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Abortion and Postabortion Care in Uganda

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Abortion and Postabortion Care in Uganda FACT SHEET Abortion and Postabortion Care in Uganda ■■ Despite large reductions in pregnancy- ■■ The abortion rate for Uganda is slightly challenge for the Ugandan health related deaths in Uganda over the past higher than the estimated rate for the system. two decades (the maternal mortality East Africa region as a whole, which ratio dropped from 684 per 100,000 was 34 per 1,000 women during High cost of abortion and live births in 1995 to 343 per 100,000 2010–2014. postabortion care in 2015), the high number of maternal ■■ The amount women pay for a clan- deaths there remains a public health ■■ Within Uganda, abortion rates vary destine abortion varies. In 2011–2012, challenge. widely by region, from 18 per 1,000 the average out-of-pocket cost for women in the Western region to 77 an unsafe procedure, treatment of ■■ Unsafe abortion continues to con- per 1,000 in Kampala. complications prior to arriving at a tribute significantly to this public health facility or both was US$23. In health problem: A 2010 report by the Availability of postabortion care 2003, an abortion was estimated to Ugandan Ministry of Health estimated ■■ Of the 2,300 health care facilities cost a woman US$25–88 if performed that 8% of maternal deaths were due across Uganda that can provide post- by a doctor, US$14–31 if performed to unsafe abortion. abortion care, an estimated 89% treat by a nurse or midwife, US$12–34 if postabortion complications. performed by a traditional healer and ■■ Ugandan law explicitly allows abor- US$4–9 if self-induced. tion to save a woman’s life. However, ■■ In 2013, 93,300 women were treated the 2012 National Policy Guidelines for complications from unsafe abor- ■■ The cost to the health care system of and Service Standards for Sexual and tion. This translates to an annual treating complicationsIntended pregnanciesfrom unsafe ending in miscarriage or birth Reproductive Health and Rights go treatment rate for complications abortion was, on average, nearly even further—permitting abortion from unsafe abortion of 12 per 1,000 US$131 per Unintendedpatient in 2010. pregnacy ending in miscarriage or unplanned birth under additional circumstances, women aged 15–49, slightly down including in cases of fetal anomaly, from 15 per 1,000 in 2003. ■■ In total, postabortionUnintended care ispregnancy estimated ending in abortion rape and incest, or if the woman is to cost nearly US$14 million annually in HIV-positive. ■■ Despite a decline in this treatment Uganda. Two-thirds of this amount— rate, injuries and illness resulting US$9.5 million—is spent on nonmedi- ■■ Yet, existing laws and policies on from unsafe abortion remain a critical cal costs (overhead and infrastructure), abortion are interpreted inconsistently by law enforcement and the judicial PREGNANCY OUTCOMES, 2013 system, which makes it difficult for women and the medical commu- More than one in 10 pregnancies end in abortion. nity to understand when abortion is permitted. 14% ■■ Because of this ambiguity, medical providers are often reluctant to per- Unintended pregnancy ending form an abortion for any reason, out in abortion of fear of legal consequences. 48% Unintended pregnancy ending in miscarriage or unplanned birth 38% Incidence of induced abortion Intended pregnancy ending ■■ In Uganda, an estimated 314,300 abor- in miscarriage or birth tions took place in 2013. This translates to 14% of all pregnancies—or a rate of 39 per 1,000 women aged 15–49, down from 51 per 1,000 in 2003. 2.3 million pregnancies FEBRUARY 2017 and the remaining US$4.4 aged 15–49 using a mod- planning services—including SOURCES million is spent on drugs, ern method remained counseling and a wide range Most data in this fact sheet are supplies, labor, hospitaliza- stagnant at 38% during this of contraceptive methods— from Prada E et al., Incidence tion and outpatient fees. period. to enable women to choose of induced abortion in Uganda, the best methods for them- 2013: new estimates since 2003, PLoS ONE, 2016, ■■ Most direct medical costs ■■ Meeting women’s contra- selves, to use methods 11(11):e0165812, doi:10.1371/ of postabortion care arise ceptive needs is a critical effectively and to switch journal.pone.0165812. from treating incomplete strategy to help women methods when desired. Additional resources can be abortion; however, a sig- avoid unintended pregnan- found in the version available nificant proportion is spent cies. In Uganda, four out ■■ Expand and improve the at https://www.guttmacher.org/ treating more serious com- of 10 married women and quality of postabortion care fact-sheet/abortion-uganda plications, such as sepsis, almost half of sexually services to treat the often shock, lacerations and active women of reproduc- serious health complica- perforations. tive age have an unmet tions resulting from unsafe need for modern contracep- abortion. Health authori- Impact of unintended tion, that is, they want to ties should allocate greater pregnancy avoid a pregnancy, but are resources to postabortion ■■ Most abortions are the either not practicing contra- care and prioritize incorpo- result of unintended preg- ception or are using a tra- rating counseling and provi- nancy. In Uganda, 52% of ditional method, which can sion of contraceptives into Center for Health, Human pregnancies are unintended, have high failure rates. this care. Rights and Development and about a quarter of these Plot 833 Old Kiira Road, ■■ unintended pregnancies end Recommendations Clarify Uganda’s abortion Ntinda-Kiwatule in abortion each year. ■■ Ensure that free or afford- law and policies, and raise P.O. Box 16617,Intended Wandegeya able public-sector family awareness of the content Kampala, Uganda ■■ Between 2003 and 2013, planning services reach all and scope of Uganda’s Tel: +256 41 532283Births Mobile: +256 772 657974 the proportion of married women—especially those abortion law among the Miscarriages* women aged 15–49 using who are poor and young— medical community, the www.cehurd.org a modern contraceptive to reduce unmet need for judicial system and women. method increased from contraception and lower 14% to 26%; however, the the incidence of unintended Unintended proportion of unmarried pregnancy. Programs should sexually active women offer comprehensive family ABORTION RATE BY REGION, 2013 Makerere University School of The rate of abortion varies greatly by Public Health region in Uganda. New Mulago Hospital Complex Kampala, Uganda Kampala 77 Tel: +256 414 543872 www.musph.ac.ug Central 1 52 Induced abortions per 1,000 women 15–49 Central 2 33 East 40 Central Eastern 25 Karamoja 26 ACKNOWLEDGMENTS The study on which this fact North 57 sheet is based was made Good reproductive health South possible by grants from the 34 West UK Government, the Dutch policy starts with credible Ministry of Foreign Affairs and research 38 West Nile the Norwegian Agency for 125 Maiden Lane Development Cooperation. New York, NY 10038 Western 18 The findings and conclusions 212.248.1111 contained within do not 0 20 40 60 80 100 [email protected] necessarily reflect the positions Induced abortions per 1,000 women 15–49 and policies of the donors. www.guttmacher.org GUTTMACHER INSTITUTE FEBRUARY 2017 10 30 50 70 90.
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