Unsafe abortion is one of the leading causes of maternal mortality in the world
By Sarah Achen
Unsafe abortion is a major challenge facing not only women but also the health system in Uganda. World Health Organization defines abortion as the termination of pregnancy from whatever cause, before the fetus is capable of extra-uterine life.
Joy Asasira the program manager of Social Justice in Health-CEHURD reveals that abortion may either be spontaneous occurs without deliberate measures to terminate the pregnancy. Abortion may also be safe or unsafe accounting for 14% of unintended pregnancies that end in abortion. She made the remark last week during media training at Hotel Africana.
According to Judith Okal policy Advisor Ipas Africa Alliance, safe abortions-those done by trained providers in hygiene settings- and early –medical abortions using medication to end a pregnancy carry few health risks.
Unsafe abortion is a procedure for terminating a pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. Unsafe abortions are characterized by the lack or insufficiency of skills of the provider, hazardous techniques and unsanitary facilities.
In 2013, an estimated 314, 304 Ugandan women risked their life and health by inducing an abortion, a 7% increase on the 2003 estimate of 294,000. Given that 2.3 m pregnancies occurred in 2013, these statistics imply that more than one in 10 pregnancies end in abortion. An estimated 14% of an unintended pregnancies end in abortion-or a rate of 39 per 1,000 women aged 15-49 years.
This is slightly higher than the regional average, which has been estimated at 34 per 1,000 women 2010-14 for the East African region. According to the 2016 Uganda Demographic and Health Survey, maternal mortality is estimated at 336 deaths per 1,000 live births; that is for every 1,000 births in Uganda, there are just over the maternal deaths.
In 2013, an estimated 93,300 women were treated for complications from unsafe abortion, which translates into an annual treatment rate for complications from unsafe abortion of 12 per 1,000 women, aged 15-49. Poor, rural women are at increased risk of unsafe abortion, 68-75% experienced complications, compared with the 17% complication rate for non-poor urban women. Because government has not clarified the parameters for legal abortion, healthcare providers are unable to provide safe and legal abortion services.
According to Dr Solome Nampewo from Ipas, unsafe abortions place a huge cost on the public health system. The cost to the health care system of treating complications from unsafe abortion was, on average, nearly US$131 m per year in overhaul and infrastructure, medicines, supplies, labour, hospitalization and out-patient fees. Criminalization of abortion undermines public health and forces women to seek clandestine and unsafe abortion.
Unsafe abortions have been fueled by many factors, such as negative attitudes, values and beliefs, stigma and others. However, negative policies and laws are a major problem as they reinforce the negative social environment. This justification reviews the legal and policy framework on abortion in Uganda, and makes a case for national standards and guidelines on access to safe abortion.
There is global consensus from health and legal experts that criminalization of abortion undermines public health and forces women to seek clandestine and unsafe abortion services in violation of their rights.
Article 22 sections 2 of the Constitution of Uganda, 1995 states that abortion is permitted if it is authorized by law. Sections 141-143 of the penal Code Act of Uganda proscribe abortion when it is ‘unlawfully’ procured. Women and providers who access or provide abortions are liable to arrest and incarceration with prison sentences ranging from 3-14years. Although, section 224 does provide for the defense of necessity by permitting abortion for therapeutic reasons to preserve the woman’s life, or provision is reasonable taking into account the patient’s state, or is in good faith, there is too much uncertainty on the extent of this provision. The provisions of the penal Code Act are ambiguously worded and have not been subjected to judicial scrutiny to clarity their meaning.
The World Health Organisation has recommended that states should adopt, implement and periodically review evidence based national standards and guidelines in order to facilitate access to and provision of comprehensive safe abortion. These guidelines are intended to provide a framework for eliminating legal and policy barriers to accessing safe abortion care.
According to Addis Ababa Declaration on population and Development in Africa beyond 2014, African Ministers pledged to eliminate preventable maternal mortality and neonatal mortality through ensuring that births are attended by skilled health personal and that there is universal access to prenatal and preventable arising from unsafe abortion in order to protect the health and safeguard lives of women, adolescent girls and neonates.