State Attorney Denis Kibirige.
Kiggundu believes this confusion has limited women's access to safe surgical and medical abortion procedures.The country has also not updated its procedures on abortion, relying on the 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health Rights for skilled medical workers.
According to these guidelines, health workers can only terminate a pregnancy in cases of foetal anomaly, rape and incest or if the woman has HIV. The challenge, however, is that these guidelines are not reflected in the existing laws.
Kibirige argued that Sections 141 to 143 and 212 of the Penal Code could be amended to remove the general criminalisation of procuring a miscarriage.