-Rights groups, Medical Experts Demand Reforms To Prevent Suffering, Deaths–
Special report
As dawn breaks, different health facilities in Uganda’s island districts and border communities begin their normal routine of treating patients. Among the patients are young girls and women whose lives are in danger and in urgent need of care.
At Kalangala Health Centre (HCIV), in the island district of Kalangala (Ssese Islands), some arrive after unsafe attempts to get rid of the pregnancies (abortion) that could not be legally terminated. They seek post-abortion care services provided by the same government that outlaws abortion through the penal code act, except for exceptional circumstances.
While the government and pro-life activists insist that a baby’s life is important from conception, other rights advocates and health professionals argue that the legal contradiction has largely created a silent public-health crisis, with abortion being extensively done underground.
For Sarah (not real name), a 20-year-old trafficking survivor in Kizzi village, Kalangala Town Council, the contradiction is painfully real and deeply personal. She was recruited in Mubende district with the promise of a well-paying hotel job in Kalangala, but instead found herself forced into commercial sex work, where she experienced repeated sexual assault, leading to unwanted pregnancies.
The fact that safe abortion remains illegal in Uganda, Sarah was scared of seeking professional assistance from any health facility. “I resorted to unsafe options, including ingesting different concoctions from a Traditional Birth Attendant (TBA),” she recalls.
As a result, several abortion attempts led to serious internal complications. But on the third time, her condition became critical because everything did not come out. “I eventually had to seek Post-Abortion Care (PAC) at Kalangala HCIV because I was going to die,” she recounts.
Other Cases
In Kizira village in Mugoye subcounty, 22-year-old Grace, a deaf mother of one, is enduring emotional stress and pain after becoming pregnant twice through sexual violence. Although she believed that “two wrongs do not make a right” and was willing to keep her first pregnancy, her parents were not ready to care for the children.
Amid pressure, with limited options, she was forced to terminate it through unsafe means. “I took local herbs and bled profusely and suffered severe pain. I survived by God’s mercy after the intervention of trained health workers,” she says through her sign language interpreter.
Having survived the first unsafe procedure and no longer able to endure forced abortion, Grace went to her grandmother for support, determined to carry the second pregnancy to term and further give birth safely, despite having gone through a similar incident.
In Kinoni town council, Lwengo district, a 15-year-old Rebecca and an 18-year-old Joan, who is living with a physical disability, became pregnant after cases of aggravated defilement and incest, respectively.
Joana says she sought help from a health worker, but she was turned away over fear of breaking the law. “I went to end the pregnancy. But I ended up going back to the same facility for PAC,” she recounts. Meanwhile, Rebecca is still receiving counselling as she considers her next step regarding the pregnancy.
Their experiences are not an exception. Across fishing communities, remote islands and border towns in Greater Masaka Region, the restrictive laws, combined with isolation and stigma, continue pushing Uganda’s most vulnerable teenage girls and women toward unsafe and often life-threatening choices.
Geographical barriers to medical support
In Mazinga, one of the hard-to-reach islands in Kalangala, 14-year-old Jessica was defiled by a fisherman. Instead, her peers advised her to get certain pills and washing detergent to terminate the pregnancy, but things did not go well. Jessica bled profusely, and her life was in danger.
In Nangoma, a porous island community (parish) along the Uganda-Tanzania border in Kyebe sub-county, Kyotera district, abortion cases are reportedly rampant. Parish leaders say that girls suffer severe pain for days before their families take them to the health centre.
PAC Services, Public Health Crisis
The World Health Organisation (WHO) estimates around 73 million induced abortions take place globally each year. In Uganda, health workers and rights activists say the legal restrictions on safe abortion have further fueled the public health crisis, arguing that fewer girls and women would die if safe abortion were more widely permitted.
Several midwives disclosed that many of these girls often go for help when it’s too late, while those in remote communities often endure the pain, and some die due lack of urgent medical attention.
Dr. Frank Kasirye, the Maternity In-Charge at Kalangala Health Centre IV, explains that 31 people reported for PACs between April and June 2025. “Many patients, especially from far islands and landing sites, struggle to get timely and specialised care for such complicated cases,” he explains.
However, he adds, abortions are reducing among school children but are still persistent among commercial sex workers. According to Kasirye, most costs of PAC arise from treating incomplete abortion. “However, a significant proportion is spent treating more patients with serious complications, such as sepsis, lacerations and perforations,” he states.
Robert Ssebalamu, the Community Health Extension Worker (CHEW) in Kalangala, reinforced Dr. Kasirye’s statistics, saying that he registers an average of 11 to 12 girls every month, in need of PAC and refers them to different health centres including the HCIV.
According to Anastazia Nassali, a midwife at Kalungu HCIV, the delays in getting medical support happen because many are afraid to be judged by the public or to be arrested for terminating the pregnancy.
The situation is even worse in remote villages and island communities where transportation is difficult to find, health facilities are far away and getting medical care is expensive. She further adds that at least three women go for post-abortion care services every month, and the majority are being saved from severe complications.
Dr. Moses Nkanika, the Lyantonde District Health Officer (DHO), reveals that many abortion cases are never reported because the survivors fear being stigmatised or criticised by religious leaders.
“In the last two years, at least 622 people have come for post-abortion care services – 337 in 2024 and 285 this year,” he explains, adding that sensitisation campaigns are needed for people to know these services are available and free.
According to Maria Nagujja, the In-charge of Maternity at Kalisizo Hospital in Kyotera district, more than 180 people have gone for post-abortion care services. These numbers reflect how many people risk their lives to use unsafe procedures because safe abortion services are restricted by law.
Lawmakers Respond
In November 2023, legislators under the Uganda Women Parliamentary Association (UWOPA) and other Civil Society Organisations backed proposals to expand access to contraceptives for sexually active teenage girls, arguing that doing so could reduce unsafe abortions. Earlier (2014), Fox Odoi, the West Budama North MP, sparked a controversial debate in Parliament by calling for the legalisation of abortion.
Police crime report 2024
The Uganda Police Force registered 728 abortion cases between 2019 and 2024, according to the 2024 Annual Crime Report. 2020 had 396 cases, becoming the highest number in six years. In 2019, 68 cases were recorded, 2021 (56), 2022 (59), 2023 (81) and 2024 (68).
The same report indicates that Greater Masaka Region recorded 951 sex-related cases, with Kyotera, Lwengo and Sembabule recording the highest number of cases.
NGOs, Activists
Patricia Namiwanda, the Sexual Reproductive Health and Rights (SRHR) and Youth Development Officer at the Association of Disabled Persons Living with HIV and Tuberculosis (TB) in Uganda (ADPHA-Uganda), notes that many people with disabilities are subjected to forced abortion and other forms of family planning without the consent of the affected girl or woman or opportunity to talk to a professional health worker.
“Most of the unwanted pregnancies among children with disabilities directly involve family members or people close to them. So, to avoid shame, these children are subjected to forced abortion, sometimes carried out in an unsafe way or crude way,” she adds.
Gloria Namyalo, an experienced Social Worker in Masaka district, says many teenage abortions are carried out with the help of Traditional Birth Attendants (TBAs) who are not trained. This is because health workers are also afraid of carrying out abortions due to the law in place.
CEHURD, HRAPF Petition
On 14th November 2025, the Centre for Health Human Rights and Development (CEHURD) and the Human Rights Awareness and Promotion Forum (HRAPF) received the long-awaited judgment in their Constitutional Petitions (No.25of 2020 and No.10 of 2017) on termination of pregnancy in Uganda.
The petitions were challenging the State’s failure to formulate and enact a law regulating the termination of pregnancy in Uganda, in line with Articles 22(2) and 79(1) and (2) of the 1995 Constitution.
However, the minority decision affirms what evidence, constitutional values and medical realities have consistently shown, that the criminalisation of abortion endangers women’s lives, violates their dignity, undermines their right to health, and contradicts Uganda’s obligations under both national and international human rights law.
CEHURD further criticises the court’s position for ignoring the plight of the many girls and women facing defilement, incest and rape, evidenced by national documents such as the annual police crime reports.
According to Rhodine Kitandwe, a Health Rights champion and lawyer at CEHURD, unsafe abortion remains one of the leading causes of maternal deaths resulting from severe complications such as sepsis and haemorrhage, among others.
Uganda records about 43 abortions for every 1,000 women of reproductive age, most of them unsafe. “Behind that number are young girls afraid of being expelled from school, mothers already struggling to feed their children, and women living with HIV, TB who know that another pregnancy could compromise their immunity and livelihood,” he says.
Kitandwe explains that the dangers are intensified when infectious diseases are part of the picture, because pregnancy weakens a prospective mother’s immune system, and the risk of opportunistic infections rises.
Uganda has made significant progress in reducing maternal deaths, currently estimated at 189 per 100,000 live births (2022). However, this figure is still far above the SDG 3.1 target of 70 per 100,000 live births.
Protection of Vulnerable Groups
According to Susan Baluka, a prominent Human Rights Lawyer, there is apparently no legal protection for vulnerable groups, especially teenagers and PWDs, when it comes to abortion, because the law expressly prohibits abortion, with the only exception being for the purpose of saving the life of the mother. In addition, the legal adjustments that can be made would be for parliament to enact a law that permits abortion in exceptional circumstances.
“The previous policies, such as the 2006 National Guidelines and Service Standards on SRHR, can be used as a benchmark,” she explains, adding that they recommend providing abortion services in the instances of rape, defilement, incest, HIV, fetal anomaly and any other threat to the life of the mother.
Obstetrics/Gynaecology Specialist
Dr. Simon Peter Kayondo, an obstetrician-gynaecologist specialist, says that excessive bleeding commonest complication and the leading cause of death associated with unsafe abortion, especially among young girls and women. Other short-term complications include post-abortion infections and injuries to the internal organs that are common with unsafe procedures.
However, Kayondo, also the Vice President of the Association of Obstetricians and Gynaecologists of Uganda (AOGU), warns that long-term effects that may emerge later (months or years) include infertility whereby the unsafe abortion survivors may struggle to conceive, the damaged uterus or cervix that can increase the risks of complications in future pregnancies, in addition to chronic pain, psychological distress among others.
Typical Medical Procedure, Response
According to the specialist, Post-Abortion Care involves various medical steps designed to address emergencies and prevent future unwanted pregnancies and repeated abortions.
He explains that the first intervention is emergency treatment to revive or stabilise the patient. “This includes giving blood, providing intravenous fluid, and oxygen,” he states, adding that this helps to lift the patients from a critical state to a stabilised one.
The next step is for the health workers to address the cause of bleeding by removing the pregnancy tissue that is retained in the womb during abortion. “This is done either through a medical procedure or with prescribed drugs,” he reveals, adding that after the emergency has been managed, the following step is to find interventions that can prevent future complications such as infertility.
Caught Between the Law and Care
According to Kayondo, while post-abortion care is a life-saving service that should be offered countrywide regardless of how the abortion happened. This is a known position by the government through the Ministry of Health. “If PAC is not available in a certain health facility, then it is a measure of inadequate readiness to save girls and women who may have abortion complications,” he says.
However, he adds, the legal restrictions affect the operations of health workers in various ways. Some health workers struggle to determine who qualifies for lawful abortion and who doesn’t. “As a result, some patients, who would ideally qualify for safe abortion services, still resort to unsafe procedures because many health providers are uncertain about the law,” he says.
Asa result, the uncertainty has continuously created persistent tension among the providers. “Some health workers are caught in the traps of the law while offering PAC. It is easy for someone to accuse them of offering an abortion when they are actually offering PAC,” he adds.
“In medical practice, the procedures used for safe abortion and PAC are often the same and quite difficult to distinguish. So, it is very difficult to distinguish them, creating an ethical and professional dilemma,” he states.
TBA Operating in the shadows
Uganda officially banned TBAs from delivering babies in 2010. Still, many continue to operate in rural and island communities. According to a TBA, who agreed to speak anonymously fearing arrest and reprimand, teenage girls often visit at night seeking their services, while others are brought by their parents and relatives because they are affordable compared to the professionals. She adds that they do not keep any records or details of the clients (young girls), fearing to implicate themselves.
As Uganda considers whether to reform its abortion law, experts and health professionals argue that the consequences of doing nothing are already felt in hospital wards across rural areas, island communities and border towns. For them, the issue is more about ideology than about the persistent but preventable deaths. “As professionals, we do not just see numbers but girls and women who come to us for help when it’s almost too late,” says Dr. Kasirye.
“Until the law, access to health services and community realities are addressed altogether, unsafe abortion will continue being a serious public-health emergency rather than a choice made privately and individually.
This story was produced with support from a reporting grant provided by AKINA MAMA WA AFRIKA (AMWA). Due to the sensitivity of the cases, the names of the survivors and their true identities have been withheld to protect their privacy and safety and support their healing process. This clearly reveals deep gaps in legal awareness, access to health services and community support systems.
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