Abortion, Maternal Mortality and the Law in Uganda :

Abstract

Abortion in Uganda [1] like in other African countries such as Nigeria [2] is legal only when performed to save a woman’s life. Therefore, Uganda’s law does not mean that abortion is legal but is rather restrictive [1, 3]. Every woman has the recognized human right to decide freely and responsibly without coercion and violence the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health [4]. Access to legal and safe abortion, as a tenet of safe motherhood is critical for the realization of these rights [5]. Uganda has one of the high total fertility rate (TFR) of 5.4, and 38 percent of women age 15-49 do not want any more children or are sterilized while Uganda’s Contraceptive prevalence rate is only 39%, with the teenagers and the least privileged of the society less likely to access family planning services [6]. Worth noting too, is that despite the progress in alleviating Uganda’s maternal mortality ratio from 524 deaths to 336 deaths per 100,000 live births for the 7-year period preceding the 2001 and 2016 Uganda demographic health survey (UDHS) respectively [6], this falls short of the Sustainable Development Goal 3.1 target of less than 70 per 100,000 live births by 2030 [7, 8].

Moreover, more than half of pregnancies in Uganda are unintended and nearly a third of this end up in abortion [9], with the poor and rural women, whose access to skilled services providers is constrained by infrastructural and financial limitations more often than not, undergoing unsafe abortions [10]. Unsafe abortion and its complications account for 5% of maternal deaths in Uganda [11]. Worse still, treating complications resulting from unsafe abortion poses significant costs to the Ugandan health care system. On average, post abortion care costs about US$130 per patient culminating into total annual costs of nearly US$14 million [9]. This is a huge sum given that Uganda’s Gross domestic product (GDP) per capita (United Sates Dollar) is only 912 [12]. Studies elsewhere in Sub-Saharan Africa show similar trends. Studies in Nigeria indicated that there were approximately 33 abortions per 1000 women aged 15–49 in 2012 [13] compared to 25 abortions per 1000 women aged 15–44 in 1996 per 1000 women [14]. These two studies convey a clear message; women’s use of abortion as a means of fertility control has increased in intervening years. In a study by Suzanne et al, found that unsafe abortion was mostly suffered by the teenagers and the least advantaged in the society, were most affected by unsafe abortion [15]. A study by Center for Health, Human Rights & Development (CEHURD) found that the unclear abortion laws cause distress to both abortion seekers and health care workers and continue to lead to morbidity and mortality [16]. Moreover, there is evidence that liberalized policies on abortion curtail maternal death [17, 18]. Conclusion It is imperative that the abortion laws be revised to provide legislation that clearly reflects the changing times of the Ugandan society, in addition to improving other aspects of sexual and reproductive health such contraceptive accessibility Key words: Abortion. Law. Uganda