Fact Sheet January 2013 Abortion in Uganda • Unplanned pregnancy is the root cause • Despite their higher use of contracep- UNSAFE ABORTION CAUSES SERIOUS of most abortions. Preventing unintended tives, sexually active unmarried women INJUry—and sometimes deaTH pregnancy, and thereby the abortions have a greater level of unmet need than • In 2008, the Ugandan Ministry of that often follow, would eliminate nearly do married women. (43% vs. 33%) Health estimated that abortion-related all injury and death resulting from unsafe causes accounted for 26% of all maternal abortion. UNSAFE ABORTION IS COMMON, BUT mortality. This proportion is considerably LEVEL OF RISK VARIES higher than the World Health Organiza- • More than half of pregnancies in • The only national estimate of abortion tion’s estimate for Eastern Africa (18%). Uganda are unintended, and nearly a incidence in Uganda comes from a 2003 Furthermore, for every maternal death third of these end in abortion. study that reported an annual abortion resulting from abortion, many more Ugan- rate of 54 abortions per 1,000 women of • Ugandan women, on average, give birth dan women suffer injuries, some severe reproductive age, or one abortion for ev- to nearly two children more than they and permanent, from unsafe procedures. ery 19 such women. This rate is far higher want (6.2 vs. 4.5). This difference— than the average rate for Eastern Africa • According to the 2003 national abor- which represents one of the highest (36 abortions per 1,000 women). tion incidence study, 15 out of every levels of excess fertility in Sub-Saharan 1,000 Ugandan women of reproductive Africa—illustrates just how difficult it is • Ugandan women from all socioeconomic age were treated for abortion complica- for women to meet their fertility desires. and demographic backgrounds have abor- tions that year. Such treatment may tions. Their experiences, however, vary • The high levels of unintended preg- require hospital care, blood transfusions considerably. Compared with their poorer nancy and unplanned births in Uganda and antibiotics—scarce resources in a counterparts, women who are well off can be attributed primarily to nonuse country with limited health care funding generally have access to a wider range of of contraceptives by women who do not and insufficient medical personnel. abortion providers and are more likely to want a child soon. use doctors, nurses and clinical officers, • Women using the least safe abortion • Married women’s use of modern con- some of whom are able to provide rela- methods had the highest levels of com- traceptives has increased significantly in tively safe procedures. plications: an estimated 68–75% of poor recent years, nearly doubling (from 14% rural women who had had an abortion • However, since abortion is legally to 26%) between 2000 and 2011. How- experienced complications, compared restricted in most cases, even skilled ever, modern contraceptive use remains with 17% of nonpoor urban women who providers must work in clandestine envi- too low to address the high rate went to a doctor. ronments, which often compromises the of unintended pregnancy. safety of the procedures they perform and • Many women delay seeking care for • In 2011, one in three married women frequently leads them to charge a high postabortion complications because they had an unmet need for contraception— premium for their services. fear that they will receive judgmental they wanted to space or stop childbear- or abusive treatment from health care • Poor and rural women, whose access to ing but were not using any method of providers. skilled providers is limited by financial contraception. constraints and geographic distance, • Midlevel providers, such as nurses and • Contraceptive use has not risen in the often resort to abortions performed by midwives, are legally permitted to provide past decade among sexually active unmar- untrained providers using unsafe methods postabortion care, but the majority lack ried women—38% were using a modern or attempt to self-induce an abortion. proper training. contraceptive method in 2000, and the same proportion was doing so in 2011. THE COSTS OF ABORTION ABORTION LAW AND tive methods, to enable women This fact sheet was made possible by AND POSTABORTION CARE POLICIES IN UGANDA to choose the best methods for grants from the Swedish Internation- ARE SUBSTANTIAL • Ugandan law allows abortion themselves, to use methods ef- al Development Cooperation Agency • The amount women pay under some circumstances, but fectively and to switch methods (Sida), the Netherlands Ministry of for a clandestine abortion laws and policies on abortion when desired. Foreign Affairs, and the David and varies. In 2003, an abortion are unclear and are often inter- Lucile Packard Foundation. was estimated to cost a woman preted inconsistently, making • Expand and improve the qual- US$25–88 if performed by a it difficult for women and the ity of postabortion care services doctor, US$14–31 if performed medical community to under- to treat the often serious health by a nurse or midwife, US$12– stand what is legally permitted. complications resulting from 34 if performed by a traditional unsafe abortion. More providers, healer and US$4–14 if the • The Ugandan Constitution including midlevel ones, must woman self-induced. states that abortion is permit- be trained in comprehensive ted if the procedure is autho- postabortion care (particularly • According to a recent study, rized by law. provision of manual vacuum as- the cost to the healthcare piration) to adequately address • According to the 2006 system of treating complica- the need for services in all parts National Policy Guidelines and tions from unsafe abortion was, of the country. Sensitivity train- Service Standards for Sexual on average, nearly US$130 per ing of providers is also needed. patient in 2009. and Reproductive Health and Rights, pregnancy termination • Improve health care providers’ • In total, postabortion care is is permissible in cases of fetal ability to offer abortion services estimated to cost nearly $14 anomaly, rape and incest, or if within the confines of the law. million annually in Uganda. the woman has HIV. It is critical to raise providers’ Two-thirds of this amount, or awareness of the content and • However, because interpreta- US$9.5 million, is spent on scope of Uganda’s abortion tions of the law are ambiguous, nonmedical costs (overhead and law and to equip them with medical providers may be re- infrastructure), and the remain- appropriate training to provide luctant to perform an abortion ing third (US$4.4 million) is safe abortion services in legally for any reason for fear of legal spent on drugs, supplies, labor, permitted circumstances. hospitalization and outpatient consequences. fees. RECOMMENDATIONS • Most costs of postabor- • Ensure that free or affordable tion care arise from treating public-sector family plan- incomplete abortion; however a ning services reach all women, significant proportion is spent especially those who are poor Center for Health, Human Rights treating more serious complica- and young, to reduce unmet and Development Plot 614 Tufnell Drive, Kamwokya tions, such as sepsis, shock, need for contraception and P.O. Box 16617, Wandegeya lacerations and perforations lower the unintended pregnancy Kampala Uganda rate. Programs should offer Tel: +256 414–532283/712 657974 comprehensive family planning www.cehurd.org services, including counseling, and a wide range of contracep- 125 Maiden Lane New York, NY 10038 USA Tel: 212.248.1111 [email protected] www.guttmacher.org January 2013.