While Uganda has made progress in reducing maternal mortality overall, adolescent maternal mortality is on the rise, driven by a crisis of teenage pregnancies that demands urgent attention. According to the National Annual Maternal and Perinatal Death Surveillance and Response (MPDSR) Report-FY2022/2023, 32% of reported maternal deaths occur among Adolescent Girls and Young Women (AGYW), with 10% specifically among adolescents. Despite a 16.4% reduction in overall maternal deaths among health facility deliveries, institutional maternal mortality rates (IMMR) among adolescents in health facilities have alarmingly increased from 46.5 to 62.9 per 100,000 deliveries. This increase is inextricably linked to the high incidence of teenage pregnancy, a pressing crisis in Uganda. According to the Uganda Health and Demographic Survey (UDHS, 2022) 23.5% of girls aged 15-19 years had already initiated childbearing. Bukedi region, in which Tororo District falls, has the highest rate of teenage pregnancy, at 25.9%. These early pregnancies, often unplanned, expose adolescents to heightened risks of complications such as unsafe abortions, hemorrhage, and sepsis, which are leading contributors to maternal mortality. Further, the National MPDSR Report 2023, reveals that while 6% of maternal deaths were attributed to abortion-related complications, AGYW bore the heaviest burden. Alarmingly, although hemorrhage was reported as the leading cause of maternal deaths at 40%, anecdotal evidence suggests unsafe abortion significantly contributes to hemorrhage and sepsis, making abortion-related deaths far higher than officially recorded. This trend appears evident in Bukedi region, which reported the second-highest rates of haemorrhage at 53% and pregnancy-related sepsis at 9.1% yet recorded 0.0% abortion-related deaths1. This discrepancy strongly implies that abortion-related complications are being subsumed under broader categories such as haemorrhage and pregnancy-related sepsis, masking the true impact of unsafe abortion on maternal mortality. Such misclassification highlights the urgent need for nuanced data collection and the provision of comprehensive abortion care to address these preventable deaths effectively. Despite the Ministry of Health (MoH) championing post abortion care as a vital public health and harm reduction strategy to prevent maternal deaths, their efforts are stymied by a perilous intersection of limited access to contraception, abortion stigma, and deeply moralized public discourse shaped by fervent religious leaders and a growing anti-rights movement. Under the veneer of “protecting African culture,” anti-rights actors continue to exploit negative social and gender norms to sway public sentiment and cast a shadow of stigma over discussions on abortion care. The launch of Protego2 Health: The Women’s Optimal Health Framework, by Valerie Huber3 in Uganda threatens to roll back any progress made on SRHR including abortion care. Wrapped up in the misleading promise of improving women’s health it promotes ineffective abstinence-only sex education, denying young people the comprehensive sexuality education and resources they need to make informed choices about their bodies and futures. Compounding this crisis are harmful cultural practices that normalize early sexual debut among girls, leaving them vulnerable to unplanned pregnancies and the dire consequences of unsafe abortions. It is important to note that of all barriers to safe abortion care, stigma stands as the most pervasive and insidious. It shames and silences women and girls who seek abortions, health-care providers who offer care, and anyone associated with abortion, creating a culture of fear and isolation. This stigma not only denies women and girls their reproductive agency but also drives them to unsafe practices, fuels secrecy around care, and deters providers from offering lifesaving services. Challenging negative norms is pivotal in destigmatizing debate around abortion care, fostering a more informed and engaged public and creating a supportive environment for advocating for progressive abortion rights policies. The restrictive and ambiguous legal environment surrounding abortion care exacerbates an already dire situation, deepening barriers to safe and lawful services and leaving women and girls to navigate a perilous landscape of stigma, fear, and unsafe practices. While post-abortion care (PAC) is permitted under the 2016 national health guidelines for sexual and reproductive health, comprehensive abortion care (CAC) remains restricted under the Penal Code, allowed only to save the life of the mother. The suspension of the Ministry of Health’s Standards and Guidelines on Reducing Maternal Mortality and Morbidity from Unsafe Abortions has further entrenched the perception that abortion services are entirely illegal. This uncertainty is compounded by inconsistent interpretations of abortion laws by law enforcement and judicial officers, leaving healthcare providers hesitant to offer even lawful services for fear of legal repercussions. As a result, women and girls in desperate need of abortion care are left with no choice but to resort to unsafe and dangerous practices, perpetuating preventable maternal deaths.Amidst this constrained legal environment, the MoH has made efforts to provide clarity and guidance tohealth service providers, notably through the recent launch of Post-Abortion Care (PAC) Guidelines; the launch of safe care guidelines, inclusive of self-managed abortion; the inclusion of combi-pack drug in the Essential Medicines List and the Uganda Clinical Guidelines as well as the recognition of PAC in the RMNCAH Plan 2022-2027, which all mark an important shift, signaling that abortion care is a necessary intervention to save lives and protect health and reinforces PAC’s permissibility. However, despite this progressive step, systemic challenges within the health sector continue to hinder their full implementation and impact. These include a lack of adequately skilled health providers and managers, frequent stock-outs of medications and supplies, deteriorating equipment, and clinical environments ill-equipped for safe service delivery.
Furthermore, unclarified personal values among healthcare providers often translate into stigmatizing attitudes within facility settings. Client journey maps conducted by Ipas AA-Uganda revealed that health care providers continue to perpetuate abortion stigma by being judgmental, indifferent, or mistreating and showing disdain toward PAC patients, which impacts abortion service delivery, access and quality. MoH’s recent pragmatism in advancing abortion care within the full extent of the law demonstrates a commendable commitment to reducing unnecessary maternal mortality by positioning abortion care as an essential health service. By underscoring the critical role of PAC in safeguarding lives, the Ministry has created a pivotal opportunity to progress abortion care in Uganda. This evolving landscape provides a timely moment to capitalize on the momentum and build sustainable pathways to improved reproductive health outcomes.
Ipas-AA’s proposed intervention is uniquely positioned to capitalize on this opportunity, offering a comprehensive and multifaceted approach to addressing barriers to accessing PAC while advancing a steady advocacy for comprehensive abortion care (CAC). Through targeted actions to improve quality of care, dismantle stigma, educate key stakeholders on the country’s abortion laws and enhance community engagement, we aim to ensure no woman or girl faces preventable death or harm due to unsafe abortion. Together, with the Ministry of Health and grassroots partners, Ipas AA with support from Embassy of Iceland in Uganda have an unprecedented chance to reshape access to abortion care in Uganda, saving lives and advancing the reproductive agency of women and girls.
The Advancing Quality Post Abortion Care to Reduce Maternal Mortality in Tororo District, Uganda through the public sector facilities is a one year project funded by Iceland’s Embassy to Ipas Uganda. The project’s overall goal is to increase access to post abortion care and post abortion family planning in Tororo district to avert unplanned pregnancies, increase couple-year protection, and reduce incidences of maternal mortality
Please refer to the attachment for details and submit your proposal through this portal.