The Individual- and Household-Level Cost of Unsafe Abortion in Uganda
• Ugandan law allows abortion under some circumstances, but laws and policies on abortion are unclear and are often interpreted inconsistently, making it difficult for women and the medical community to understand what is legally permitted.
• As a result, almost all abortions in the country take place under clandestine settings and pose a serious threat to women’s health and well-being.
• Unsafe abortion is one of the leading causes of maternal morbidity and mortality in the country, though the exact incidence is unknown. In 2011, Uganda had a maternal mortality ratio of 438 maternal deaths per 100,000 live births—well above the average of 240 per 100,000 among all developing countries.
• The cost of treating complications of unsafe abortion drains already scarce resources from the national health system and places a heavy economic burden on women and their families.
• According to a survey of 1,338 women who received postabortion care at 27 health facilities, on average, Ugandan women paid 59,600 shillings (US$23) for their abortion procedure and any treatment received prior to arriving at a health facility.
• Including the cost of treatment for complications arising form the abortion procedure brought the average cost of abortion to 128,000 shillings (US$49) per woman.
• For many women these expenditures are significant. Uganda has one of the lowest per capita incomes in the world, and a substantial proportion of the population lives in poverty.
• Women treated for postabortion care reported that their unsafe abortion had adverse effects on their productivity (73%), their children’s well-being (60%) or their household’s economic well-being (34%).
ECONOMIC LOSS AND REDUCED PRODUCTIVITY
• Women staying one night in a health facility had more than twice the odds of experiencing some economic deterioration of their household, compared with women who had not had an overnight stay.
• Women who spent one or more nights in a health facility were more than twice as likely as those who did not to suffer loss of productivity or to experience the loss of economic assets (such a home, farm or livestock), to lose a job, to incur debt or reduce consumption.
• Women who incurred higher postabortion care expenses were 60% more likely than those with lower expenses to have seen their economic circumstances worsen.
• Loss of productivity was more commonly reported by married women than by unmarried women.
NEGATIVE CONSEQUENCE FOR CHILDREN
• The likelihood that a woman’s child would experience negative consequences— having less food than usual, missing school or both—was almost three times as high among women who had spent one or more nights at a health facility as among other women.
• Children of the poorest women were the most likely to experience these negative consequences.
• The proportion of women who reported that their children had suffered negative consequences was highest among teenagers (92%), followed by women in their 20s (62%) and older women (51%).
• Children of married women were more than twice as likely to have suffered negative consequences as were children of unmarried women.
• Programs and policies are needed to help reduce recourse to unsafe abortion and lessen the negative consequences of such abortions. In particular, it is important that safe abortion services be provided to the full extent allowed by law.
• A concerted effort is needed to reduce the costs associated with postabortion care in order to reduce the economic burden it places on women, especially poor women, and their families.
• Women’s access to effective contraceptives needs to be improved to address the root cause of most abortions: unintended pregnancy. This is particularly important in light of the high cost of unsafe abortion. It would be much more cost effective for women to have access to cheaper contraceptives than to have to undergo costly and unsafe procedures.
• Women need accurate information on the availability of contraceptive services, and greater efforts are needed to ensure that poor women, in particular, are aware of and have access to these services.
The data in this fact sheet are drawn from Sundaram A et al., Documenting the individual- and household-level cost of unsafe abortion in Uganda, International Perspectives on Sexual and Reproductive Health, 2013, 39(4):174–184.