Every baby is a blessing, my friend Barbara told me. At that point, I could not understand how something that was threatening to turn my life inside out could be a blessing. Nothing would ever be the same again; in seven months, I was going to become a mother.

"It did not help that the father-to-be was also not enthusiastic.

"I had to get rid of whatever had pitched camp in my womb. But Barbara was not being supportive; she wanted me to let my life go down the drain."

You might scowl at Rachael Namubiru, but if you are a young woman in this age, it is not difficult to find yourself in her shoes - a woman desperate to terminate a pregnancy.

A lot of women who become pregnant when they did not plan to, face a difficult situation that many people do not understand. At such times, issues like abortion not only become a moral issue, but an intensely personal one where the line between right and wrong becomes blurred.

Had Uganda ratified the Maputo Protocol or had the Regional Strategic plan on sexual and reproductive health and rights in East Africa not been withdrawn in March, Namubiru would be able to get an abortion.

The two documents aim at providing comprehensive sexual and reproductive health rights.

Uganda and 43 of the 53 African Union members has signed the Maputo protocol, but the country is not among the 21 that have ratified it.

During the second session of the East African Community sectoral council of ministers of health in September 2007 in Arusha, Tanzania, ministers from Uganda, Rwanda, Burundi, Tanzania and Kenya endorsed the regional plan.

However, after about five months, they had back-tracked, withdrawing their signatures and asking that the document be revised.

What scared them off was a statement in both documents that read: "State parties shall take all appropriate measures to... protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus."

State minister for health, Dr Richard Nduhuura says this is tantamount to legalizing abortion.

Nduhuura says there could be an argument for abortion if the woman is raped since the pregnancy could add to the trauma. However, he believes abortion could also cause more mental distress from guilt. "They become haunted for killing their babies. The solution is to fight rape and encourage women to seek immediate medical attention for emergency contraceptives and HIV post exposure prophylaxis to prevent infection," he says.

But Nduhuura adds that although abortion is illegal in Uganda and considered murder with a 14-year maximum jail sentence, it is authorised in cases where a mother's life is at risk.

However, Dr. Peter Ibembe of Reproductive Health Uganda believes the regional plan can still be implemented in accordance with the laws of individual countries.

"Rights have to be adopted in a social and cultural context to promote national harmony, norms and laws that are in place," Ibembe says.

East African Legislator Lydia Wanyoto says: "They should have specified the rights they did not want. That document holds more than just abortion."

Dr. Sam Okuonzi, the director of Regional Centre for Quality Health Care, Uganda, says: "This is a sensitive moral issue for Africa. It requires careful deliberations otherwise the whole point of addressing reproductive health issues will be lost."

A 2006 study by U.S-based Guttmacher Institute estimates that about 297,000 abortions are performed in Uganda every year. This translates into 54 out of every 1,000 women aged between 15 and 49.

More than half of the abortions are said to be performed by nurses, midwives and doctors while the other half are carried out by traditional healers, pharmacists and the women themselves.

About 110,000 women in Uganda seek post-abortion care annually.

Access to and use of contraceptives, which would lead to lower rates of unintended pregnancies, the underlying cause for abortion, is low. The Uganda Demographic Health Survey 2006 shows that 41 per cent of women would have liked to stop their next pregnancy had they had access to family planning services.

However, only 18 per cent of the women surveyed had used a modern family planning method - a sure way of stopping an unplanned pregnancy.

The Guttmacher Institute report notes that while there is political will to improve reproductive health care in Uganda, there are financial constraints.

"We have been holding surgical camps for long-term family planning options but the numbers are overwhelming. Recently we were in Katakwi District and over 200 people turned up, 95 per cent of whom were women. However, we treated only 80," Ibembe says.

Ibembe says there is need to overhaul the supply and records system of delivering family planning commodities, such as pills.

Reproductive health is a key sector of any health system. But the funds allocated to reproductive health every year is very low.

"More women die from bleeding after birth than they die from abortion-related complications. A fully functional healthcare system will meet all women's reproductive health needs," a reproductive health advocate, who prefers anonymity, said.

Okuonzi, who led a team that studied how the Government could address reproductive health issues says: "We concluded that you cannot address maternal death effectively without rehabilitating and equipping health centres." 
 
Millions of Ugandan women, like Namubiru, could certainly benefit from family planning education. But while she was not able to prevent pregnancy, Namubiru was lucky to find another option - counselling. Now she is the proud mother of a two-year-old son.

Source: allafrica.com, 14 July 2008