Last month, Uganda joined the rest of the world to celebrate the Global Day of Action for Access to Safe and Legal Abortion for Women who use Drugs.
Yes, such a day exists. What stood out even more, was how women who previously carried out an abortion freely engaged in a discussion about the practice without remorse. Abortion being illegal in Uganda, it is a topic women who have done it, talk about in low tones, if ever.
Most of the women who talked at the conference held at Emerald hotel in Kampala on September 28, said they have at one time been victims of unsafe ways of carrying out an abortion or know of a colleague who has carried out an abortion using unsafe methods.
Lillian*, 32, for instance, confessed to having procured two abortions that almost took her life; apart from the fact that she did not have money to seek an abortion from a trained medical worker, she was afraid of the stigma.
“This is my story. I was on the streets as a [commercial sex worker] and had two abortions. I decided to abort because I was not ready for the child and I did not know the father,” she told the gathering.
Lillian, now a peer trainer, further explained: “The abortions were not done in the hospital, but I used herbs got from an old woman.”
She said she resorted to herbs because as a sex worker and a drug user at the same time, she feared that because of her drunken nature, she could not be attended to at government facilities.
“The old women gave me herbs which I inserted in my private parts. It was too painful and I also bled a lot [until I lost the baby], but the pain is still in my mind up to now,” she said.
She describes the pain of the ordeal as unimaginable.
In her second abortion, she again used herbs, suffered painful bleeding for four days, and thanks to friends who attended to her, she recovered. But now that she is out of prostitution, she is worried she may never conceive again.
“My biggest worry was death. I had seen a friend who tried to abort a pregnancy of six months and she died. I also feared what my parents would say if they knew; so, I resorted to unsafe abortions in the ghettos,” she said.
As for Nansamba, she was a drug addict when she was raped and got pregnant. Her option was to abort in order to continue as a sex worker.
She told the conference she tried using tea leaves, anti-malaria drugs and even tried to insert metallic wires through her vagina to puncture the foetus.
No wonder, so many women lose their lives every year, trying to terminate pregnancies through similar means.
“When a woman gets pregnant, life takes a dramatic turn. If the girl is school-going, she may drop out of school, be disowned by her family or even be married off despite the age. To fit in my family, I had to do that,” she said. “I’m lucky that I still have my uterus; I have a friend who even got a husband but she has failed to conceive because her uterus had been removed earlier to save her life in an abortion gone bad.”
Agatha Mukanza, physician at Uganda Harm Reduction Network (UHRN), said when individuals are able to access safe abortion, along with comprehensive sexuality education and contraceptives, the social good outcomes are numerous.
“When women are allowed by law to have safe abortion, there will be reducing maternal mortality and morbidity and significantly reduced rates of STIs and teenage pregnancy,” she said.
Mukanza said considering that women who use drugs are marginalized, their vulnerabilities transcend unwanted and unplanned pregnancies, and they are unable to procure sexual reproductive services due to the restrictive policy and legal environment.
According to Syrus Ajuna, the coordinator, Partnership to Inspire Transform and Connect the HIV response (PITCH) project at UHRN, 300,000 abortions are carried out in Uganda annually, despite the practice being criminal.
He said 17 per cent of abortions are carried out under safe conditions, but 83 per cent are done under unsafe conditions using unsafe methods.
“The unsafe abortions, as a result, cause 26 per cent of maternal mortality due to abortion complications,” he said.
The UHRC Client Report 2016, indicates that 45 per cent of female injectable drug users are also HIV-positive compared to 21 per cent among their male counterparts.
Ajuna said because regular opiate use, poor nutrition and stress can cause amenorrhea (the cessation of monthly menstrual flow), women drug users may not know they are pregnant for several months.
Mukanza said when drug users conceal pregnancies from health workers and family, it limits their access to harm reduction information and specialized care.
A health worker from one of the clinics in Kampala who requested anonymity said they receive many women at the clinic who do not have uteruses, some knowingly or unknowingly.
“Women with no uteruses are many. I believe even the many cancers of the uterus Uganda registers are as a result of unsafe abortions,” she said.
Why the fight must continue
Ajuna said restrictive laws don’t reduce the number of abortions but, rather, make them unsafe, thus having negative health, social and economic consequences.
“Policies and practices that impede access to safe abortion where legal terminations are available must be eliminated so as to reduce cases of unsafe abortions as well as reduce maternal mortality and morbidity rates,” he explained.
Ajuna added, “As we commemorate this global day for action under the theme #IResistWePersist, we are calling for action for women drug users’ increased access to needed reproductive health services.”
*Not real name.