Some pregnant girls wait for treatment at Bwindi Community Hospital in Kayonza Sub-county in Kanungu District. Photo by Brian Mutebi
In May 2013, 22-year-old Florence* from Nyamigoye village, Nyamigoye Parish, Kanyantorogo Sub-county in Kanungu District, was admitted to Bwindi Community Hospital in Kayonza Sub-county with severe post-abortion effects. Florence, a housemaid, feared to inform her boss about her pregnancy. She got a cattle syringe and tried to pierce the foetus through the cervix. She hoped the foetus would die and get expelled from the womb. In the process, however, she pierced her cervix, and possibly the uterus, yet out of fear, kept everything to herself.
Days later, part of her reproductive system started rotting. The unbearable pain would lift the lid off her cup of silence. She begged to be taken to hospital. There, almost breathless, she narrated her ordeal to Sarah Uwimbabazi, a midwife.
Days later, part of her reproductive system started rotting. The unbearable pain would lift the lid off her cup of silence. She begged to be taken to hospital. There, almost breathless, she narrated her ordeal to Sarah Uwimbabazi, a midwife.
“We rushed her to theatre to remove the dead foetus but it was rather too late, she died on the operating table,” says Uwimbabazi.
Another traumatising case the hospital has dealt with involved a teenage girl admitted with a septic abortion or perforated uterus.
Septic abortion is a uterine infection caused by induced abortion. In rural communities such as Kanungu, induced abortions are carried out using crude methods. Girls and women reportedly use herbs or sharp objects to induce abortions.
Another traumatising case the hospital has dealt with involved a teenage girl admitted with a septic abortion or perforated uterus.
Septic abortion is a uterine infection caused by induced abortion. In rural communities such as Kanungu, induced abortions are carried out using crude methods. Girls and women reportedly use herbs or sharp objects to induce abortions.
The numbers
The statistics are grim. In 2012, there were 282 recorded cases of abortion in the district. In 2013, the cases increased to 351, almost an abortion every single day. 2014 registered a slight drop to 331 cases and by mid-2015, 251 cases had been recorded. The cases may even be more since some are never reported.
However, Dr Julius Nkalubo, a gynaecologist at Bwindi Community Hospital, says despite this, the situation is improving. “It is the reporting of abortion cases that has improved in Kanungu. Given the stigma associated with abortion, health facilities tend to only report spontaneous abortions so as to avoid the legal implications,” he says, adding: “But we have been encouraging reporting of all abortions regardless of how it comes hence such figures.”
The statistics are grim. In 2012, there were 282 recorded cases of abortion in the district. In 2013, the cases increased to 351, almost an abortion every single day. 2014 registered a slight drop to 331 cases and by mid-2015, 251 cases had been recorded. The cases may even be more since some are never reported.
However, Dr Julius Nkalubo, a gynaecologist at Bwindi Community Hospital, says despite this, the situation is improving. “It is the reporting of abortion cases that has improved in Kanungu. Given the stigma associated with abortion, health facilities tend to only report spontaneous abortions so as to avoid the legal implications,” he says, adding: “But we have been encouraging reporting of all abortions regardless of how it comes hence such figures.”
Abortion
Abortion is either unintended or induced. Dr Nkalubo explains that the unintended abortions are due to factors such as diseases, including sexually transmitted infections and malaria. In such cases, the expectant mother inadvertently loses the pregnancy before the baby is fully developed, often before 23 weeks of pregnancy.
Induced abortions are aided abortions. Induced abortions can be carried out with the assistance of a skilled health worker. In Uganda, however, abortion is illegal so while there are allegations of some health workers assisting women to abort, such cannot be ascertained. The commonest cases, therefore, are those done by non-professionals. It could be by use of herbs or objects. Induced abortions cause the most risks to the expectant mother.
Abortion is either unintended or induced. Dr Nkalubo explains that the unintended abortions are due to factors such as diseases, including sexually transmitted infections and malaria. In such cases, the expectant mother inadvertently loses the pregnancy before the baby is fully developed, often before 23 weeks of pregnancy.
Induced abortions are aided abortions. Induced abortions can be carried out with the assistance of a skilled health worker. In Uganda, however, abortion is illegal so while there are allegations of some health workers assisting women to abort, such cannot be ascertained. The commonest cases, therefore, are those done by non-professionals. It could be by use of herbs or objects. Induced abortions cause the most risks to the expectant mother.
In Kanungu, gender-based violence was cited among the causes of abortion. The commonest form of gender-based violence was physical abuse, particularly beating up expectant wives. Eight out of the 282 cases of abortion recorded in 2012 were a result of gender-based violence. Fifty two cases or 15 per cent of the 351 abortion cases in 2013 were as a result of gender-based violence, just like the 10 out of 331 cases in 2014.
Uwimbabazi, who is also the hospital’s family planning coordinator, says abortion is common among adolescents and majority of cases are a result of unwanted pregnancies. Girls are lured into sexual relationships on promises of material benefits.
Uwimbabazi, who is also the hospital’s family planning coordinator, says abortion is common among adolescents and majority of cases are a result of unwanted pregnancies. Girls are lured into sexual relationships on promises of material benefits.
“Because of a booming tourism industry and foreign tourists who flock this area, some unscrupulous men lure girls into sexual relationships on promises of getting them sponsors from the foreign tourists,” Uwimbabazi explains. “Many girls give in and end up getting pregnant for men who do not take responsibility. The anticipated burden of carrying a pregnancy without family and social support causes girls to opt for abortion.”
Part of Bwindi Impenetrable Forest that is popular for gorilla tourism is found in Kanungu District and the Batwa, one of the indigenous people, with a peculiar lifestyle, form a big part of the community which attracts many tourists in the area.
Part of Bwindi Impenetrable Forest that is popular for gorilla tourism is found in Kanungu District and the Batwa, one of the indigenous people, with a peculiar lifestyle, form a big part of the community which attracts many tourists in the area.
There are also low levels of knowledge on sexual and reproductive health rights by both adolescents and their parents, which affects use of contraceptives. The problem is also attributed to urbanised lifestyle. Dr Stephen Ssebudde, Kanungu District health officer, says in places like Kanungu Town Council, adolescents copy practices they watch in movies, leading them to engage in sexual relationships, resulting in pregnancies they are not ready for. He adds that access to mobile phones among adolescents or the desire to acquire one, particularly on the side of girls, makes it easy for such relationships to thrive.
What is the solution?
Dr Nkalubo says efforts are being made to reduce the abortions by screening and treating sexually transmitted infections and malaria during pregnancy, which diseases contribute to spontaneous abortions. This is in addition to encouraging use of contraception, sexual and reproductive health education to prevent unwanted pregnancies.
Dr Nkalubo says efforts are being made to reduce the abortions by screening and treating sexually transmitted infections and malaria during pregnancy, which diseases contribute to spontaneous abortions. This is in addition to encouraging use of contraception, sexual and reproductive health education to prevent unwanted pregnancies.
The use of contraceptives remains a delicate subject of discussion in sections of society because of cultural and religious beliefs. Uwimbabazi, however, says their aim is to save lives. “Not that we are encouraging adolescents to have sex but we are trying to save lives,” she says, adding: “Having sex alone is a risk, so to that risk, we tell girls not to add another of getting pregnant and carrying out abortion.”
The chaplaincy at Bwindi Community Hospital helps in sensitisation through churches and holiday camps for adolescents where sexuality and reproductive health issues are discussed.
The district authorities are working to prevent gender-based violence through, among others, Male Action Groups (MAG). According to Saturday Jackson, the Kanungu District population officer, MAGs are helping in raising awareness against gender-based violence and improving uptake of family planning services and sensitisation through radio talk shows.
The district authorities are working to prevent gender-based violence through, among others, Male Action Groups (MAG). According to Saturday Jackson, the Kanungu District population officer, MAGs are helping in raising awareness against gender-based violence and improving uptake of family planning services and sensitisation through radio talk shows.
Some local politicians have also come up to support efforts of raising awareness on sexual and reproductive health, the inadequacy of which is considered the major cause of unwanted pregnancies and abortions. One hopes the efforts will be concrete that girls and women will not have to die while attempting to abort.
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