Abortion’s Bad Buzz

When Lydia Baraza, a teenager, was writing her final O-level exams towards the end of 2012, she was upbeat about the future. Like many students her age, she looked forward to enjoying her vacation before embarking on her A-level studies in 2013. But that dream was prematurely crashed when she got pregnant a couple of months into her vacation.

Lydia panicked even more when her boyfriend fled on hearing news of her pregnancy. Alone and frightened, Lydia kept the burden in her young tummy a secret. She also hatched a plan.

With her savings of Shs 100,000, she proceeded to the nearest clinic in her neighbourhood of Namayiba in Wakiso District. She wanted to get rid of the pregnancy and asked two clinicians for help. One refused outright, citing the law. The other agreed to perform the abortion but only if the young girl paid more money. He wanted Shs 300,000. After haggling they settled at Shs120, 000.

If getting an unwanted pregnancy was a mistake, opting to abort led to a nightmare for Lydia. Her internal organs were damaged during the abortion. Days after the abortion, the pain in her lower parts became too much. Still, she was determined not to tell anybody at home about her ordeal. When the pain became unbearable, her sister-in-law also noticed something queer in the way Lydia was walking. She could not hide anymore. She confessed her condition.

By the time she was taken to Mulago Hospital to receive post abortion care, it was too late–her perforated internal organs, including her uterus, had got rotten. She died last October.

One of thousands:

Baraza’s is one of thousands of such cases in Uganda every year, according to Dr. Charles Kiggundu, one of Uganda’s leading gynecologists and obstetricians. He says statistics show that 800 abortions are procured across the country every day and “a good number of these end up in complications”.

Dr. Charles Kiggundu, who is a consultant at Uganda National Referral Hospital at Mulago in Kampala, says the statistics show that one in three women aged 15-24 who have never married have already had sex. He says at this level of premarital sex, the rate at which women get unwanted pregnancies and die in botched abortions is alarming. He says it is the 12-19 year-old age group who are particularly at risk of unintended pregnancies and risk of unsafe abortion.

Speaking in Kampala on Feb.17 at a meeting of MPs and civil society organisations under their umbrella body, the Coalition to Stop Maternal Mortality due to Unsafe Abortion, Kiggundu said unsafe abortions are devastating the country’s women.

“Abortion is now the second leading cause of pregnancy-and-child-bearing-related deaths in Uganda,” he said.

“Unsafe abortion continues to kill many women and yet we know it is preventable,” he added.

Medical experts in the country want to end the hemorrhage.

Although most agree that they want the law and policies around abortion to be reviewed, many are reluctant to say they want abortion legalised.

They criticise the laws and policies governing termination of pregnancy in Uganda as “inconsistent, unclear, and often contradictory, but stop short of demanding a law that specifies when a woman can get a safe legally-sanctioned abortion.

Judith Okao from the Centre for Reproductive Rights is focused more on ensuring that existing law is understood by medical and legal practioners. She says lack of access to vital information has led to the existing laws and policies not being understood.

Okao’s analysis became evident at the Feb. 17 meeting when a senior police officer said abortion was unlawful in Uganda, “no matter the circumstances”. That is not true and is the reason Okao wants the Ministry of Health’s 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights to be widely distributed.

This is the only government-issued document that clearly outlines the circumstances under which a safe and legal abortion can be procured in Uganda.

Meanwhile other activists, like Moses Mulumba, the executive director of the Centre for Health, Human Rights and Development (CEHURD), are focused on tackling unintended pregnancies.

“These findings make (it) clear that more must be done to reduce unintended pregnancy by ensuring Ugandan women have access to family planning services,” he says.

Dr. Kigundu is unimpressed by the flip-flopping. “When we talk about (legalizing) abortion, everybody runs to their religion,” he says.

Cost of unsafe abortions:

The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating an unwanted pregnancy either by people lacking the necessary skills or in an environment lacking minimal medical standards or both.

According to a report entitled, “The Stakes Are High the tragic impact of unsafe abortion and inadequate access to contraception in Uganda,” approximately one in five pregnancies in Uganda ends in an induced abortion.

Kiggundu says about half of the two million pregnancies that occur every year in Uganda is unwanted. While most are eventually tolerated, about 400,000 are aborted and, as in Lydia’s case, 90,000 of them result in severe complications, which most times, lead to death.

Research shows that in Uganda, 54 abortions occur among every 1,000 women of reproductive age, which are far higher than the average of 36 abortions per 1,000 women for East Africa.

Of the 6,000 pregnancy or childbirth-related deaths that occur every year, 1,200 women are from unsafe abortion. Unsafe abortions also contribute 40% of admissions for emergency obstetric care in hospitals.

Dr Kigundu says if it were not for the stigma attached to abortion, the statistics for deaths resulting from abortion would be even higher. He says many are hidden in deaths related to over-bleeding (26%) and rotting wounds (22%) figures.

For Sarah Opendi, the minister of state for Primary Health Care, the cost of dealing with the after-effects of unsafe abortions Shs 38 billion per year is unacceptable.

“This money can be invested elsewhere,” she said at the unsafe abortion meeting.

Many studies show that women’s access to increased rights in making reproductive choices, including safe abortion services leads to better health for women, more satisfactory reproductive health outcomes and less morbidity and mortality related to unwanted pregnancy and unsafe abortion.

In South Africa, when the government liberalised its abortion law in 1997 by enacting the “Choice on Termination of Pregnancy Act, abortion-related deaths dropped by 91%. In Nepal, abortion-related complications fell from 54% to 28% of all maternal illnesses treated at relevant facilities between 1998 and 2009, following the liberalisation of its abortion law in 2002.

Kenya also relaxed its abortion laws in the 2010 constitution to give health professionals more flexibility to determine when abortion is permitted.

Dr. Elizabeth Kimani of the African Population and Health Research Centre says trained health care professionals and safe abortion care are yet to be established even after the promulgation.

“There is still resistance and stigma not only towards abortion but also reproductive health in the country,” she says.

African Union steps in:

Dr. Eunice Brookman-Amissah of the Nairobi-based Ipas Africa Alliance, which has been working with regional governments to reduce maternal deaths, noted at the Feb.17 meeting that the African Union has lined up initiatives to compel member states reduce unsafe abortion.

She said the AU wants member states to ratify and domesticate the 2003 AU Protocol on the Rights of Women, by particularly activating article 14 (2).

Brookman said, of all the 53 states that ratified and agreed to this article, it is only Uganda which has failed to activate the article.

That article says, in part, that state parties shall protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or life of the mother or the foetus.

Brookman said it is important that Uganda works on “a progressive law that will save women from dying unnecessarily”.

“It is not true that when abortion is legalised, it will make women rush to procure the abortion. A lot of antipathy and opposition towards abortion is because of a lack of knowledge on the issue,” she said.

In Uganda, termination of pregnancy is permitted to preserve the life and mental and physical health of a pregnant woman. Experts say this health exception is meant to cover cases of sexual violence. It, however, does not permit women to seek legal abortions in cases of defilement, rape and incest. That, some experts say, needs to change.

Source : The Independent

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