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By Patience Akumu,
When the woman entered Kiggundu’s office and requested an abortion, he felt his hands were tied: abortion is essentially illegal in Uganda. Kiggundu, a law-abiding citizen, told her that while he appreciated her predicament, he could only refer her for proper antenatal care so that she could deliver safely.

Three days later, he was called to the emergency gynaecology ward. And there, on the verge of death, was the same woman. “She was now a sick-looking, dirty young woman,” Kiggudu recalls. “Her intestines were out of her vagina and she was bleeding profusely.” The doctor asked the woman what happened.

“You are asking me what happened?” she answered. “I was here three days ago and you refused to help me; I did what I had to do.”

Kiggundu had to perform an operation to remove her uterus to save her life. She spent four weeks in the hospital recovering. Yet it could have been worse for Kiggundu’s patient. In 2008, the ministry of Health estimated that abortion-related causes accounted for 26% of all maternal mortalities in Uganda.

Uganda’s maternal mortality rate from abortion is 8% higher than that of East Africa which stands at 18%. The restrictive legal and ethical regime means that many women continue to die as a result of unsafe abortions both in and outside the hospital setting. The Constitution forbids abortion except as authorised by law, while the penal code criminalises abortion except where it is necessary to save the mother’s life.

Prof Ben Twinomugisha, a health law expert and lecturer at Makerere University, says that at the end of the day it is not really about statistics and legal provisions but, rather, about the woman who should be placed at the centre of the abortion debate.

“There is law and there is ethics. But what does the woman say?” he argues. “Whenever Kiggundu thinks of the woman without a uterus, he has regrets.”

According to Twinomugisha, the law is only restrictive and not prohibitive, and in fact he recognises that there can be lawful abortions. He points out that health workers are not utilising the law to provide abortions to women for whom having babies would mean adverse effects on their psychological and physical health. The 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights provide for circumstances where a woman should be able to terminate her pregnancy.

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