KAMPALA, Uganda (WOMENSENEWS)--Nulu Lwanga was barely managing to feed her four children selling banana juice from a roadside shack when she learned she was pregnant again.
Abortion is illegal in Uganda. It is also widely practiced, as Lwanga well knew. A woman in her neighborhood had recently bled to death at the hands of a traditional healer who had unsuccessfully tried to end her pregnancy with poisonous herbs.
Asked if she told her husband about her predicament, Lwanga just laughed. "These African men, they just want to have babies, babies," she explained through a translator. "They don't want to be responsible for them."
Abortion--which is banned, except in special circumstances, in most African countries--is a leading cause of the continent's very high maternal mortality rates. According to the World Health Organization, about 4.2 million unsafe abortions occur each year in Africa, resulting in about 30,000 deaths, nearly half of the total number of women who die from abortion complications worldwide.
But abortion has long been a no-go topic for local politicians, who typically walk a tightrope between the arguments of health workers and influential Christian leaders by saying as little about the issue as possible.
That may be changing.
Liberalizing Moves in Africa
Lawmakers in Mozambique, under pressure from the health ministry there, are expected this fall to end--or liberalize--the country's more than century-old prohibition on the procedure, joining the handful of African countries, mostly in Francophone West Africa, where abortion is legal. And an increasing number of high profile Kenyan leaders have been calling for "an open debate" on the issue. Among the latest is Vice President Moody Awori, a practicing Catholic.
In Uganda, the controversy that bubbles up on newspaper editorial pages and radio talk shows every time the abortion question is raised here has become familiar. A few months ago, the well respected leader of the country's Human Rights Commission, Margaret Ssekagya, provoked anger from the country's powerful religious establishment when she declared that "we should promote safe abortion instead of running away from the reality."
That reality is particularly grim here.
A study last year by the Guttmacher Institute in New York and doctors at Kampala's Makerere University found that a staggering 85,000 Ugandan women are treated for abortion-related health complications each year. Unsafe abortion is the country's leading cause of maternal death. At current rates, the study found, half of all Ugandan women would require treatment for complications related to abortion sometime in their lives.
"You don't need a microscope to see that this is going on; most of these women are being treated in public health facilities," said Elly Mugumya, executive director of the Family Planning Association of Uganda. Based in Kampala, it is one of the country's oldest reproductive health organizations. "Government is not keen to enforce this law. The fact is that abortion is an unavoidable reality. How many prisons could you build?"
Lobbying for Gradual Change
No one thinks, however, that legalization is on its way anytime soon. Even contraception--forbidden in the 1970s, under former dictator Idi Amin--is only relatively recently widely available in Uganda. Mugumya argues that a more practical strategy for those who would like to see the law changed is lobbying for liberalizing the legislation gradually.
"Our job as health advocates is to encourage the debate and soften the stance; and it has worked," said Mugumya. "Now you see arguments for and against legalizing abortion, which is healthy."
That is relatively new. Uganda, which has long been home to an influential Christian majority, is currently in the midst of a fundamentalist revival. Sylvia Namabidde Ssinabulya, a member of Parliament who lobbies for women's reproductive rights, believes that many lawmakers favor at least a liberalization of the abortion ban. But in a country where the first lady, Janet Museveni, opposes the promotion of condoms, even touching the topic is politically treacherous.
"It has not been something that is talked about here, and now when it is, it is only brought as a moral issue rather than a health one," said Ssinabulya.
It is common for poor women in villages to resort to desperate methods ranging from poisonous remedies from traditional healers to drinking detergents or inserting sharp sticks into their vaginas.
"Post-abortion care" is one of the main services provided by the Kampala-based Uganda Private Midwives Association.
Clinicians Ask No Questions
One of the contradictions in abortion law here is that while it makes the procedure illegal--except in very specific instances where the woman's life is in danger--clinics and hospitals that treat women suffering from bleeding, infections or other complications following abortion or miscarriage are forbidden from interrogating her or calling the authorities.
Sakina Kiggundu, who heads the group, says that while Ugandan women are aware of modern birth-control methods, they often don't use them because of widespread myths about contraception; that it will lead to birth defects or infertility, for example. Studies have shown that nearly half of all babies born in the country are the result of accidental pregnancies.
But Kiggundu says that even health workers such as herself are hesitant to lobby publicly in favor of changing the abortion law in Uganda. Those who are particularly reluctant often receive funding from the U.S. government, which thanks to the so-called global gag rule of current administration, are forbidden to use the funds to provide abortions, inform their patients about the availability of abortion or to lobby for change in their nation's abortion laws.
"Many people here would like to see (abortion) legalized, but those who are opposed are much stronger," says Ssinabulya.
One of the things that rarely gets mentioned by either side is that a relatively safe abortion is available in Uganda, for those fortunate enough to have the means and knowledge to obtain one.
The campus of Kampala's Makerere University--where "abstinence rallies" are now regularly held on Friday nights--is one well-known place where a young woman can ask around for the names of reputable nearby clinics that quietly provide the service. The price is negotiable.
Nulu Lwanga didn't know any of this, but she was lucky: A sympathetic neighbor happened to work for a nongovernmental organization that provides health services to women.
Terrified, and yet more frightened of the prospect of giving birth to a child she didn't have the means to feed, she scraped together 30,000 Uganda shillings (about $18) and went to a clinic recommended by her neighbor. The procedure went smoothly. She never told anyone.
Rachel Scheier is a freelance writer based in Kampala.
This series is supported by the Carnegie Corporation of New York.
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