The famous decision in the Roe v Wade case of 1973 recognized that the decision to continue or end a pregnancy belongs to the individual and not the government. The case affirmed that the constitutional right to privacy encompasses a woman’s decision to have an abortion. Earlier this year, in June, Roe v Wade was overturned by the Supreme Court of the United States in the case of Dobbs v. Jackson Women’s Health Organization, in a decision that ruled that there is no constitutional right to abortion.
This unfortunate turn of events has created a lot of uncertainty and questioned the rise of positive activism for abortion rights. As we reflect on the International Safe Abortion Day (Sept. 28), this year’s theme – “abortion in uncertain times” – reflects the uncertainty on which abortion is operating in the legal and social ambiance in the world. It draws the picture of Uganda’s legislation towards abortion as a case study.
The “uncertain times” in Uganda were especially realized after the COVID-19 pandemic with the escalated sexual violence and teenage pregnancy cases. How can a country that does not effectively provide safe abortion respond to cases of girls who conceived as a result of sexual violence or that unable to carry pregnancies at a premature age? Theses uncertain times question the denial of safe abortion in such extreme cases and in turn the rights of these young girls.
Uganda has very restrictive laws on abortion. Whereas its Constitution highlights that exceptional circumstances for abortion will be provided in law, there is no provision for when a woman seeks a safe abortion in Uganda. There is need to strike a balance between protecting the life of the fetus as well as the life of the mother. The laws in Uganda have failed to provide this clarity. No jurisdiction has ever been able to reach a consensus on abortion, given the underpinning moral controversy(1) and it seems Uganda is no exception. It is no wonder that such laws have created uncertainty for women and girls that need safe abortion services.
The major risks involved in advocating for safe abortion in the country include security threats from extreme activists, opposition and being a victim of a judgmental society. The lack of information on safe abortion and maternal and morbidity also poses a huge threat to young girls and women because it restricts their access to health services. This in turn results in unsafe abortions that claim their lives. Skilled providers are reluctant to provide comprehensive services in fear of criminal prosecution. Despite large reductions in pregnancy-related deaths in Uganda over the past two decades (the maternal mortality ratio dropped from 684 per 100,000 live births in 1995 to 343 per 100,000 in 2015), the high number of maternal deaths due to unsafe abortions remains a public health challenge(2). According to the Ministry of Health, unsafe abortion contributes 8% to maternal deaths.(3)
The legal ambiguities have created a perceived illegality of abortion services which has led to stigma, fear, and secrecy that drives abortions to be practiced underground; forcing women to take desperate measures, with deadly consequences. A system that refuses to provide safe services when approached, ultimately ends up providing the same women with post-abortion care (PAC) services after they are already experiencing life-threatening complications from unsafe abortions(4). It is thus necessary to address these underlying factors.
As the Women’s Probono Initiative, we continue to take part in advocacy initiatives to ensure that women’s access to sexual and reproductive health services are realized. Among the legal tools we have used is the institution of a public interest case that challenges the withdrawal of the 2015 Standards and Guidelines for the Reduction of Mortality and Morbidity due to Unsafe Abortion in Uganda. These withdrawn guidelines gave clarity on the parameters upon which a safe and legal abortion can be procured.
This advocacy journey on abortion rights has not been a smooth path. It is a lonely journey. Different coalitions have been formed to mitigate risks through advocating for safe abortion. The coalition groups not only offer a united front but also offer financial, social and moral support to members as they advocate for access to safe abortion services.
Throughout the world, legal policy and other barriers continue to undermine women’s access to sexual reproductive health and rights. The bias against discussion on abortion laws has created a grey area for the enforcement and realization of women’s sexual reproductive health and rights. This increases the rates of unsafe abortion, and the most affected are poor women and girls. In order to reduce the appalling rates of maternal mortality due to unsafe abortions, it is pertinent for Government to put in place a clear legal framework in these very uncertain times. We will continue to work to achieve this.
1. SAM Mclean “Abortion law: Is consensual reform possible?” (1990) 17/1 Journal of Law and Society 106.
2. World Health Organization (WHO) et al., Trends in Maternal Mortality: 1990 to 2015, Geneva: WHO, 2015.
3. Uganda Ministry of Health, Health Sector Strategic Plan III: 2010/11-2014/15, Kampala, Uganda: Ministry of Health, 2010.
4. The Stakes are High: The Tragic Impact of Unsafe Abortion and Inadequate Access to Contraception in Uganda, June 2013 ©2013 Center for Reproductive Rights, the International Women’s Human Rights Clinic at Georgetown Law, and the O’Neill Institute for National and Global Health Law at Georgetown