A Situation Analysis of Induced Abortions in Uganda

Florence M. Mirembe

Dr Florence M. Mirembe is a Senior Lecturer, Makerere University, Department of Obsterics & Gynaecology, Kampala.

Abortion Situation in Uganda:

Uganda has a population of 17 million with a growth rate of 2.8% and a total fertility rate of 7.3 children per woman. The government of Uganda is actively promoting family planning mainly on health basis. Abortion in Uganda is illegal and permitted only, to save the mother's life. However, abortion remains a major problem in Uganda both spontaneous and induced. Over the years abortion has contributed strongly to the high maternal mortality in this country (550/100,000 live births). In spite of Uganda's record high fertility rate of about 7.3 children per woman and of 110/1000 live birth there is a remarkably low contraceptive prevalence rate of 6 -15 % rural to urban (UDHS 1991), worth noting too is the very high teenage pregnancy rate with 54% of all women having their first birth before the age of 18 years (UDHS 1991 and Dept. of Obstetrics and Gynaecology Delivery reports 1992 - 1993). In the 50s Rendle Short (1961) in Uganda recorded a very small proportion of abortion cases admitted to Ugandan hospitals. This was further observed by Greech (1969) with only 3.5% of all the maternal deaths being attributed to abortion. It is, however evident over the time that the hand of induced abortions in Uganda is on the increase. High maternal mortality rates related to abortions have been registered in Ugandan hospitals. Turyasingura (1984) in Mulago hospital (the national and referral hospital) studying maternal mortality did find that abortion - related death comprised of 35% of all the maternal death. Bazira (1992) analysed all the abortion cases in Mulago Hospital between 1983 to 1987 and found that induced abortion constituted 25.4% of all abortions admitted on the gynaecological emergency ward. The induced abortion - related maternal morbidity was estimated as 333 per 100,000 induced abortions.

More recent study (1992 - 1993) conducted in three major Kampala hospitals recorded 3132 cases of all abortions in 13 months. There were 420 certainly induced abortions. 28 death occurred among the induced abortion giving a maternal mortality abortion - related rate of 6667/100,000 induced abortion. Induced abortion during this period Contributed 6.6% to the total maternal mortality registered in the Kampala Hospitals.

Socio-demographic characteristics of Induced aborters:

Generally single, young and of low parity most often students in secondary schools followed by University undergraduates formed the bulk of all induced abortions. Irumba (1984 and Bazira 1992), recent study 1992 -1993 confirm the above findings.

Reasons for Termination of Pregnancy

In order of significance (Bazira 1992):-

Contracepting Status in Induced abortion Patients:

There is a generally low contraceptive prevalence rate in Kampala, the study on mortality and morbidity due to induced abortions seem to indicate even a lower contraceptive" prevalence among induced abortion patients. Striking enough, the two major reasons for non use of contraceptive among these patients was lack of knowledge about contraception and unavailability of contraceptives.

Induced Abortion related Complications as Observed in Uganda

The leading complications resulting from induced abortion were sepsis and haemorrhage comprising of 60% (Bazira 1993) and 93% (risk factors for maternal mortality 1992 and 84.6% (Irumba 1983). Genital tract trauma occurred in 15.3% (Bazira 1993) and 93% (risk factor for maternal mortality report 1993). This did indicate that patients came in late for treatment i.e several days after the introduction of the abortion I.e. average of 5 days (Turyasingura 1984). This was mainly due to fear, stigmatization associated with abortion as well as the law which

Prohibits induced abortion. From observation in Mulango Hospital it is evident that there is less and less genital tract trauma observed. This May be due to the great shift that has occurred that despite the restrictive law most of the abortions though illegal are performed by medical doctors (Bazira 1993) Self induced or induction by other non medically trained personnel still remain the frequent cause of genital tract trauma which at times is fatal or cause a lot of morbidity.

References

1. Uganda Demographic Health Survey 1991.

2. Bazira E.R. (1992). Induced abortion in Mulago Hospital Kampala 1983 -1987 - a case for contraception and abortion law reform. Tropical Health 1.1 13-16.

3. Mpangile G.S (1992). Factors associated with induced abortion in Public Hospitals in Dar es Salaam, Tanzania Family Planning Association.

4. Turyasingura (1984). M. Med Thesis, Department of Obsterics & Gynaecology, Makerere University, Kampala.

5. Irumba (1984). Dissertation for Masters of Public Health, Makerere University, Kampala.

6. Multicentre Study on Risk Factors Associated with Maternal Mortality - Report.

7. Kirumira E (1993). Study on sexual and reproductive health in Ugandan women. (Report)