Tales of Unsafe Abortion complications in Uganda
Local NGO comes to the rescue of sex workers living on Lake Victoria landing sites
By
Umar Weswala:
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| FMP team in Kyondo, one of the Sex workers' communities in Kigungu Landing site |
On a sadder note, many of
those who suffer these complications lose lives because they cannot afford or
quickly access Post Abortion Care (PAC) depending on where they are offered.
Private facilities charge
highly for such services and public facilities are either distant or the health
workers stigmatize the sex workers seeking medical care.
On average, Post Abortion
Care costs about UGX 500,000= (US$130) an amount that an average Ugandan cannot
afford in a private facility.
Through its Care Plus project,
Family Medical Point (FMP), a Non-Governmental Organization (NGO) based in
Entebbe is seeking to empower women and girls; particularly female sex workers living
on the four landing sites of Kigungu, Kasenyi, Nakiwogo and Guuda (on the
shores of Lake Victoria) with accurate information on Sexual Reproductive
Health Rights (SRHR) services that will enable them to make informed decisions
regarding their health.
This follows heart
breaking stories and testimonies from a selection of female sex workers and
health workers living and working on the said landing sites, about the trials they
go through in search of affordable, quality and friendly reproductive health
services.
These trials include
stigma and discrimination directed at the female sex workers by some health
workers because of the nature of their work (sex work).
Others include the high
costs of SRH services or commodities and the rampant stock outs of essential
commodities like modern contraceptive items.
Sex workers are regular
consumers of contraceptive information and services because according to
Kadaama, a female sex worker based in Kasenyi landing site, sex work and
pregnancy do not mix.
“You either get pregnant
and be out of work or you prevent pregnancy and stay in business” she said.
It is upon this background
that sex workers invest a lot in contraception, including stocking male condoms
in case their preferred contraceptive methods are out of stock or expensive.
Annet Ninsiima, a peer
educator attached to FMP says despite their great efforts towards avoiding
pregnancy and Sexually Transmitted Infections (STIs), some of the sex workers
get unintended pregnancies.
Majority of such
pregnancies are a result of uncooperative male clients who either covertly put
holes on the condoms or force themselves on the sex workers without protection.
According to Annet, this
has become common practice not because it is acceptable but because the men
involved in such risky and criminal behaviors are not brought to book.
“With the exception of a
few male clients, we are always in fights with them over either payment or protection.
I got this scar on the eye during a fight with a man who wanted my services
without a condom. When I reported it to Police, they said I deserved the
beating because I am a sex worker” says Kyasimire Caroline, a female sex worker
based at Kigungu landing site.
“As long as the public
and the law enforcers treat us as low lives or outlaws, we will never be safe”
she noted.
She says the offender who
moves freely was not even detained or cautioned by the authorities.
Despite sustaining
injuries in the process, Caroline says she succeeded in fighting off the
offender.
But her colleague Night,
now deceased did not succeed when she was in a similar situation. A male client
drugged her drink and forced himself on her without protection.
Night conceived in the
process and according to Caroline, this was the beginning of her unfortunate and
tragic journey to the grave.
The deceased’s colleagues
say pregnancy was never an option for her but fate had it that at a time when
she did not go for her family planning injection and relied on condom
protection is the day she met a goon of a client who violated her.
“After learning about the
pregnancy, night had only one thing on her mind and that was abortion and she asked
me not to stop her” says Namakula Josephine aka Fiina the head of sex workers
based in Kyondo, a highly congested neighborhood in Kigungu landing site.
According to Fiina, no
sober female sex worker would willingly conceive, carry a pregnancy to term and
bring up a child in Kyondo.
“Besides the fact that
pregnancy is bad for business, this is no place for child bearing and
upbringing; not with this poverty, poor housing, poor sanitation and violence”
she said.
Aware of the stigma
associated with abortion and sex work in public facilities, Night procured an
unsafe abortion from a quack but the complications that resulted from the
process did not spare her life.
She could have gone for
Post Abortion Care at the nearby Kigungu Health Center III but apparently the
person who gave her the concoction assured her that the bleeding was just a
side effect and would end shortly. Unfortunately, she succumbed to over
bleeding and was buried on a small island on Lake Victoria because her home
area or next of kin could not be traced.
Polyne Nabwire, the head
of communications at FMP says such heartbreaking stories prompted them to come
up with the Care Plus project to prevent such preventable deaths and injuries
not only among sex workers but also among adolescent girls and women.
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| FMP's Polyne Nabwire (R) talking to a health worker at one of the partner facilities in Kigungu Landing site |
According to the Ministry
of Health, Unsafe Abortion complications are among the top three causes of
maternal mortality and morbidity in Uganda
An abortion rate of 39
per 1,000 women aged between 15 and 49 years was reported in Uganda in 2013 by
Guttmacher
Institute, representing approximately 314,300 abortions per year.
Majority of such
abortions are a result of unintended or unplanned pregnancies which stand at
about 46% according to the UDHS 2022.
Polyne say the unplanned
pregnancies wouldn’t be a big problem if there was universal access to
contraception in Uganda, noting that FMP has invested a great deal of its
resources in promoting and providing SRHR information and rights among female
sex workers on the landing sites.
“We conduct Musawo (health
worker) sessions where we engage the sex workers and other beneficiaries in
small discussions and provide them with accurate information on where, how and
when to access comprehensive SRH services, debunk myths about Family Planning
and other SRHR related issues” she said.
FMP has also invested in
training and equipping Community Peer Mobilisers (CPMs) who have been able to
take services to the hard to reach communities like Kyondo and Makusa among
others.
“These CPMs are equipped
with knowledge and skills to sensitize communities and refer them for SRH
services. We also use telemedicine where clients who are far away can call and
get diagnosis and treatment through doctor’s directions via phone” Polyne adds.
Thembo Enoc, a Clinical
Officer at one of the facilities that partners with FMP in Kigungu landing site
says the partnership has paid off because the number of girls and women seeking
SRHR information and services at the facility has increased significantly
courtesy of the out reaches supported by FMP.
“To us, this is a great
output because the more girls and women access SRH information and services,
the lower the chances of getting un planned pregnancies.
If one wants to prevent unsafe
abortions, her first stop should be at a family planning clinic, not some witch
doctor or herbalist” Thembo said.
He also says his medical
staff have benefitted from the partnership because through trainings and value
clarification and attitude transformation session, health workers have
appreciated the value of not only preventing unsafe abortions but also treating
those who seek PAC in the facility.
FMP has partner
facilities in each of the landing sites where it operates and all the health
personnel there have received training in providing family planning and PAC.
For some time and out of
ignorance, some health workers have been reluctant to provide PAC fearing being
arrested for proving abortion.
In Uganda abortion is
considered illegal unless performed by a licensed medical doctor in a situation
where the woman’s life is deemed to be at risk.
Therefore, many abortions
are self-induced and often conducted privately under unsafe conditions.
Moreover, the stigma surrounding induced abortion makes it difficult for women
to report in case of complications. This make unsafe induced abortions hard to manage
and measure leading to missed mitigation opportunities.
The 2012 Uganda national
policy guidelines and service standards for sexual and reproductive health and
rights permitted abortion under specific circumstances, including in cases of
fetal anomaly, rape and incest. These however, have not been operationalized
due to opposition from some sections of the public.
Therefore, family
planning (FP) use remains one of the cost-effective public health intervention
for preventing unintended pregnancies.
Being among the most underserved
communities in the country, sex workers operating on landing sites therefore
need urgent and universal access to SRH services if Uganda is to achieve
universal health coverage.
The fact that FMP is
already on ground promoting these services is a step in the right direction but
the war cannot be won without significant commitments and investments in the
health sector in general.
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