KAMPALA, Uganda – At 17 years old, and four months’ pregnant with twins, Dorothy knew if she gave birth her family would kick her out of the house. So she did what hundreds of Ugandan teenagers do every day and sought out an illegal abortion.
“A friend took me to a health clinic that is hidden away,” she says. “There were lots of girls there, around 15 of them … They were lying on the floor.”
The clinic was clean, she says, but the equipment looked old, and there was just one bed where the operations were carried out. “I was given an injection in my arm that made me go to sleep and it seemed to be over very quickly,” she says. “When I came around, I could see the twins in a basin. I felt like killing myself when I saw them.”
As the next patient climbed onto the bed, Dorothy was told to lie on the ground with the other girls. She was in a lot of pain, but her postoperative care consisted only of some Coca-Cola, which she threw up soon after drinking. She paid her 180,000 shillings ($55) and was sent home.
Uganda’s teen pregnancy rate is one of the highest in the world, but abortion is illegal unless the life of the mother is at risk. Anyone found guilty of performing the operation faces a prison sentence of up to 14 years, while any woman found to have undergone the procedure can get up to seven years in prison.
And yet, the Ugandan Ministry of Health estimates that over 300,000 women have illegal, and often unsafe, abortions every year – that’s over 800 a day, far higher than anywhere else in East Africa. Pointing out that unsafe abortion costs the government 7.5 billion shillings ($2.2 million) a year, the Ministry of Health is considering a bill to decriminalize the procedure. But the move faces fierce criticism from many of the country’s religious leaders and politicians. Meanwhile, Uganda’s girls continue to suffer the consequences of illegal abortion, which can range from short-term complications to lifelong disability and sometimes death.
“We have around 90,000 serious complications arising annually from unsafe abortions, and we lose close to 1,500 young women every year,” says Dr. Charles Kiggundu, a consultant gynecologist at Mulago hospital in Kampala and former president of the Association of Obstetricians and Gynaecologists of Uganda. “We need the population to understand that passing a law against abortion does not completely stop it. It makes the process more clandestine, and women suffer and die.”
In August, a group of MPs issued a joint statement declaring their opposition to any change in the law: “Calling for wholesale legalization of murder [abortion] would have the adverse consequence of mass killings since the people concerned would engage in irresponsible sex knowing that should they become pregnant, they would abort.”
Kiggundu accepts that it’s unlikely any bill aimed at relaxing Uganda’s abortion ban will make it through parliament and become law. At least not now. “Ten years ago it was very difficult to discuss the issue of abortion here. People are now willing to listen and talk about abortion,” he says. “Maybe in another 10 years the real conservative [people] might decide to keep quiet about it, so we might see more and more women accessing [safe] abortion.”
Until then, groups working to cut down the risks associated with illegal abortion are focusing on increasing access to contraceptives and reaching out to young people before they become sexually active.
In Kasumbi, a slum in a Kampala suburb, a mobile Marie Stopes clinic has set up to discuss contraception with the girls and women who live there. “It is a slum area; there are no hospitals here,” says Nantatya Mebra, 20, who has a four-year-old daughter. When Mebra’s father found out she was pregnant, he kicked her out of her home. She went to live with her boyfriend and dropped out of school. Now she works as a peer educator for the charity, talking to other young girls in the slum who find themselves in the same position she was in.
She’s heard plenty of horror stories about girls trying to perform abortions on themselves, taking drugs and drinking laundry detergent. So she tries to convince girls to use contraception, to catch them before they find themselves with an unwanted pregnancy. “They listen to me, and accept what I tell them,” she says. “I usually talk to them about why early pregnancy is not good, because you have to get a child by choice and not by chance. I talk to them about the difficulties I was in.”
To young women who already have children, “I tell them they must use family planning to stop getting pregnant again,” she says.
On offer at the clinic are condoms, as well as long-term contraceptives like the coil and implants. A queue of women wait under a tent in the midday sun. “If you get pregnant when you’re not ready, you’re going to suffer,” says Jackie, 21, who works as a commercial sex worker. “We use the condoms they give us. They also give us medication in case we get an STI [sexually transmitted infection] so we are safe.”
But projects like these can’t reach everyone, and every day hundreds of women in Uganda decide their only option is an illegal and potentially dangerous abortion.
Still recovering from her abortion two years ago, Dorothy, now 19, says she will be ready for children one day. But she is afraid of the physical damage the back-alley operation may have caused. “I’m worried it means that I won’t be able to have children now,” she says. “The memories are so, so painful.”
The names of some of the women in this story have been changed to protect their identities.