Ugandan Women Risk Their Lives to Access Abortion

Culton Scovia Nakamya

Journalist & media entrepreneur

Friday, 8 March, 2024

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For Jovia (not her real name), 2023 was the worst year of her life. The 20-year-old business student was gang-raped at a drunken house party in the Kampala suburb of Kansanga and six weeks later realised that she was pregnant. 

“I wondered what I am going to tell my parents. For God’s sake, I am just in my second semester of year one, and I didn’t know who did it,” she said.

Her options were limited, as abortion is illegal in Uganda except under rare circumstances. She confided in a female friend, who suggested they visit the Kampala suburb of Nakulabye, an area known as a hub of clinics that administer clandestine abortions, mostly to students.

Jovia and her friend sought the services of one of the clinics and were asked to pay 300,000 Uganda shillings (78 US dollars). 

“My friends would judge me as a killer.”

“I didn’t have a penny on me,” Jovia recalled. “I couldn’t even solicit from my friends because they would judge me as a killer or even tell my parents. I thought of going to a government facility, but then they don’t administer abortion. So the only option was doing it privately. My friend came up with another idea to buy medicine at the pharmacy to end it.”

Jovia went to a chemist and bought a dose of Cytotec, a drug commonly used to prevent stomach ulcers but also a known abortifacient.

A few hours after taking two of the tablets, Jovia began bleeding uncontrollably. 

Severe complications ensued, and weeks later she was forced to undergo a hysterectomy. She is now receiving psychological treatment for the trauma.

While abortion in Uganda is illegal apart from under exceptional circumstances, the practice continues unregulated, posing grave risks to women and girls who choose to terminate their pregnancies.

Article 22(2) of the 1995 Uganda Constitution denies any individual the right to terminate the life of an unborn baby. An amendment to the Penal Code Act of 2007 prohibits abortion with a sentence of life imprisonment upon conviction for medical practitioners who engage in this procedure. 

The only legal reason for the termination of a pregnancy is if it is deemed necessary to save a woman’s life.

In reality, however, the Ugandan authorities turn a blind eye to the realities that women and girls like Jovia go through to seek such a service.

Clinics perform the procedure covertly, with no kind of medical documentation or oversight. This has facilitated exploitation by fraudulent practitioners who use unsafe methods that often end up seriously damaging patients.

Joselyn Nalujja Kuteesa, a midwife at Jinja regional referral hospital in eastern Uganda, recalls one 16-year-old she treated in 2022. 

The girl, pregnant by another teenager, was afraid she would be expelled from school if her pregnancy was discovered. She decided to seek an abortion from a private clinic. 

When Nalujja examined her she found her swollen abdomen filled with pus. An operation to treat the infection led to further complications.

“We had to take her back to the theatre for cleaning,” the midwife said. “But it was too late; the uterus was rotten. We concluded removing it was the only procedure left.”

That same year, Nalujja saw another patient, a 26 year-old woman who presented with a perforated uterus because the abortion clinic she visited had used rudimentary methods. Sepsis followed and she was also forced to undergo a hysterectomy to save her life.

Unsafe Methods of Abortion

The use of over-the-counter medicines is the leading cause of unsafe abortion complications, according to a 2017 report by the Guttmacher Institute and Makerere University School of Public Health on abortion and post-abortion care in Uganda.

Private clinics often use speculum and manual vacuum assimilators to administer abortion, charging exorbitant fees between 400,000 – 600,000 (103 – 155 dollars). However, with no regulation and often very basic hygiene and safety procedures, this risks life-threatening complications.

Other women who are unable to access formal services use traditional herbs and rudimentary methods to try and end their pregnancies.

“Society’s perceptions will not change now, but should women continue to die?”

For instance, the common household plant tradescantia, locally known as enanda, is often used to try and induce abortion. Young women squeeze out the sap and apply it vaginally. While the plant is scientifically proven to contain oxytocic agents which stimulate uterine contractions, administration in its raw form poses risks including infection and hemorrhage. 

Others use sharpened cassava stems to try and pierce the uterus; there have also been cases in which a metal clothes hanger has been used to try and cause abortion.

Rose Wakikona, deputy executive director of the Women Pro Bono Initiative, argued that these brutal and unsafe methods would be eliminated if there was access to safe abortion. 

She recalled a shocking incident in 2019 in Busia in which a 15-year-old girl tried to use a cassava stem to induce an abortion. The girl bled to death after suffering for three days. 

“This incident brought to my attention the fact that many girls are dying because we have chosen to ignore them,” Wakikona said.

Though the Ugandan government provides post-abortion care at the majority of health centres across the country, there is no specific data to show how many women and girls die or develop serious complications due to abortion. 

The 2016 Uganda demographic and health survey report indicated that unsafe abortion contributed to eight per cent of registered maternal deaths. 

The National Demographic and Health Surveys (DHS) now records deaths linked to abortion under maternal mortality rates. The annual health sector performance report 2021/22 indicated a maternal mortality rate of 85 per 100,000 births, with hemorrhage accounting for 41 per cent of these deaths. 

The 2017 Guttmacher Institute and Makerere University report found that 14 per cent of unintended pregnancies ended in abortion, with post-abortion care costing Uganda 14 million dollars annually.

According to the Center for Reproductive Rights, only ten countries in Africa have liberalised their abortion laws.

Local groups like the Centre for Health, Human Rights and Development (CEHURD) and Human Rights Awareness and Promotional Forum (HRAPF) filed cases before the constitutional court in 2017 and 2020 respectively, seeking decriminalisation of abortion. The cases were consolidated and are pending verdict.

In May 2022 the Women’s Pro Bono Initiative filed a case with the East African court of justice, a treaty-based regional body, seeking for it to order the Ugandan government to reinstate the abortion policy guidelines that were withdrawn in January 2016 due to political and religious pressure.

Wakikona said that criminalising abortion was fundamentally unjust to women. 

“You are criminalised for not looking after your child and criminalised for choosing not to have a child. Our point is, no woman wakes up to have sex and get pregnant with a mission to abort. This is not an adventure.”

Efforts to legalise abortion in Uganda have faced resistance from cultural and religious institutions that view it as morally unacceptable and equivalent to murder. 

Florence Kasaato, the president of the Mothers Union, believes Uganda needs more rehabilitation and counseling centres rather than liberalised laws on abortion. 

"Sex crime is so high, but the unborn baby is innocent,” she said. “Let's create more awareness against incest, defilement, and rape.”

In 2020, Uganda was among six countries to sign a nonbinding international anti-abortion declaration to counter a UN declaration of abortion as a human right. 

However, this contradicts with the African charter on human and people’s rights on the rights of women in Africa, also known as the Maputo protocol. This was adopted by the African Union in 2003 to uphold the rights of women and girls and challenges African states to ensure access to safe abortion to improve safety procedures and reduce maternal deaths.

The Ministry of Health has acknowledged the prevalence of unsafe abortions in the country but maintains that Uganda was not yet ready to legalise the practice.

Jescia Nsungwa, the commissioner for maternal and child health, said that care guidelines were in place to guide practitioners on abortion as prescribed in the law. 

“We know that our medical workers sneak women in and conduct their procedures in secrecy within government facilities,” he said. “They admit them as other patients and administer abortion. Others take them to their private clinics and do it. It is illegal, and we have penalised those we have found culpable.”

Nsungwa also called for what he described as the underlying causes of unwanted pregnancy, adding, “Let's do more parenting guidelines and fight poverty, which is a key driver.”

As the constitutional court delays its decision, advocates like Wakikona continue to call for the government to take urgent action to save women from unsafe abortion. 

"Women are dying; laws exist to protect the minority and correct imbalance,” she said. “Society’s perceptions will not change now, but should women continue to die?