Time to act—comprehensive abortion care in east Africa

Abstract

Time to act-comprehensive abortion care in east Africa Inaccessible sexual and reproductive health care continues to be a major obstacle to women's health and a violation of their rights. 1 Access to comprehensive abortion care-comprising induced abortion and postabortion care, including contraceptive services 2-is fundamental to avert preventable maternal mortality and morbidity. 1,3 In east Africa, abortion rates have not declined since 1990 and about 2•7 million abortions are estimated to occur annually in this region. 4 The vast majority of these abortions are unsafe, making them a major cause of maternal mortality and morbidity. A workshop was organised in Kampala, Uganda, in March, 2016, to address the challenges of implementation and expansion of access to comprehensive abortion care in east Africa. Workshop participants included researchers from teaching institutions and health-care providers from Kenya, Uganda, and Sweden, members of the Uganda Ministry of Health, WHO, the International Federation of Gynecology and Obstetrics working group on the prevention of unsafe abortion, representatives of non-governmental organisations and aid organisations, and journalists. Although the workshop focused on Uganda and Kenya, delegates also presented research from Tanzania and Rwanda. Here we summarise key action points needed to speed up implementation and expand access to comprehensive abortion care in east Africa, as identifi ed by the workshop delegates. Kenya and Uganda have restrictive abortion laws dating from the time of British rule. In both countries the constitution and penal code are not harmonised, leaving room for ambiguous interpretation of the legal environment. 5,6 Standards and guidelines on reduction of morbidity and mortality due to unsafe abortion were developed by the respective ministries of health in Kenya in 2012, 7 and in Uganda in 2015. 8 These standards and guidelines were an expansion of existing national policies and standards and the 2012 WHO Technical Guidance on Safe Abortion, 9 supported by the constitutions. However, the standards and guidelines were withdrawn in Kenya in December, 2013, and in Uganda in January, 2016, because of disagreements between stakeholders regarding their content. Absence of clear standards and guidelines specifi c to comprehensive abortion care leaves vital questions on health-care access and provision-such as roles,

Access to safe abortion in Uganda: Leveraging opportunities through the harm reduction model

“…The realization of sexual and reproductive health rights for all in Uganda still faces numerous challenges. Indicators still point to high levels of unintended pregnancies, resulting in high levels of unplanned births of undesired children and unsafe abortions . Access to safe and legal abortion services is a far reach for women and girls in Uganda.…”

The duty to make abortion law transparent: A Malawi case study

“…Without the authority of the court to provide the legal foundation, and the support of the Ministry of Justice, including the office of the Attorney General, it might be challenging to achieve consensus around what constitutes lawful abortion. Indeed, this has been the experience in Tanzania and Uganda where, having issued standards and guidelines on access to safe abortion, the Ministry of Health in the respective countries later withdrew them because of disagreements amongst stakeholders about the legality of the guidelines …”

“…The Ministry of Health should develop and implement standards and guidelines for healthcare providers and the public on lawful abortion. It would be useful to seek judicial interpretation of the law to avoid disagreements among stakeholders about the legality of the standards and guidelines . Strategic litigation would be useful not only to address ambiguities, but also to ensure that the standards and guidelines comply with the Constitution and international human rights law.…”

Barriers to safe abortion access: uterine rupture as complication of unsafe abortion in a Ugandan girl

“…In 2015, a workshop was held in Kampala, Uganda, that examined the barriers to expanding safe abortion care in east Africa. Abortion stigma was consistently identified as restricting access and decreasing quality of current care 13. In countries around the world, moral and social judgement exists related to a woman’s choice in pregnancy termination, contraceptive use and sexual intercourse.…”