Kampala — CATHOLICS forbid it, the African culture is against it, while the law in Uganda says it is murder. But this all pales in comparison to the Uganda Demographic and Health Survey (UDHS) 2006 report which says there are 297,000 abortions induced annually, while an estimated 65,000 women experience complications, but receive no treatment.Dr. Simon Musani, a gynaecologist/obstetrician consultant at MedAfrik Laboratory, Mbale, defines abortion as the termination of a pregnancy by the expulsion from the uterus of a foetus, resulting in death.
He says abortion can occur spontaneously due to pregnancy-related complications. "An abortion can be induced to preserve the health of the mother," he adds.
Musani says abortion can be induced using herbal concoctions, sharpened tools, physical trauma and other traditional methods.
"However, contemporary medicine utilises medication and surgical procedures to induce abortion," he says.
The 2006 UDHS report says one in four abortions are performed by doctors, four in 10 by nurses or midwives, and one-half by pharmacists or dispensers; two-thirds are done by traditional practitioners and seven in 10 of those which are self-induced result in complications. This includes excessive bleeding, fever, infection including pelvic inflammatory disease, increased risk of cervical cancer, damage to the uterus and high maternal mortality.
A UDHS study of women who were treated for pregnancy-related problems in three Kampala hospitals, found that 21% of maternal deaths were due to post-abortion complications.The main reason behind the complications is lack of access to post-abortion care services and accurate family planning information.
Need for post-abortion care
In Uganda, post-abortion care (PAC) is permitted under the Ministry of Health's reproductive health policy.
"PAC is the emergency care provided to women following pregnancy loss," says Dr. Kari Koita of Mulago Hospital.
Post-abortion care also serves to promote safe abortion to the extent allowed by law - if the mother's life is in danger.
Services provided
Dr. Charles Kiggundu, an abortion focal person at the Ministry of Health and Mulago Hospital, says in Uganda, post-abortion care services include emergency care, where the mother is treated for infections or diseases suffered and other complications.
"We induce or remove the unwanted parts of a foetus that have remained in the womb using manual or eleDr. Frank Kaharuza, the president of the Association of Obstetrics and Gynaecology of Uganda, says almost all hospitals and health centres that treat abortion complications can provide antibiotics for women with infections, and also prescribe oxytocics - drugs that stimulate contractions of the uterus - to complete the expulsion of the foetus.
He explains that health facilities are also equipped with drugs to stop bleeding of mothers after an emergency, adding that Oxytocin and Ergometrine are the drugs used for this.
Kaharuza says family planning services are also given to advise the couple to delay the next pregnancy.
"The woman is also counselled to relieve her and the family of trauma. This is because they experience problems like alcoholism, divorce or domestic violence after abortion," Kaharuza explains.ctric vacuum aspiration."Kiggundu adds that they also screen for and treat sexually transmitted infections and HIV/AIDS.Constraints
Kaharuza, however, explains that Oxytocin and Ergometrine are unstable at room temperature and administration is difficult for untrained health workers. They are in liquid form and administered as an injection, he adds.
He also regrets that PAC services remain limited to a few urban settings, largely due to low level of investment in infrastructure, equipment and technical skills to undertake it.
"Although nearly 70% of PAC is provided by health centres or private midwives, skilled and complex post-abortion care is largely available only in hospitals," Kaharuza says.
Kiggundu says in Uganda, post-abortion care services are free in government health facilities.
A comprehensive package costs sh50,000 in private not-for-profit hospitals and between sh40,000 to sh140,000 in private for-profit health centres.Misoprostol could save women
Kiggundu says Misoprostol has been noted to greatly help in the prevention and management of post-partum haemorrhage. It is also used for treatment of incomplete/missed miscarriages or induced abortion."Prof Florence Mirembe of the Gynaecology and Obstetrics department of Makerere University, says Misoprostol is cheap and easy to use.
"A dose may cost about sh5,000, and it can be administered by a trained health professional. But the dilemma is that it is not available in government health facilities," she says.
She adds that its only side-effects are diarrhoea, nausea, vomiting, chills and fever.
Kiggundu says in co-operation with the Ministry of Health, Mulago University Teaching Hospital and Mbarara University Referral Hospital have set up pilot projects to provide Misoprostol in their post-abortion care services.
"We are going to evaluate the findings after one year," Kiggundu says.
He says abortion can occur spontaneously due to pregnancy-related complications. "An abortion can be induced to preserve the health of the mother," he adds.
Musani says abortion can be induced using herbal concoctions, sharpened tools, physical trauma and other traditional methods.
"However, contemporary medicine utilises medication and surgical procedures to induce abortion," he says.
The 2006 UDHS report says one in four abortions are performed by doctors, four in 10 by nurses or midwives, and one-half by pharmacists or dispensers; two-thirds are done by traditional practitioners and seven in 10 of those which are self-induced result in complications. This includes excessive bleeding, fever, infection including pelvic inflammatory disease, increased risk of cervical cancer, damage to the uterus and high maternal mortality.
A UDHS study of women who were treated for pregnancy-related problems in three Kampala hospitals, found that 21% of maternal deaths were due to post-abortion complications.The main reason behind the complications is lack of access to post-abortion care services and accurate family planning information.
Need for post-abortion care
In Uganda, post-abortion care (PAC) is permitted under the Ministry of Health's reproductive health policy.
"PAC is the emergency care provided to women following pregnancy loss," says Dr. Kari Koita of Mulago Hospital.
Post-abortion care also serves to promote safe abortion to the extent allowed by law - if the mother's life is in danger.
Services provided
Dr. Charles Kiggundu, an abortion focal person at the Ministry of Health and Mulago Hospital, says in Uganda, post-abortion care services include emergency care, where the mother is treated for infections or diseases suffered and other complications.
"We induce or remove the unwanted parts of a foetus that have remained in the womb using manual or eleDr. Frank Kaharuza, the president of the Association of Obstetrics and Gynaecology of Uganda, says almost all hospitals and health centres that treat abortion complications can provide antibiotics for women with infections, and also prescribe oxytocics - drugs that stimulate contractions of the uterus - to complete the expulsion of the foetus.
He explains that health facilities are also equipped with drugs to stop bleeding of mothers after an emergency, adding that Oxytocin and Ergometrine are the drugs used for this.
Kaharuza says family planning services are also given to advise the couple to delay the next pregnancy.
"The woman is also counselled to relieve her and the family of trauma. This is because they experience problems like alcoholism, divorce or domestic violence after abortion," Kaharuza explains.ctric vacuum aspiration."Kiggundu adds that they also screen for and treat sexually transmitted infections and HIV/AIDS.Constraints
Kaharuza, however, explains that Oxytocin and Ergometrine are unstable at room temperature and administration is difficult for untrained health workers. They are in liquid form and administered as an injection, he adds.
He also regrets that PAC services remain limited to a few urban settings, largely due to low level of investment in infrastructure, equipment and technical skills to undertake it.
"Although nearly 70% of PAC is provided by health centres or private midwives, skilled and complex post-abortion care is largely available only in hospitals," Kaharuza says.
Kiggundu says in Uganda, post-abortion care services are free in government health facilities.
A comprehensive package costs sh50,000 in private not-for-profit hospitals and between sh40,000 to sh140,000 in private for-profit health centres.Misoprostol could save women
Kiggundu says Misoprostol has been noted to greatly help in the prevention and management of post-partum haemorrhage. It is also used for treatment of incomplete/missed miscarriages or induced abortion."Prof Florence Mirembe of the Gynaecology and Obstetrics department of Makerere University, says Misoprostol is cheap and easy to use.
"A dose may cost about sh5,000, and it can be administered by a trained health professional. But the dilemma is that it is not available in government health facilities," she says.
She adds that its only side-effects are diarrhoea, nausea, vomiting, chills and fever.
Kiggundu says in co-operation with the Ministry of Health, Mulago University Teaching Hospital and Mbarara University Referral Hospital have set up pilot projects to provide Misoprostol in their post-abortion care services.
"We are going to evaluate the findings after one year," Kiggundu says.
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