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Why women opt to abort


Medics observe that unlike teenagers who can be counselled and many times agree to keep the pregnancy, older women are more desperate and will have an abortion at all costs.

A senior gynaecologist/obstetrician who runs a reproductive health clinic in Ntinda says: "Educated career women know where to get it. They step out of office like they are going for lunch and conduct their business. The ones you see in Mulago are the illiterate ones who go for crude methods."

"Forget the teenagers who are dying with complications because they cannot afford the safe procedure or do not know where to go," he says.

What about counselling? "Of course I give them counselling, but the educated and career women will tell you they have thought it through and their mind is made up," he discloses.

"The reasons they consider abortion a primary option are as complex as sexual relations," he says, giggling. "'My husband is cheating', 'I was simply playing and do not want to be tied down', 'I am married', 'I have just got a job', 'I have a research scholarship abroad', 'we have separated,'" the doctor says. As if on cue, in walks a woman in her mid-30s. He excuses himself to attend to her.

"Infidelity is one reason," Nakirijja says. "A woman tells you, 'musawo tomanyi' (doctor you do not know), my husband will kill me. The marriage will be over. I have kids. What do I do with the kids?" she says.

"Nothing you say will change her mind," Nakirijja says. Dr. Daniel Zaake, a gynaecologist/obstetrician at Nsambya Hospital, says the other reason older women choose to abort is poverty. "She will tell you she cannot afford another child. Others say family planning failed, while there are those who get pregnant almost immediately after childbirth.

"Then there are those rare cases who think that they have reached menopause only to realise they are pregnant. When women reach their 40s, their menstrual cycle becomes unstable. For some, the cycle may stop, but they are still fertile.

"If one is not using any family planning method, they may find themselves pregnant," he says remarking: "Ever heard of kids being branded 'accidents' because the one they follow is 18 years older?"

Nakirijja substantiates the doctor's view: "We have had a few cases of women getting pregnant in the pre-menopause period. Many would rather abort than be seen pregnant again. Some have grandchildren and are afraid that people will think they are competing with their children.

"And when they have the abortion it's often fatal. Last year we had three 49-year-olds who died from post-abortion complications," she discloses.

According to the 2007 Guttmacher Institute report on Unintended Pregnancies and Induced Abortion in Uganda, there are 1.3 million pregnancies in Uganda annually. An estimated 775,000 of them are unintended with 16% (about 300,000) of these pregnancies ending in induced abortion, 26% in unplanned births, 42% in planned births, and 15% in spontaneous abortions.

The report notes that HIV/AIDS is one factor that has contributed to these dire statistics. It goes on to say an exploratory study of HIV-positive women in Kampala showed that almost all had at least one pregnancy since learning their HIV status. "Most did not want the pregnancy and half considered obtaining an abortion," the report notes.

It also shows that many women do not use modern contraceptives because they do not trust them and because accurate information about the safety of these methods is not available.

Dr Henry Kakande, the deputy chief of party management sciences for health says: "Family planning programmes should focus more on education, counselling and follow-up of users to help women deal with the various obstacles to continued use."

He adds that long-term methods like IUDs or norplants and permanent methods like female sterilisation would be ideal for those who want to permanently stop having babies.

"Women will not stop having abortions, but many will become infertile or die, if we do not step up use of contraceptive methods," Kakande says.


All articles are republished on AEGIS by permission. Material may not be redistributed, posted to any other location, published or used for broadcast without written authorization from Managing Director/Editor-in-chief, The New Vision, P.O. Box 9815, Kampala - Uganda, Tel/fax: 256-41-235221, E-mail: 

Information in this article was accurate in July 27, 2009. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.