Abortion can be defined as an ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus. An abortion that occurs without intervention is known as a miscarriage or spontaneous abortion while deliberate methods done to end a pregnancy is called an induced abortion.
In this paper, emphasis was put on induced abortion where globally 56% of unintended pregnancies end up in induced abortion. (Singh S et al., 2016). In Africa, from 2010-2014, an estimated 8.2 million induced abortions occurred each year and the annual abortion rate in this continent is estimated to be 34 per 1,000 women of reproductive ages of 15-44 according to Guttmacher Institute, (2017) with about 1.6 million women being treated with abortion complications each year. (Singh S and Maddow- Zimet I, 2015).
Unsafe abortions performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities are of great concern worldwide because they cause injury and death to women and other severe complications, such as incomplete abortion, sepsis, hemorrhage, and damage to 2 internal organs (Okonofua, F. 2006). It is estimated that deaths from unsafe abortion account for around 13% of all maternal deaths (Darney, et al., 2010).
State of abortion in Uganda
Abortion in Uganda is illegal however the Ugandan Ministry of Health’s 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights gives a number of specific cases in which women have the right to seek an abortion, that includes rape, sexual violence, or incest, or when the woman has pre-existing conditions such as HIV or cervical cancer. It can also be performed by a licensed medical doctor in a situation where the woman’s life is deemed to be at risk.
In Uganda, 52% of all pregnancies are unintended, and about a quarter of these unintended pregnancies end in abortion each year (Sedgh G et al., 2016). It is estimated that 314,300 abortions took place in 2013 alone translating to 14% or at a rate of 39 per 1,000 of all pregnancies of women aged 15–49 in the country with Kampala leading at a rate of 77 per 1,000 and western Uganda region least at 18 per 1,000 according to a 2013 brief from Guttmacher Institute.
Uganda’s existing laws and policies on abortion are interpreted inconsistently by law enforcement officers and the judicial system in most cases. This has made it difficult for women and the medical community to understand when abortion is permitted and thus fueling the need for pregnant women to resort to unsafe abortion practices consequently leading to around 5 million Ugandan women annually getting injured or getting disabled due to abortion-related consequences and 5.3% of maternal deaths occurring as a result of abortion complications. (Larsson, et al., 2015).
Ugandan women mainly seek abortion because the demand for modern contraception especially emergency contraception is still unmet with modern contraceptive prevalence rate (mCPR) of women ages 15-49 in Uganda reported at 41.8 % according to the World Bank collection of development indicators, compiled from officially recognized sources in 2018 and Total Fertility Rate (TFR) estimated at 5.0 live births per woman in 2020 (Worldometer, 2020). This unmet need for modern contraception has led to many unintended pregnancies where many have ended up being aborted.
General dangers of abortion in Uganda.
It is reported that women of ages 20–24 tend to have the highest abortion rates mainly because they feel they are not ready to have a child, they want to continue schooling and also fear parents’ reactions towards them. All these compel these young ones to terminate the pregnancy. In Uganda pre-marital sex is common where one in three never-married women aged 15 to 24 years admitting to having already had sex (UBOS, 2011). These young women are also reluctant in seeking contraceptive services since culturally and socially premarital sex is not acceptable. This danger of abortion as a result of this pre-marital sex has led to an estimated 1,500 girls dying from complications resulting from unsafe abortion as reported in Uganda’s New vision news paper of 22nd October 2013.
Abortion has an impact on future pregnancies where it is reported that having multiple abortions may make it difficult for a woman to have children in future and also increases the risk of low birth weight, preterm birth, vaginal bleeding during early pregnancy, blood clots in the uterus which produce severe cramping. Abortion also leads to tearing of the cervix, hemorrhage (heavy bleeding), tearing of the wall of the uterus and placenta problems such as retained placenta.
Emotional or Psychological risks as a result of abortion should also not be underestimated since this can create a lasting positive and negative impact on a woman. One woman may feel sad and emotionally down because of ending a life of an unborn child and may live with this guilty for some time or the rest of her life while another one may feel some relief especially if her life was at stake in case the pregnancy was due to rape, incest, sexual violence and also in instances where a woman had cervical cancer. Negative emotional risks are so dangerous and should be discouraged seriously since they can lead to suicidal thoughts, an acute feeling of grief, loss of self-confidence especially school-going adolescents, shame in the community where one comes from, anger, nightmares, depression, Increased alcohol/drug abuse and sometimes repeated abortions in the future.
The writer recommends the following in order to reduce induced abortion rates and its dangers in Uganda;
The government should ensure that there are free or affordable family planning services accessed by all women plus giving them a wide range of contraceptive methods to choose from putting much emphasis on those women who are young, poor, and in rural areas. This will help in reducing the unmet need for contraception in turn reducing unintended pregnancies in the country.
Men involvement in reproductive related issues is very pivotal in reducing these high abortion rates. In Uganda, issues of reproduction and especially using family planning services have been left to women and in most cases, men have not taken heed to get the views of their partners. Ensuring that men get involved in all these issues that involve planning for their children and family would help much in reducing the unintended pregnancies that have ended up in unsafe abortion.
Different health campaigns should be enrolled countrywide through different line ministries especially the health ministry highlighting the dangers and risks involved in abortion. This can be done on radios, Television stations, school outreaches, and seminars in Universities and other tertiary institutions where these young women are.
Religious and cultural leaders have a great task of counseling and preaching against premarital sex to their followers highlighting the dangers of abortion. These leaders should drop their strong conservative beliefs on abortion by explaining to their followers avenues when abortion can be done in line with the law. When this is done plus post-abortion counseling, it would reduce the shame and fear associated with abortion and women would go for safer abortions.
Much as in Uganda, 89% of health centers can offer post-abortion care services, most of these centers are hard to reach and also women fear revealing to health personnel their complications resulting from unsafe abortion mainly because of fear of reprimand and this hampers effective treatment. It is recommended therefore that women should be empowered to seek post-abortion health care services without fear.
A clarification on Uganda’s abortion law and policies should be done at all levels in all languages since this will raise awareness on the contents and the scope of Uganda’s abortion law among the medical community, the judicial system, and women.
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