An estimated 314,300 Ugandan women had abortions in 2013, according to a new study conducted by researchers at the U.S.-based Guttmacher Institute and Uganda’s Makerere University. This translates to a rate of 39 abortions per 1,000 women aged 15–49, a significant decline from the rate in 2003, which was 51. The study also found that 93,300 women were treated across the country for complications from unsafe procedures. The annual hospitalization rate for complications from unsafe abortion is estimated to be 12 per 1,000 women aged 15–49, down from 15 per 1,000 in 2003.

Although Ugandan law explicitly allows abortion to save a woman’s life and the 2012 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights permit abortion under additional circumstances—including in cases of fetal anomaly, rape and incest, or if the woman is HIV positive—in practice, legal abortion is both difficult to obtain and to provide. The country’s abortion laws and policies are inconsistently interpreted by law enforcement officials and the judicial system, and many providers and women remain unaware of the circumstances under which abortion is legal. As a result, most abortions in Uganda are clandestine procedures, which are often unsafe.

“Close to one third of Ugandan women who have abortions each year are treated in health facilities for complications resulting from unsafe procedures, and many other women who experience complications do not get the care they need,” says Elena Prada, consultant with the Guttmacher Institute and the study’s lead author. “Notwithstanding the Ugandan government’s efforts to improve postabortion care services, stigma and fear of mistreatment are significant barriers for many women in need of these services.”

The study also produced new pregnancy estimates, finding that 52% of all pregnancies in Uganda in 2013 were unintended and about a quarter of these unintended pregnancies nationally ended in abortion. The high proportion of unintended pregnancies reflects the finding that among women of reproductive age, 38% of married women and 45% of unmarried sexually active women had an unmet need for modern contraception in 2011. 

“Despite some gains in modern contraceptive use over the past decade, unmet need for contraception in Uganda remains high and must be addressed by improved family planning services,” says Professor Christopher Garimoi Orach, head of the department of community health at Makerere University’s School of Public Health and a study coauthor. “For example, integrating comprehensive contraceptive counseling into all postabortion care visits can be a powerful intervention to help women avoid future unintended pregnancies.”

The study’s authors recommend efforts to expand existing postabortion care services to ensure that all women with abortion complications are able to get the care they need, particularly in rural areas. Given that most abortions result from unintended pregnancies, improving family planning services is critical to reducing the incidence of unsafe abortion. In particular, contraceptive counseling should be strengthened to address high rates of method discontinuation and women’s concerns about side effects. The authors emphasize that counseling must acknowledge the challenges women experience and provide accurate information on the side effects of different methods. Further, they recommend that family planning services provide a full range of modern contraceptive methods, including long-acting reversible methods such as IUDs and implants, so women can choose whichever method works best for them. Finally, the researchers suggest clarifying and raising awareness of existing laws and policies on abortion in Uganda among the medical community, the judicial system and women. Every woman who meets the criteria for a legal abortion should be able to obtain a safe procedure at an affordable cost from a trained health care provider.

Incidence of Induced Abortion in Uganda, 2013: New Estimates Since 2003,” by Elena Prada of the Guttmacher Institute et al., is available online in PLOS ONE.

This study was made possible by grants from the UK Government, the Dutch Ministry of Foreign Affairs and the Norwegian Agency for Development Cooperation. The findings and conclusions contained in the study do not necessarily reflect the positions and policies of the donors.