KAMPALA – Maternal mortalities remain an enormous concern in both restrictive and liberalized legal contexts. For social and political reasons, the comprehensive SRHR services i.e. abortion care delivery is not included in national responses for maternal healthcare improvement in Uganda.
The Alliance of Women Advocating for Change (AWAC) on International Safe Abortion Day on September 28, together with other Civil Society Organisations – CSOs including Wellspring Philanthropic Fund (WPF) through Coalition to Stop Maternal Mortality Due to Unsafe Abortion (CSMMUA) organized a media café dialogue to spotlight the effects of unsafe abortion among marginalized women including female sex workers, and AGYW engaging in sex work.
The dialogue held at AWAC Offices in Mengo was also attended by several other CSOs; Center for Health, Human Rights and Development (CEHURD), Action for Improved Health and Wealth – Mbarara, Rella Women’s Foundation, Human Rights Awareness and Promotion Forum – HRAPF to call on policymakers to revise laws that criminalize abortion in Uganda.
Resty Kyomukama Magezi, Sexual Reproductive Health and Rights Services – SRHR and Gender Specialist at AWAC says that abortion is under maternal mortality which happens a lot in developing countries which means that it happens a lot in those who are less privileged economically.
Accordingly, unsafe abortion practices remain one of the top most contributor to maternal death in Uganda, impeding the achievement of universal health coverage and quality of maternal health care.
According to the Uganda Demographic Health Survey 2016, the maternal mortality ratio is still at 336 per 100,000 live births, and maternal deaths are estimated at 16-18 per day with 4 – 6 deaths attributed to unsafe abortion.
Generally, abortion in Uganda remains illegal unless performed by a licensed medical doctor in a circumstance where the woman’s life is deemed to be at risk. With women lacking access to safe and legal abortions, many of them turn to rudimentary and unsafe abortion practices, such as self-induced abortions.
Ms. Ruth Ajaro Okello from CEHURD noted that one of the challenges they are faced with is that stakeholders do not have information regarding safe abortion.
“They need a lot of capacity building but also our laws are not progressive. Up to now, we’re still implementing laws from our colonial masters. These laws are now alive the fact that we have moved on, the lives are changing and the trends are different.”
“We need to go through a law reform process. We have to engage leaders, the line ministries and the Parliament. The ministry says we have policies but when you have a policy saying YES and the law says NO, that policy can’t override the law,” she said.
Dr. Justus Ampaire – Medical Doctor, Obs Gyne at St. Augustine Community Health Centre also revealed that the biggest challenge remains the law because everyone knows that the law is against abortion which makes many fear to seek for service but also health workers to fear to help procure an abortion.
“So, someone will fear to come to the health center thinking that someone might see them. The health worker may fear giving the service because they fear being imprisoned. So, it is not an open service that people can come and access. That’s why they go for those bad methods (unsafe abortion practices).”
Dr also attributed the fear by those who need to terminate the pregnancy to the stigma associated with it. “Most people are religious-based; they think you are killing someone.”
According to him, the post-abortion care which is supposed to be a legal service, some of the health workers don’t have the skills, leaving the service to midwives which at times delays service delivery.
He decried the fact that “this affects the poor because the rich will go to good health facilities, procure and go away.”
Ms. Immaculate Nyamwija – Executive Director, Action for Improved Health and Wealth – Mbarara says that women themselves go with self-stigma to seek abortion services, but also the health workers have that fear of falling victims if caught.
“But also even if they accept to work on you, they ask for a lot of money that most of the marginalized women do not have. Sometimes they tell you we don’t have the resources to work on you.”
Nyamwija wants policymakers to revise those laws that tight hands of everybody but also sensitize the health workers “to know that if someone comes for service, they should access the services without being discriminated or stigmatized.”
Abortion is and remains a contentious issue globally. While countries like Spain are looking to allow girls as old as 16 to choose abortion without parental consent, in others, for example, the United States, millions are rallying against a possible move by the Supreme Court to strike down a 1973 ruling that the Constitution of the land gives women the liberty to terminate pregnancies without government restriction. Examples of such laws are bound.
What law says
In Uganda, abortion remains generally illegal. The Constitution of the Republic of Uganda (1995), Article 22(2) states:
No person has the right to terminate the life of an unborn child except as may be authorised by law.
The Penal Code Act (Cap. 120), as amended through the Penal Code (Amendment) Act, 2007 (Act No. 8 of 2007), criminalizes abortion in Sections 141-143, 212 and 224
Attempts to procure abortion.
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.
Any woman who, being with child, with intent to procure her own miscarriage, unlawfully administers to herself any poison or other noxious thing, or uses any force of any kind, or uses any other means, or permits any such things or means to be administered to or used on her, commits a felony and is liable to imprisonment for seven years.
Supplying drugs, etc. to procure abortion.
Any person who unlawfully supplies to or procures for any person anything, knowing that it is intended to be unlawfully used to procure the miscarriage of a woman, whether she is or is not with child, commits a felony and is liable to imprisonment for three years.
Killing unborn child.
Any person who, when a woman is about to be delivered of a child, prevents the child from being born alive by any act or omission of such a nature that if the child had been born alive and had then died, he or she would be deemed to have unlawfully killed the child, commits a felony and is liable to imprisonment for life.
A person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon any person for his or her benefit, or upon an unborn child for the preservation of the mother’s life, if the performance of the operation is reasonable, having regard to the patient’s state at the time, and to all the circumstances of the case.
According to statistics, unsafe abortion makes up for about 18% of Maternal mortality in Uganda.