Like in many parts of the world, abortion has generated divisive debate in Uganda. It is one of those issues that does not offer even the most politically correct of us the luxury of a middle ground. One is either for or against it; with both sides holding each other in almost equal contempt.
Many social and technical commentators have consistently recited what appear to be appalling statistics. The conclusions therefrom have been unanimous, unambiguous and despicable. For instance, in its 2011 Uganda Demographic and Health Survey, the Uganda Bureau of Statistics (Ubos) reported that Ugandan women possessed one of the highest fertility rates in Sub-Saharan Africa. They were more likely to give birth to two extra children above what they would ordinarily want (6.2 vs 4.5). Moreover, the same report indicated that contraceptive use did not appear to be increasing. A measly 38 per cent of sexually active unmarried women used a modern contraceptive method in the year 2000, a proportion that did not change at re-evaluation in 2011. Yet access to these services in rural settings is also problematic.
As one would expect, unanticipated pregnancies have resulted and the number of those seeking quick solutions has risen. Ubos reported that although experiences may vary across income tiers, there is no socioeconomic peculiarity to the Ugandan women having abortions. Poor, rich, rural, urban – all are seeking and getting abortion services.
The last time Ubos did an abortion incidence estimate in Uganda, it was revealed that there were 54 abortions for every 1,000 women of reproductive age. But that was in 2003. My educated guess is that that number has significantly increased. From here, a variety of graphic and often harrowing tales have been recounted; the eventual cost to the taxpayer in post-abortive care bemoaned; and the contribution of failed abortions to maternal mortality rate cited.
Yet some still insist that we should hide our heads in the sand; that we should embrace the holier than thou stance that abortion is not a societal reality. Many have even suggested simplistic solutions; that women and girls should simply stop having premarital sex and reconnect with their moral bearings.
What is not surprising is that the most spirited of those fronting such ideas are men; far flung and secure from the reality of unsafe abortion consequences on account of their gender. We, the men, conveniently forget that behind many an abortion sought is a cowardly man fearing to own up. Granted, some women might choose, and should be allowed the independent choice to terminate if they feel unready. But in suspiciously many cases, a teenage girl is the victim and nudging her on is an embarrassingly older man, a father figure, prominent politician, or a teacher perhaps, for whom the risk of exposure is deemed intolerable.
The economics of abortion might prove this point. The majority of clandestine abortions in Uganda involve women and girls in the 15-24 age range. If educated in Uganda, it is safe to assume that these girls are either in secondary school, in post-secondary institutions, or have just completed tertiary studies. Whichever the case, most are not yet women of means and many are yet to get a stable paying job.
Yet a 2005 report by The Alan Guttmacher Institute (Abortion and postabortion care in Uganda: a report from health care professionals and health facilities) estimated the cost of abortion to be $25–88 if performed by a doctor, $14–31 if performed by a nurse or midwife, $12–34 if performed by a traditional healer and $4–14 if the woman self-induced. Someone is meeting those bills, and it is neither the victims nor their parents.
But I digress. Let us compare the abortion question to HIV, a scourge that affects male and female alike (never mind that women are still disproportionately affected). Like abortion, HIV is associated with unprotected sexual contact. In the Ugandan society, judgemental opinions about the moral standing of one that is HIV positive are still secretly propagated by many. A surprising number still blame the victims for not having taken sufficient precaution or for being promiscuous. But unlike abortion, there are people living with HIV in almost all walks of life.
By the same standard, and given its largely sexual connection, one would expect HIV to inspire similar wrath. Instead, and I suspect because we are all affected in some respect, the tone is different. Those suggesting that women and girls who seek abortion are simply immoral and deserve no legal mechanism to exercise choice suddenly taper their aggression. For HIV, religious pulpits cease to be alters of condemnation but are being justifiably used to spread prevention messages, to encourage the afflicted, and to demand for increased treatment access and coverage from the government. And we are all the better off for it.
Why can’t abortion benefit from similar objectivity? Rather than condemnation, why cant those with a platform and voice argue for increased government interest in provision of safe and professional abortion services for all those that choose? Is it fair that the overwhelmingly male religious and cultural leaders hijack the abortion debate with preconceived and markedly prejudiced opinions? Is it even moral for those that finance and thrive on abortion by night to condemn it by day? In the face of spiralling HIV and STD infections, can we as a society maintain a straight face in upholding sexual morality as the principal inhibition to positive action on abortion?
If we are determined, as a society, to label abortion a legal and moral wrong, then let us at least not blame the scapegoats but unmask the real perpetrators. It might surprise you where we are to find them; in churches, mosques, government buildings, schools, stable homes and I could go on. Regardless, there is no confusion as to their gender; they are most definitely male.
Mr Owagage is a Global Health Corps Fellow