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Jessica Malter
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IN UGANDA, SLOW PACE IN SCALING UP ACCESS TO REPRODUCTIVE HEALTH CARE SERVICES COSTING THOUSANDS OF LIVES AND BILLIONS OF SHILLINGS

One in three sexually active women in Uganda, both married and unmarried, want to avoid pregnancy, but are not using a method of contraception—one of the highest recorded levels of unmet need for contraceptives in Sub-Saharan Africa—according to a new report by the Guttmacher Institute that analyzes data from Uganda's 2011 Demographic Health Survey (DHS) and other recent research. The report, "Unintended Pregnancy and Abortion in Uganda," which was released today by Guttmacher and the Center for Health, Human Rights and Development (CEHURD), identifies critical gaps in reproductive health care and recommends steps urgently needed to reduce Uganda's high levels of unintended pregnancy and to improve maternal health.

On average, Ugandan women give birth to nearly two more children than they want (6.2 vs. 4.5). Only 26% of married women and 38% of unmarried women in the country use a modern method, and more than half of all pregnancies are unintended. This epidemic of unintended pregnancy takes a devastating toll on women, families and communities; it leads to nearly 700,000 unplanned births a year and extremely high levels of unsafe abortion, maternal morbidity and illness. Approximately 26% of all maternal deaths are attributed to unsafe abortion, and for every woman who dies many more are injured.

"It is time we recognize unsafe abortion for what it is, a serious public health crisis that must be addressed," said Moses Mulumba, director of the Center for Human Rights and Development in Kampala, the Secretariat for the Coalition to Stop Maternal Mortality Due to Unsafe Abortion in Uganda. "Because unintended pregnancy is the root cause of most abortions—and the injuries and deaths that often follow—providing better family planning services would dramatically improve maternal health in Uganda."

Ugandan women from all levels of society experience unintended pregnancy and thus may seek out abortion, virtually all of which are clandestine and unsafe. However, the level of risk varies considerably, depending on a woman's socioeconomic status. While wealthier women are more likely to turn to doctors, nurses and clinical officers for an abortion, poor and rural women most often obtain abortions from untrained providers using unsafe methods or attempt to self-induce an abortion. As a result, it is these women who are most likely to suffer injury and death from an unsafe procedure.

The report also highlights research showing that investing in family planning services not only improves women's health, but also saves money. A recent study, "The Health System Cost of Postabortion Care in Uganda," published in the peer-reviewed journal Health Policy and Planning, found that every dollar spent on family planning in Uganda could save nearly five dollars by decreasing the number of women who need postabortion care. Treating complications of unsafe abortion poses a significant burden on the Ugandan health system. On average, each patient needing postabortion care costs about US$130 (UShs 350,000), totaling nearly US$14 million (UShs 37.8 billion) annually.

"Investment is needed to expand the scope of services available to women. Women must have appropriate counseling as well as a choice of affordable contraceptive methods that meet their needs," said Dr. Charles Kiggundu of Mulago Hospital. "But as long as women have unwanted pregnancies, they will continue to resort to unsafe abortion—the provision of postabortion care must be expanded and the existing legal framework must be implemented."

"Uganda's abortion law is much more expansive than commonly believed—abortion is permitted to preserve the life and mental and physical health of the pregnant woman," noted Mulumba. "Clarifying the current law and implementing existing guidelines is an important step we should take now as a country to dramatically improve the health and save the lives of Ugandan women."

For more information about abortion and unintended pregnancy in Uganda:
Unintended Pregnancy and Abortion in Uganda (In Brief)
Abortion in Uganda (fact sheet)
Contraception and Unintended Pregnancy in Uganda (fact sheet)

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