Over 1,000 Ugandan women die every year as a result of unsafe abortions and an additional 68,000 suffer serious health complications, according to a recently released report from the Ministry of Health.

"As many as 1,200 unsafe abortions result in death each year. Nearly a quarter (23 percent) of all abortions result in serious complications," said the report Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity in Uganda.

A 2007 study by the US-based Guttmacher Institute estimated that 56 percent of all abortions in Uganda are carried out by medically trained personnel and 44 percent by untrained or traditional providers.

EXPENSIVE QUALIFIED MEDICAL FEES

Poor women in rural areas suffer the most as they cannot afford what qualified medical personnel charge for an abortion and instead opt for the cheaper cost of a midwife or herbalists, or do it themselves, state-owned New Vision quoted the study on Saturday as saying.

A doctor charges in Uganda between 40,000 Ugandan shillings ( about 23.5 US dollars) and 140,000 shillings (82.4 dollars), a nurse or midwife between 22,000 shillings (12.9 dollars) and 50, 000 shillings (29.4 dollars), while the fees of a herbalist or pharmacist range from 8,000 shillings (4.7 dollars) to 54,000 shillings (31.8 dollars). The Guttmacher study said, "The more highly trained the practitioner, the less likely an abortion will place a woman at risk."

In addition, many level III and level IV health centers do not have the medical supplies or sufficiently trained health professionals to provide proper post-abortion care.

"We still have problems with such care especially in up-country facilities where things like blood transfusion are not there," said Anthony Mbonye, the assistant Commissioner reproductive health in the Ministry of Health.

"Post-abortion care involves the administration of antibiotics and the removal of retained products but the drugs, equipment and skills are insufficient," Mbonye added.

UNSAFE METHODS

It estimated that serious health consequences, such as excessive bleeding, infection or injury to the reproductive organs, result from a quarter of abortions performed by doctors, about half of those provided by nurses, midwives and pharmacists, two- thirds of those carried out by traditional practitioners, and 70 percent of those that are self-induced.

Untrained practitioners use a variety of methods, including hormonal drugs or manual vacuum aspiration. Others use more dangerous techniques, such as the insertion of rubber catheters or sharp objects into the uterus, the consumption of vaginal application of caustic substances or powerful herbal remedies, according to the study.

Traditional methods used also include inhaling steam from cooked herbs, wearing dried herbs, drinking detergents or applying combinations of these techniques.

As a result, half of all abortions carried out in Uganda every year result in complications.

But even abortions performed by trained health workers are not always safe. The proportion of abortions performed by doctors that lead to serious health conditions is higher in Uganda than most western countries.

"Many of our doctors have not been well trained to offer safe methods and are working under unsafe conditions," said Charles Kiggundu of Makerere University who participated in the study.

REPUTATION CONCERN

Because abortion is illegal in Uganda, and because of the widespread social stigma attached to the practice, many women who experience complications are not seeking or receiving any help.

"Roughly one in five of the estimated 297,000 women who have an abortion each year suffer complications that require medical care but do not get treatment in a medical facility," said the study.

The study said that the reason why women don't go for treatment, are the inability to pay for care, the fear of revealing that they have had an abortion and concern that they will receive hostile or judgmental treatment from clinic and hospital staff.

Veronica Bakayana, a midwife, said that women who show up in hospital fear to reveal that they are suffering from complications of abortion.

"Most times we have to employ guesswork. Sometimes, health workers are forced to shun such women because you may be misunderstood," she said.

UNINTENDED PREGNANCIES

Each year, about 775,000 women in Uganda are pregnant against their wish. The proportion of births that were unplanned rose from 29 percent in 1995 to 38 percent in 2001.

The desire for a smaller family has not been matched by an increase in the use of contraceptives.

The use of effective contraceptive methods in Uganda is very low.According to the 2006 Uganda demographic and health survey, only 24 percent of married women use contraceptives, 18 percent a modern method and 6 percent a traditional method.

A quarter of women who want no more children but they do not use contraceptives said they feared side effects, 14 percent of those said their partners were against it, 13 percent said they did not know where to obtain them, while 5 percent said their religion forbids it.

In addition, reports of shortages of contraceptive supplies in many health centers are seen as a factor discouraging women from practicing family planning.

Sex education for adolescents is another area, which is wanting. Although Uganda provides family life education in schools, a recent survey found that only 44 percent of boys and 50 percent of girls aged 15-19 had ever attended a sex education class or talk.

The Guttmacher Institute called for a broader public discussion about unsafe abortion. "More public attention to the issues of unintended pregnancies and unsafe abortion is greatly needed," said the report.

"The standards of post-abortion care must be raised and the coverage expanded. Access to family planning services and accurate information about contraception must be widely and effectively provided to reduce the incidence of unintended pregnancy," said the study.

The institute, above all, calls for policies that support girls' education. "Education can help women understand the dangers of unsafe abortion, improve their status in the community and empower them to play a more active role in their own reproductive health."

(Xinhua News Agency September 16, 2007)