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.
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.
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.
It is for this reason that VODA'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.
In the three years since VODA started their SAAF supported 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 school counsellors 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 abortion-related complications after her grandmother used local herbs to terminate her pregnancy.
“A man just caught me and raped 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 themselves 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 about the need to avert the deaths that were occurring due to unsafe abortion.
“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 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 in support of safe 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.”
Owoli, a father of six said, before he joined VODA, he had heard about family planning and unsafe abortion but he did not think they were big issues. “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.
*not her real name