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
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.