The long road to ending unsafe abortion

When we were 17, a friend of mine got pregnant. When she told me she planned to terminate the pregnancy, I was relieved. She was one of my smartest friends, but like all of my friends, she was so young to me. I couldn’t imagine what life would be like for her or the baby.

As Americans living in a fairly liberal state, we were extremely fortunate. We called around and found the nearest safe clinic – an hour away – and came up with a plan, which essentially took 2 months from start to finish. Throughout the whole thing, we never really talked about what was going on in her head and her heart. We were little punk rockers – we didn’t talk about our feelings – but really, we were both so terrified that we couldn’t even think about how we felt.

At the end of the summer, before we went away for college, she handed me a haunting pen-and-ink drawing of a girl, surrounded by questions and sadness. I don’t know where my friend is now… but I know that it’s rare for a week to pass when I don’t think of her.

I wonder what would have been different if we had been facing imprisonment for our actions, or if we had not been lucky enough to access competent care. If it was so hard for her – in a community where girls’ sexuality was at least somewhat acceptable – to talk about her feelings and process what was going on, what happens when girls and women don’t have this kind of support and access?

Working in Uganda has helped me find some answers to this question.

Uganda’s laws about abortion are murky and confusing. The two main documents addressing the issue essentially use circular logic: “abortion is illegal except where permitted by law,” leaving medical service providers and the general public the idea that abortion is completely illegal in the country. It doesn’t help that members of the police force periodically arrest service providers for carrying out “criminal abortions,” even if none of the people arrested face actual prosecution. The atmosphere is enough to create a serious chill in abortion-related services.

Amidst this national chill, at least 4 women and girls die every day in Uganda as a result of unsafe abortions. Add to this number the many girls who die from unsafe abortions, their deaths attributed to unspecific “infections.” Girls and women are also dying from poisoning, drinking bleach or petrol in hopes of ending their pregnancies.

It is easy for me to look at these daily tragedies with an outsider’s point of view and feel outraged and indignant. Truthfully, nothing can dispel the sense of urgency it creates to know that people will die today because of confusion and misinformation. However, the public information around this issue leaves out the crucial work that is being done behind the scenes by dedicated Ugandans who are passionate about saving lives and putting a stop to the deaths caused by unsafe abortion.

Over the past few months I have had the incredible privilege of taking part in a working group that is taking major steps to fill in the gaps in legal and medical policy that lead to the deaths of so many girls and women. As part of this group, I have seen highly competent Ugandan lawyers, doctors, public health workers, and public servants debate the most effective, socially acceptable ways to end unsafe abortions and the deaths and disabilities that they cause.

The approach we are using builds on a basic structure supported by the WHO and Ipas, which has had success in other African countries. It intends to create a national policy document relying on three basic components: building systems and supporting communities to prevent unwanted pregnancies, improving standards and providing safe abortions when legally permitted, and boosting the availability of emergency care for complications from unsafe abortions.

Because the document aims to address the underlying causes of unsafe abortion and clarify the medical and legal misconceptions around abortion-related care within the existing legal and constitutional frameworks, it will be poised to make a swift impact on the 400,000 women who experience unwanted pregnancies each year in Uganda. Of course, the policy document itself has to pass through several reviews and become official – a process that could take months – but the group is hoping to complete everything by June.  Next, training and resources have to be put into place in order to raise awareness and improve services and access across the country, and this will probably take many years.

In spite of these inevitable delays, this working group is taking one of the first crucial steps toward ending daily needless and senseless deaths. It is quietly reinforcing strong advocacy and medical work done by national and international consortia supporting women’s rights, in a deliberate and thoughtful way – matching the political and cultural context of Uganda.

By participating in this group, I am learning volumes about unsafe abortion and abortion rights, as well as coming to understand the frustrations of high-level advocacy and policy work. But the most valuable lesson I have learned from taking part, and observing, is that it is my duty to do my homework when it comes to delicate political and cultural issues. So much happens behind the scenes here, just like in my home country of the United States. I am simply unable to perceive it easily and quickly as an outsider.

I am so fortunate to be part of this process, and it makes me very hopeful to see such passionate and intelligent individuals working to improve the lives of women and girls in Uganda. It may be a long way off, but one day far fewer girls and women will have to make the decision that my friend made years ago – and those who do will do so in an environment of competence and support instead of fear and danger.