Over 1,000 Ugandan women die every year as a result of unsafe
abortions and an additional 68,000 suffer serious health
complications, according to a recently released report from the
Ministry of Health.
"As many as 1,200 unsafe abortions result in death each year.
Nearly a quarter (23 percent) of all abortions result in serious
complications," said the report Road Map for Accelerating the
Reduction of Maternal and Neonatal Mortality and Morbidity in
Uganda.
A 2007 study by the US-based Guttmacher Institute estimated that
56 percent of all abortions in Uganda are carried out by medically
trained personnel and 44 percent by untrained or traditional
providers.
EXPENSIVE QUALIFIED MEDICAL FEES
Poor women in rural areas suffer the most as they cannot afford
what qualified medical personnel charge for an abortion and instead
opt for the cheaper cost of a midwife or herbalists, or do it
themselves, state-owned New Vision quoted the study on Saturday as
saying.
A doctor charges in Uganda between 40,000 Ugandan shillings (
about 23.5 US dollars) and 140,000 shillings (82.4 dollars), a
nurse or midwife between 22,000 shillings (12.9 dollars) and 50,
000 shillings (29.4 dollars), while the fees of a herbalist or
pharmacist range from 8,000 shillings (4.7 dollars) to 54,000
shillings (31.8 dollars). The Guttmacher study said, "The more
highly trained the practitioner, the less likely an abortion will
place a woman at risk."
In addition, many level III and level IV health centers do not
have the medical supplies or sufficiently trained health
professionals to provide proper post-abortion care.
"We still have problems with such care especially in up-country
facilities where things like blood transfusion are not there," said
Anthony Mbonye, the assistant Commissioner reproductive health in
the Ministry of Health.
"Post-abortion care involves the administration of antibiotics
and the removal of retained products but the drugs, equipment and
skills are insufficient," Mbonye added.
UNSAFE METHODS
It estimated that serious health consequences, such as excessive
bleeding, infection or injury to the reproductive organs, result
from a quarter of abortions performed by doctors, about half of
those provided by nurses, midwives and pharmacists, two- thirds of
those carried out by traditional practitioners, and 70 percent of
those that are self-induced.
Untrained practitioners use a variety of methods, including
hormonal drugs or manual vacuum aspiration. Others use more
dangerous techniques, such as the insertion of rubber catheters or
sharp objects into the uterus, the consumption of vaginal
application of caustic substances or powerful herbal remedies,
according to the study.
Traditional methods used also include inhaling steam from cooked
herbs, wearing dried herbs, drinking detergents or applying
combinations of these techniques.
As a result, half of all abortions carried out in Uganda every
year result in complications.
But even abortions performed by trained health workers are not
always safe. The proportion of abortions performed by doctors that
lead to serious health conditions is higher in Uganda than most
western countries.
"Many of our doctors have not been well trained to offer safe
methods and are working under unsafe conditions," said Charles
Kiggundu of Makerere University who participated in the study.
REPUTATION CONCERN
Because abortion is illegal in Uganda, and because of the
widespread social stigma attached to the practice, many women who
experience complications are not seeking or receiving any help.
"Roughly one in five of the estimated 297,000 women who have an
abortion each year suffer complications that require medical care
but do not get treatment in a medical facility," said the
study.
The study said that the reason why women don't go for treatment,
are the inability to pay for care, the fear of revealing that they
have had an abortion and concern that they will receive hostile or
judgmental treatment from clinic and hospital staff.
Veronica Bakayana, a midwife, said that women who show up in
hospital fear to reveal that they are suffering from complications
of abortion.
"Most times we have to employ guesswork. Sometimes, health
workers are forced to shun such women because you may be
misunderstood," she said.
UNINTENDED PREGNANCIES
Each year, about 775,000 women in Uganda are pregnant against
their wish. The proportion of births that were unplanned rose from
29 percent in 1995 to 38 percent in 2001.
The desire for a smaller family has not been matched by an
increase in the use of contraceptives.
The use of effective contraceptive methods in Uganda is very
low.According to the 2006 Uganda demographic and health survey,
only 24 percent of married women use contraceptives, 18 percent a
modern method and 6 percent a traditional method.
A quarter of women who want no more children but they do not use
contraceptives said they feared side effects, 14 percent of those
said their partners were against it, 13 percent said they did not
know where to obtain them, while 5 percent said their religion
forbids it.
In addition, reports of shortages of contraceptive supplies in
many health centers are seen as a factor discouraging women from
practicing family planning.
Sex education for adolescents is another area, which is wanting.
Although Uganda provides family life education in schools, a recent
survey found that only 44 percent of boys and 50 percent of girls
aged 15-19 had ever attended a sex education class or talk.
The Guttmacher Institute called for a broader public discussion
about unsafe abortion. "More public attention to the issues of
unintended pregnancies and unsafe abortion is greatly needed," said
the report.
"The standards of post-abortion care must be raised and the
coverage expanded. Access to family planning services and accurate
information about contraception must be widely and effectively
provided to reduce the incidence of unintended pregnancy," said the
study.
The institute, above all, calls for policies that support girls'
education. "Education can help women understand the dangers of
unsafe abortion, improve their status in the community and empower
them to play a more active role in their own reproductive
health."
(Xinhua News Agency September 16, 2007)