Tuesday, February 26, 2013

Uganda: The high cost of unsafe abortion

Photo: Charles Akena/IRIN. Too many unplanned pregnancies (file photo)

KAMPALA, 25 February 2013 (IRIN) - Boosting women's access to reproductive healthcare could significantly reduce both the number of unsafe abortions and the high cost of post-abortion medical care in Uganda, experts say.

Although there are few studies on the subject, experts estimate that some 297,000 abortions are performed annually, with 85,000 women treated for complications.

"Post-abortion care is estimated to cost nearly US$14 million annually in Uganda... The epidemic of unsafe abortion takes a tragic toll on women and their families. It poses a significant, avoidable economic burden on Uganda's already underfinanced health system," Moses Mulumba, director of the Kampala-based Centre for Human Rights and Development (CEHURD), told IRIN.

A recent brief by the Guttmacher Institute, a reproductive health think tank, and CEHURD estimates that post-abortion care costs nearly $130 per patient. "Most of the costs of post-abortion care arise from treating incomplete abortion; however, a significant proportion can be attributed to more serious complications, such as sepsis, shock, lacerations and perforations," the authors said.

Understanding the law

A major problem is poor understanding of Uganda’s abortion laws. A 2012 Technical Guide to Understanding the Legal and Policy Framework on Termination of Pregnancy in Uganda, by the US-based Center for Reproductive Rights, found the country's abortion laws to be "inconsistent, unclear and often contradictory".

"The confusing content of these laws and policies is compounded by their limited interpretations by Ugandan courts and other government authorities, such as the statutory councils established to regulate the healthcare professions," the report found. "As a result, women, healthcare providers and regulators often lack comprehensive information about the content of the law and what it permits."

The guide found that, contrary to the widely held belief that abortion is illegal across the board in Uganda, "Uganda's laws and policies are more expansive than most believe, and the current legal and policy framework offers ample opportunities for increasing access to safe abortion services". For instance, abortion is not illegal when a woman's life is in danger.

According to Annociata Kampire, director of the Alliance for Integrated Development and Empowerment (AIDE), the government has a responsibility to ensure medical professionals and women understand the country's abortion policy.

"One easy step that Uganda should take to reduce death and disability from unsafe abortion is disseminating information about the existing law and implementing existing guidelines... [This] urgently needed step would dramatically improve the health and save the lives of Ugandan women," she said. "They can start by widely disseminating and popularizing the 2012 Ministry of Health's National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, which describe circumstances under which abortion is permitted in Uganda."

"Making abortion illegal does not stop it from a occurring; it simply forces women to turn to risky procedures and methods... It is just matter of whether it is safe or clandestine and dangerous," Mulumba said. "Unsafe abortion needs to be recognized as a health crisis in Uganda that must be confronted by our policy makers, healthcare workers and communities."

Boosting contraceptive use

According to the Guttmacher brief, one of the key reasons for the high number of abortions is unplanned pregnancy. Uganda's unmet need for family planning stands at 34.3 percent, according to the 2011 Demographic and Health Survey (DHS); women are considered to have an unmet need if they wish to space their children's births or limit childbearing but are not using contraception. Just 30 percent of married women of reproductive age use any form of contraception, according to the 2011 DHS, and only 26 percent of married women and 43 percent of sexually active unmarried women use a modern method.

"Closing the gap in access to contraceptives would save thousands of lives, promote economic development and advance the rights of women, especially in rural areas, among young women, and among women with less formal education," Peter Ibembe, director of programmes at Reproductive Health Uganda (RHU), told IRIN. "Women and men need appropriate counselling so they understand the facts about modern contraception and are not influenced by myths. They also need a choice of affordable contraceptive methods that meet their needs."

"Government should also actively promote the use of contraceptives by women and men in Uganda rather than sending conflicting messages about family planning," he added.

Advocates of family planning have accused Uganda's President Museveni of working against efforts to promote more manageable family sizes.

However, at a global family-planning summit in July 2012, Museveni announced that his government would increase its annual expenditure on family planning supplies from $3.3 million to $5 million for the next five years. The Ministry of Health has also laid out a roadmap for providing universal access to family planning, involving the integration of family planning into other health services, and it plans to reduce the 'unmet need' for family planning to 10 percent by 2022.