The Tragic Impact of Unsafe Abortion and Inadequate Access to Contraception in Uganda
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THE TRAGIC IMPACT OF UNSAFE ABORTION AND INADEQUATE ACCESS TO CONTRACEPTION IN UGANDA International Women’s Human Rights Clinic Georgetown Law June 2013 ©2013 Center for Reproductive Rights, the International Women’s Human Rights Clinic at Georgetown Law, and the O’Neill Institute for National and Global Health Law at Georgetown Law. Any part of this report may be copied, translated, or adapted with permission from the authors, provided that the parts copied are distributed free or at cost (not for profit) and the Center for Reproductive Rights, the International Women’s Human Rights Clinic at Georgetown Law, and the O’Neill Institute for National and Global Health Law at Georgetown Law are acknowledged as the authors. Any commercial reproduction requires prior written permission from the authors. The Center for Reproductive Rights and the International Women’s Human Rights Clinic at Georgetown Law would appreciate receiving a copy of any materials in which information from this report is used. Center for Reproductive Rights THE TRAGIC IMPACT OF UNSAFE Morningside Office Park 1st Floor, Wing A ABORTION AND INADEQUATE Ngong Road P.O. Box 48136-00100 ACCESS TO CONTRACEPTION Nairobi, Kenya Tel. +254 20 251 8361 IN UGANDA 120 Wall St, 14th Floor New York, New York 10005 USA Tel. 917 637 3600 Fax. 917 637 3666 [email protected] www.reproductiverights.org The International Women’s Human Rights Clinic Georgetown Law, McDonough 562 600 New Jersey Avenue N.W. Washington, D.C. 20001 USA Tel. 202-662-9641 Fax-202-662-9497 http://www.law.georgetown.edu/academics/academic-programs/clinical-programs/our-clinics/IWHR/index.cfm The O’Neill Institute for National and Global Health Law Georgetown Law 600 New Jersey Avenue N.W. Washington, D.C. 20001 USA TABLE OF CONTENTS Acknowledgments......................................................................................................................................4 B. Lack of Access to Contraception: A Root Cause of Unwanted Pregnancies in Uganda.....................................................................................................................40 Foreword......................................................................................................................................................6 Personal Testimonies Introduction.................................................................................................................................................7 Lack of Access to Contraceptive Information and Services.................................42 Methodology and Structure...................................................................................................................10 Edith.................................................................................................................................42 Testimonials.............................................................................................................................................12 Pervasive Myths and Misconceptions about Contraceptive Use........................ 44 Nansubuga......................................................................................................................44 A. The Impact of Unsafe Abortion on Women and Families.........................................................12 Joyce.................................................................................................................................45 Personal Testimonies Denial of Access to Contraceptives Due to Negative Provider Preventable Risks of Maternal Injuries and Death.................................................14 Attitudes and Fear of Unplanned Pregnancy............................................................46 Hajara................................................................................................................................14 Elizabeth...........................................................................................................................16 Diana................................................................................................................................ 46 Maureen...........................................................................................................................17 Rachael.............................................................................................................................18 Perspectives from Key Stakeholders Tewi...................................................................................................................................19 Discriminatory Cultural and Social Standards Regarding Women’s Equality and Autonomy..................................................................................48 Increased Risks of Injuries and Death for Adolescent Girls Based On Fear of Loss of Family Support and Education...................................20 Annet................................................................................................................................ 48 Deus Kiwanuka............................................................................................................. 50 Nicki..................................................................................................................................20 Husain............................................................................................................................... 23 Dora Musinguzi...............................................................................................................53 Agnes................................................................................................................................54 Perspectives from Key Stakeholders Government’s Failure to Provide Adequate and Accurate Increased Exposure to Abortion-Related Stigma and Its Family Planning Information and Establish Sexuality Education Tragic Consequences.........................................................................................................24 in Schools...............................................................................................................................55 Josephine.........................................................................................................................24 Ms. Peters.......................................................................................................................26 Dr. Milton Awudo......................................................................................................... 55 Roselyn.............................................................................................................................28 Solomy............................................................................................................................ .56 Honourable Monicah Amoding.................................................................................57 Honourable Sylvia Ssenabulya.................................................................................58 Lack of Access to Life-Saving Care Due to Inadequate Knowledge of the Law, Fear, and Stigma..................................................................30 Inadequate Access to Contraceptives Resulting from High Costs Dr. Collins Tusingwire.................................................................................................30 and Stock-Outs.....................................................................................................................61 Dr. Andrew......................................................................................................................32 Irene..................................................................................................................................61 Professor Tamale..........................................................................................................34 Anna..................................................................................................................................62 Prosecution and Imprisonment for Abortion-Related Charges............................36 Lack of Government’s Leadership Role in Coordinated and Sarah.................................................................................................................................36 Sustainable Provision of Contraceptive Services.....................................................64 Peter Masinde................................................................................................................39 Ms. Zaamu Kaboneke..................................................................................................64 Emma............................................................................................................................... 67 Recommendations ..................................................................................................................................68 2 | CENTER FOR REPRODUCTIVE RIGHTS THE STAKES ARE HIGH THE TRAGIC IMPACT OF UNSAFE ABORTION AND INADEQUATE ACCESS TO CONTRACEPTION IN UGANDA | 3 ACKNOWLEDGMENTS Acknowledgments This report is a joint publication of the Center for Reproductive Rights (the Center), the International Women’s Human Rights Clinic (IWHRC) at Georgetown Law, and At the Center, special thanks to Melissa Upreti, Regional Director for Asia, the O’Neill Institute for National and Global Health Law (O’Neill Institute) at Johanna B. Fine, Legal Adviser and Manager for Projects and Operations, and Georgetown