Close this search box.

350,000 abortions in Uganda are induced – experts

Article by Catherine Mwesigwa Kizza ( New Vision)

Infanticide, child abandonment and abuse — the Ugandan media is full of the stories. The missing story though is that the abused and murdered children are most probably survivors of induced abortion.

“There are over two million conceptions in Uganda every year. 200,000 to 300,000 of these miscarry or abort spontaneously but 350,000 abortions in Uganda are induced,” said Dr. Charles Kiggundu an obstetrician and gynecologist at a breakfast meeting convened by the Center for Reproductive Rights and Centre for Human Rights and Development in Kampala Wednesday, to discuss the laws and policies on abortion in Uganda.

“90,000 of the induced abortions end up with severe complications but only a half of them access post abortion services,” he added.

“Only half of the women with complications seek medical care. A few survive but many others die,” he added.

Joy Asaasira of CEHURD said of the 20 women in Uganda who die due to pregnancy and childbirth-related complications every day, four to five of these are due to induced abortion.

Dr. Kiggundu says these are needless deaths. The policy environment allows women to receive healthcare for post- abortion complications, however, studies have shown that when they seek care, it takes about 44 hours for them to get attention compared to 35 to 45 minutes other women spend in hospital before getting a service.

“Health workers do not want to treat women with abortion complications because they do not want to be seen to be accomplices to the termination of pregnancy,” he said.

He also pointed out that phrases on hospital documents like “Police notify” worry health workers and are a deterrent to provision of care for women.

‘Health workers do not want to get involved with police. They want to do their work unencumbered,” he said.

Women induce abortions due to unwanted pregnancies due to wrong timing of pregnancy or economic and social hardships.

“Some men tell their wives to abort because ‘they stopped having children’ and yet did nothing about it,” Dr. Kiggundu said.

Those who survive death end up with chronic pain, anemia, and infertility among other complications.

He said safe abortion services were available but hidden to the poor.

“You must be connected and well-oiled to access the services. Some women fly to South Africa to terminate pregnancies and return,” he revealed.

The consequences for the majority who go to quacks or unskilled medical workers working undercover are dire.

“We recover forks, pens, knitting needles, bed springs, sticks, herbs from women who run to us with botched abortions. Some of these things kill the woman before they even kill the foetus,” he said.

Treatment for those who survive death is expensive. According to CEHURD, sh17.6bn is spent on treating abortion complications.

Not only can this money be saved and spent on worthwhile health causes but women’s lives can be saved as well.

According to Dr. Kiggundu, the Ministry of Health’s comprehensive abortion care includes sexuality education to promote safe sex practices, family planning use including access to emergency contraception, reducing fertility, providing safe abortion services and quality post-abortion care.

Government is also training nurses and giving them skills to perform manual evacuation procedures to attend to women with incomplete abortions.

“There are still many gaps,” said Dr. Kiggundu. “Uganda still produces health workers for export and retains only a few.”

He revealed that only 30% of the vacancies for skilled health personnel required to provide safe motherhood are filled.

It is no wonder that despite government commitments, advocacy efforts, plans and policies to reduce maternal deaths in the country, there has been no progress in this indicator in the past five years.

New data from the Uganda Demographic Health Survey report of 2011 show that the maternal mortality ratio increased from 435 deaths per 100,000 live births in 2006 to 438 deaths, though other international studies show a decline to 310 deaths per 100,000 live births.

“26% of these deaths are due to unsafe abortion,” said Elisa Slattery the Regional Director, Africa Program Center for Reproductive Rights.

Once addressed, reduction in unsafe abortion contributes to reduction in maternal death.

Slattery said studies on the law on abortion in Uganda have found that “abortion is permitted where a mother has severe illnesses threatening her health like cardiac disease, renal disease, eclampsia.”

The Centre for Reproductive Rights study also found that healthcare providers are not required under the Uganda law to consult one or more providers to get their consent before terminating pregnancy as has been previously believed.

The organization is calling on government to broaden access of information among healthcare professionals and the public as a means of stopping the tragedy.


Activists to Pursue Maternal Health Case Against Government

By Andrew Green

Kampala — A petition backed by over 50 NGOs and charging Uganda’s government with failing to prevent the deaths of expectant mothers was thrown out by the constitutional court on 5 June, but the petition’s supporters plan to appeal.

The constitutional court argued that upholding the petition, which urges the government to boost health services, would have forced judges to wade into a political issue that was outside their jurisdiction.

However, the petitioners said the court relied on outdated international law in making its decision and overlooked its constitutional obligation to protect Uganda’s mothers.

Principal State Attorney Patricia Mutesi, who argued the case for the government, said the petition “was asking the court to do the work of the parliament in reviewing the efficiency of the health sector”.

The petition, which centred around the deaths of two mothers (Sylvia Nalubowa in central Uganda and Jennifer Anguko in the north), got nationwide media coverage when it was filed in March 2011. It said the women’s deaths could have been prevented if the health centres where they died had had “basic indispensable health maternal commodities” and if health workers at the facilities had not neglected the two women.

In throwing out the case, the justices suggested the petitioners seek an order from the high court compelling a public officer, such as a government health worker, to carry out his or her duties, or to request compensation for individual deaths from the government.

On 14 June the petitioners filed a notice informing the Supreme Court and the Attorney General’s office of their plan to appeal against the constitutional court decision; they have 50 days to finalize and file the appeal.

Rights denied?

Moses Mulumba is the executive director of the Centre for Health, Human Rights & Development (CEHURD) – the group that originally pushed the petition forward. He said the court’s decision not to wade into a “political question” was based on antiquated law and failed to address the fact that women were being denied rights guaranteed under Uganda’s constitution.

“I think it was very wrong for the judiciary to rely on very old United States jurisprudence to inform their decisions on clear violations of human rights,” he said. The courts should focus on upholding the constitution, he said, instead of “hiding under old political doctrines.”

In a country where statistics show that 16 women die every day from childbirth complications, the activists generally charged the government with perpetuating a maternal death rate that is “unacceptably high”. Ultimately, they are looking for the government to invest more in the country’s health system, to improve care and make sure critical resources are always available.

Valente Inziku, Anguko’s husband and one of the petitioners, said he watched his wife bleed to death as he tried to get nurses at the hospital to attend to her. “When she started bleeding seriously, the only the thing [the staff] did was they came and they told me… to clean the blood,” he said.

“People are disappointed, but we are not stopping there,” said Sylveria Alwoch, of the Uganda National Health Consumers Organization, one of the groups that supported the petition. “We are encouraging people to always report those cases. They shouldn’t be demotivated… They should still have that courage, that vigilance to speak out and bring out those issues.”

Win or lose, CEHURD’s Mulumba said;

the petition had raised awareness of the country’s ongoing maternal deaths and helped rally people around the cause.


For lack of Shs300,000, teacher bleeds to death in Labour Ward

The contractions had started at dawn. Cecilia Nambozo, a teacher at Busamaga Primary School in Mbale Municipality, knew it was time, so she did what was expected—checked into a hospital at 6am so she could give birth with expert attention at her disposal.
But that was not to be, for more than 10 hours after Nambozo checked into Mbale Regional Referral Hospital to bring unto the world a life, she was ignored, neglected and writhing in pain. Her crime? She did not have Shs300,000 the hospital medical staff demanded before they could attend to her. And so she wasted away as her husband, Mr Richard Wesamoyo, made desperate runs around the village to raise the money.
That chilly September 6 still haunts Mr Wesamoyo. Nambozo arrived in the hospital at 6am but was reportedly neglected in the Labour Ward until 8pm when she breathed her last. Even then, it is the hospital cleaners who helped remove the baby from her womb. “The lady could not push because the baby was big. The doctors demanded for Shs300000, which we could not raise,” said Ms Grace Acham, a neighbour who had helped transport her to the hospital.
Ms Acham said they had spent the little money they had to purchase surgical equipment. “And when I came back, I found her in pain, crying, there was no help. The medical workers looked on as they asked for money,” she added. Ms Acham said after three hours of waiting and sensing that Nambozo’s situation was deteriorating, she approached a midwife and asked her to attend to her as the husband ran to the village to sell property and raise the money but the midwife and a doctor allegedly declined.
“At about 6pm, Nambozo started gasping; she fell on the floor and was bleeding. That was when the doctor responded and took her into the theatre but it was too late; her life could not be saved. She died.” she said.
The doctor emerged from the theatre after about 10 minutes and announced that both the child and the mother had died, Ms Acham added.
Mr Wesamoyo told Sunday Monitor that his humiliation was iced when medics abandoned his wife’s body in the Labour Ward with the foetus in her womb. He said the body was removed by cleaners
“They rolled the bed out in the open and started operating her naked for all to see. It was very dehumanising and humiliating for her to be stripped naked by cleaners,” said Mr Wesamoyo. He said they had been going for antenatal check-ups at the hospital and the midwives had told them the baby was big and that it would be difficult for her to have a normal birth. Apparently, the midwives had recommended a caesarian operation for Nambozo.
Police investigate
Dr Bernabas Rubanza, a police surgeon who carried out the postmortem, said the baby weighed 5.2 kilogrammes and that Nambozo died due to failure to push that made the uterus to rapture. He added that due to neglect after the uterus malfunctioned, Nambozo had bled to death.
“This lady reached the hospital at 6am and pleaded with the medical workers for an operation because she knew her status but the medics refused to attend to her until her uterus raptured. This is a pure case of neglect,” said Dr Rubanza. He added: “And this is not the first case at this hospital; many women have died in labour out of neglect.”
Mbale District Police Commander Jacob Opolot said a case has been registered and investigations have started. “We received a complaint and we have opened a file and summoned the medical staffs on duty that night and the day to furnish us with information,” said Mr Opolot.
However, the hospital director, Dr BenonWanume, said at the time of Nambozo’s death, there was another woman undergoing an operation in the theatre and that it was inadvisable to halt the ongoing operation.
“And in any case, it is not the patient who asks for theatre but we examine the patient and recommend. Doctors on duty examined her and by the time they recommended her for theatre she had already raptured her uterus,” he said.
Dr Wanume added: “She was bleeding and we could not save her life. I can’t rule out the issue of asking for money. Some staff do it but we need to investigate this further because it has no proof.”
He said the people who operated Nambozo to remove the foetus where not hospital workers but imposters who sneaked into the hospital.
Source: Daily Monitor