Saving lives in rural Uganda

Female peer educator in a rural school in Uganda, IPPF
The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA).

When Noah Musoke was a young man his older sister had an unsafe abortion that nearly took her life. Luckily, his sister was able to tell him what had happened. He put her on his bicycle in rural Uganda and took her to the nearest health centre where she received post abortion care.

Project worker with VODA.
Noah Musoke, project manager for VODA in the VODA office in Kasawo.

Abortion was highly restricted in Uganda then and remains so today. The law and constitution are very unclear as to when an abortion is allowed and in practise it is almost impossible to receive a legal abortion in the country.

It was because of these legal restrictions that Noah’s sister resorted to crude unsafe abortion which haunted her for life.

“She never had a child. She lost many marriages; she lost many of them until she died. I think if there was a safer way to do this my sister would have had happier life” said Noah, one of the few Ugandan men advocating for access to safe abortion in Uganda.

His experience led Noah to set up an inspirational organization called Volunteers for Development Association in Uganda (VODA Uganda) which, following a successful application to the Safe Abortion Action Fund (SAAF), in 2013 has been helping women and girls to avoid unwanted pregnancies and to access post abortion care.

The SAAF funded project works with schools, communities and healthcare providers, training people to become community counsellors and referrers who are able to listen to young people, offer advice and refer them for services to well-trained local health providers.

“People are conservative on some issues and one of very sensitive issues is sexual reproductive health and most especially abortion. Many people have very negative feelings about this yet it is a cause of maternal mortality in Uganda‚” Noah said.

The 2016 Uganda Demographic Health Survey put teenage pregnancy at 25% from the 24% in the previous surveys. The increase means 1 in every 4 girls aged between 15-19 years in Uganda is either pregnant or already has a baby.

Young school girl
Mabel Nalubwama, a student counsellor with VODA.

It is for this reason that VODA Uganda’s project targets school girls in Kasawo and Namuganga sub counties located in Mukono district.

“Here sex is assumed to be for married people and it is a private issue. Now when these young people, for various reasons, engage in sex, they get pregnant and they know they will miss school or their parents will be very harsh to them so they resort to unsafe abortion” he said.

“And as a result, people resort to very crude methods in case she needs to have an abortion. They will resort to very unsafe methods which have always led to death and serious complications,” he adds.

  • Milly, a teacher and VODA community volunteer, at a primary school in Kasawo, Uganda.
    Milly, a teacher and VODA community volunteer, at a primary school in Kasawo, Uganda.
  • Milly, a teacher and VODA community volunteer, provides information on sexual and reproductive health to pupils at a primary school in Kasawo, Uganda.
    Milly, a teacher and VODA community volunteer, provides information on sexual and reproductive health to pupils at a primary school in Kasawo, Uganda.
  • Noah is the VODA Project Manager. “People are conservative on some issues and one of the very sensitive issues is sexual and reproductive health and most especially abortion. Many people have very negative feelings about this, yet it is a cause of maternal mortality in Uganda.”
    Noah is the VODA Project Manager. “People are conservative on some issues and one of the very sensitive issues is sexual and reproductive health and most especially abortion. Many people have very negative feelings about this, yet it is a cause of maternal mortality in Uganda.”
  • Helen Grace is one of the local midwives working with VODA. "Unsafe abortion is very prevalent. In a month you can get more than five cases. It is a big problem."
    Helen Grace is one of the local midwives working with VODA. "Unsafe abortion is very prevalent. In a month you can get more than five cases. It is a big problem."
  • Christine, a VODA community volunteer, with the bike she uses to visit clients, outside her house near Kasawo, Uganda.
    Christine, a VODA community volunteer, with the bike she uses to visit clients, outside her house near Kasawo, Uganda.
  • Sharon, Ritah and Mabel are just three of the 99 VODA-trained student counsellors in their community. Peer educators in schools provide counselling and advice to other students, who otherwise would have no one to turn to in times of crisis.
    Sharon, Ritah and Mabel are just three of the 99 VODA-trained student counsellors in their community. Peer educators in schools provide counselling and advice to other students, who otherwise would have no one to turn to in times of crisis.
  • "As a peer counsellor I have benefited a lot. I have acquired information which I have used to keep myself safe in terms of unwanted pregnancies. In the past, I couldn’t manage to speak in public but now I can stand and talk freely." Mabel, is in her final year of O'Levels at a senior school in Kasana.
    "As a peer counsellor I have benefited a lot. I have acquired information which I have used to keep myself safe in terms of unwanted pregnancies. In the past, I couldn’t manage to speak in public but now I can stand and talk freely." Mabel, is in her final year of O'Levels at a senior school in Kasana.
  • "Many young girls have been lured into early sex because they need money that is why we end up with unwanted pregnancies. Many girls admire things which their parents cannot provide. In the past we have lost girls who were aborting through unsafe abortion methods. For me I think that the lives of those girls would have been saved if they had knowledge about contraceptives." Says school counselor, Sharon.
    "Many young girls have been lured into early sex because they need money that is why we end up with unwanted pregnancies. Many girls admire things which their parents cannot provide. In the past we have lost girls who were aborting through unsafe abortion methods. For me I think that the lives of those girls would have been saved if they had knowledge about contraceptives." Says school counselor, Sharon.
  • Now at senior school, Ritah has been a student counselor since she was at primary school. "I wasn’t as serious with studies before I became a counsellor but because I want to maintain that status, I have improved in my studies because I don’t want to feel ashamed in front of my fellow students. VODA gave us T-shirts for identification purposes. It also made people in the community respect me."
    Now at senior school, Ritah has been a student counselor since she was at primary school. "I wasn’t as serious with studies before I became a counsellor but because I want to maintain that status, I have improved in my studies because I don’t want to feel ashamed in front of my fellow students. VODA gave us T-shirts for identification purposes. It also made people in the community respect me."
  • Stevens, a nurse and VODA volunteer, counsels a student during a mobile outreach event on safe abortion and reproductive health at secondary school.
    Stevens, a nurse and VODA volunteer, counsels a student during a mobile outreach event on safe abortion and reproductive health at secondary school.
  • Jonathan from VODA and teacher Peter talk to students at a secondary school in Kasana about pregnancy, STIs and safe abortion.
    Jonathan from VODA and teacher Peter talk to students at a secondary school in Kasana about pregnancy, STIs and safe abortion.
  • Students at a secondary school in Kasana attend an information session on reproductive health by VODA staff and volunteers.
    Students at a secondary school in Kasana attend an information session on reproductive health by VODA staff and volunteers.
  • Students take the opportunity to write down their thoughts and questions for VODA staff to answer.
    Students take the opportunity to write down their thoughts and questions for VODA staff to answer.
  • Jonathan from VODA answers a students' questions on abortion, relationships and sexual health.
    Jonathan from VODA answers a students' questions on abortion, relationships and sexual health.
  • Peter, a teacher at a secondary school, talks to students about safe abortion and reproductive health during an event arranged by VODA in Kasana.
    Peter, a teacher at a secondary school, talks to students about safe abortion and reproductive health during an event arranged by VODA in Kasana.
  • Perceptions about abortion are changing and young people are keen to promote messaging to avoid unsafe abortion.
    Perceptions about abortion are changing and young people are keen to promote messaging to avoid unsafe abortion.
  • Maria, a student, says "At school I heard about VODA. They came to give us girls information about how to avoid unwanted pregnancies as well as safe abortion services."
    Maria, a student, says "At school I heard about VODA. They came to give us girls information about how to avoid unwanted pregnancies as well as safe abortion services."
  • Children run through a village in Kasawo, Uganda, as a storm approaches.
    Children run through a village in Kasawo, Uganda, as a storm approaches.

In the three years since VODA Uganda started their SAAF funded project they have been able to see some very positive results. They have changed perceptions about abortion in the community, bringing community leaders and health workers on board, explaining the problems of unsafe abortion and directing girls and women to post-abortion care services.

Currently there are four health centres in the two sub counties that are offering post-abortion care, contraception and counselling to girls and women referred there by VODA Uganda school counselors as well as community volunteers.

At a health facility in Namuganga, Anne* has just received post-abortion-care services from a midwife, Grace. The 14-year-old nearly died of post-abortion complications after her grandmother used local herbs to terminate her pregnancy.

“A man just caught me — or raped or defiled me— when I had gone to visit my grandmother. After he had finished, he told me to go back home and never to tell anyone about it” she said.

The midwife at the facility, Grace, said the cases of unsafe abortion especially among teenage girls are widespread.

“Most of them do come here and the situation is very bad, when they are bleeding severely. We don’t have blood at the health centre so we just give first aid then we refer to the main hospital.” Grace explained.

“They go to local herbalists and they give them some drugs. Some of them tell me that they give them emilandira (roots) which they insert inside there to rupture the membranes.” She added. Anne is lucky she did not die. With the successful post-abortion-care, she looks forward to returning to school next term.

At the next health centre in Kasawo, Josephine, the midwife would never have thought of helping girls and women with abortion services before she was trained by VODA Uganda about the need to avert the deaths that were occurring in villages due to unsafe abortion.

Midwife
Josephine, a midwife trained by VODA in post abortion care

“I used to have negative attitude about it. Because according to my religion, it was not allowed in the church. But again when you look into it, it’s not good to leave someone to die. So I decided to change my attitude to help people.” revealed Josephine.

Today, she is happy that fewer women and girls are dying because of unsafe abortion. “VODA people have helped us. We even provide the clients with family planning to avoid another pregnancy since their hormones are very sensitive” she added.

In Namuganga and Kasawo, the approach of using school girls and a team of volunteers has worked in changing community perceptions about abortion as well as helping girls to access information about unwanted pregnancies.

At Kakoge village, 35-year-old John Owoli is one of the VODA Uganda Community volunteers. He knows that his Catholic religion does not support abortion. However Owoli who is a catechist at a nearby church has used his position to preach against unsafe abortion. Asked why? He replied:

“Just to save life. I attended two burials from unsafe abortions because they had used local drugs so I saw that it was a good thing to participate in saving people’s lives.”

Man standing outside his home.
John Owoli, a VODA-supported community volunteer, counsellor and catechist.

Owoli, a father of six said before he joined VODA Uganda, he had heard about family planning and unsafe abortion and he did not think they were big issues. “But after this training, I saw it was a serious issue. And I must be included in stopping it. Because if we stop this kind of dying, most especially the young ones, it means that development is coming to our community”.

Most girls according to Owoli have changed their behaviours by using condoms, family planning, abstinence and now know about safe abortion. Owoli would like to see more health facilities constructed closer to the villages so that those referred for post-abortion care services don’t have to walk for seven kilometers to a health centre.

*not her real name

Stories

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