To that effect, the prevailing restrictive legal environment has led to an increase in unsafe abortions which have resulted into high rates of maternal mortality and morbidity in the country. The Constitution restricts abortion and it can only be performed when the pregnancy is endangering the life of the expectant mother.
DAMNING STATISTICS
According to a 2018 Guttmacher report on Uganda, an estimated 314,300 abortions took place. This translated to 14 per cent of all pregnancies—or a rate of 39 per 1,000 women aged 15–49.
The report is authored by the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights globally.
Within Uganda, abortion rates vary widely by region, from 18 per 1,000 women in the western region to 77 per 1,000 in Kampala. However, the publication ‘harm reduction model’ could turn around this reality by reducing on the number of termination of unintended pregnancies.
WHAT IS HARM REDUCTION MODEL?
The harm reduction model is intended to prevent unsafe abortion, ensure that women facing an unintended pregnancy receive comprehensive information and care so that they can make autonomous decisions.
Through this model, health professionals are mobilized to become agents of change, training them on medical ethics and client’s right to information, health and confidentiality.
The model has three main goals which include reducing the risks of unsafe abortion, reducing the number of pregnancies that are terminated in unsafe conditions and reducing morbidity and mortality related to unsafe abortions.
HOW THE MODEL WORKS
The model has two visits encompassing the pre-consultation (before visit), where a woman who presents an unwanted pregnancy is offered accurate information and services by a qualified health professional.
This information pertains to party obligations in regards to keeping the consultation confidential, information on health service provider obligation to provide the woman with all the necessary information for her to make an informed decision regarding her pregnancy.
This is based on the patient’s right to access health information and her right to privacy and confidentiality of information. Medical examinations are done to ascertain the presence of the pregnancy and foetal viability, information regarding legal status of abortion in Uganda, information on family planning methods, their advantages and disadvantages.
It is this information provided by a health service provider that a woman uses to determine whether she wants to carry on the pregnancy to term or abort. Depending on her choice, the woman is then allowed to see the health professional again.
If she carried the pregnancy to term, the health service provider is expected to guide her through the pregnancy and if she opted to terminate it, the health service provider provides post-abortion care as well as providing her information on available family planning methods, their advantages and disadvantages to allow her not get pregnant again unless she wished too.
The three core principles
Neutrality
Under this principle, health providers should not judge the underlying activity’s legality or morality but should concern themselves with the given activity; unsafe abortion is above all a contributor to maternal mortality and morbidity.
Therefore, health service providers have the obligation to provide information about technologies and procedures that minimize the personal and social harms of unsafe abortion even in contexts where abortion is legally restricted or prohibited.
Humanism
Under this principle, the model demands that regardless of how abortion may stand within the general moral opinion or legal norms, all women should be treated as deserving of concern for their health and lives.
The model further under this principle states that irrespective of moral or legal considerations, women’s health needs should be understood and addressed.
Pragmatism
Under pragmatism, the model demands that even in a restrictive regulatory environment, women may decide to have an abortion.
It adds that where there is evidence that women are continuing to attempt or undergo unsafe abortions, health service providers are obligated to attempt to mitigate as much harm as possible by providing information about the safest and most effective services and methods available to them.
The harm reduction model is an ambitious strategy that forms part of a broader movement focused on sexual and reproductive health and rights, particularly safe abortion.
This movement includes efforts to reduce unintended pregnancies through comprehensive sexual education and access to contraceptive methods as well as efforts to ensure access to legal abortion services.
WHAT SERVICE PROVIDERS SAY
According to Noor Nakibuuka Musisi, an official from CEHURD, the model raises the input of health service provider.
“Actually, it is meant to prevent harm. It’s a model based on a woman’s decision. As CEHURD, we have developed a legal defence of the model, we have scrutinized all laws and policies including international legislation to ensure that a health service provider is not caught up in the criminal justice system while implementing the model. We totally understand this model protects rights including, among others, the right to health, life, access information, confidentiality among others,” she says.
Meanwhile, Dr Charles Kiggundu, a senior gynaecologist at Mulago hospital, says for the last 10 years, more than 200 women have contacted him to help them abort but many of them don’t normally meet the requisite requirements for legal abortions.
“I have practiced it and I don’t know how many women I have saved who had wanted to abort their pregnancies. In the last six months, I have received one woman who legally qualified for an abortion. Likewise, about 10% of the women who had wanted to abort changed their minds after I counselled them and they continued carrying on with their pregnancies,” he says.
