Human Rights of Women

Boosting women's access to reproductive healthcare could significantly reduce both the number of unsafe abortions and the high cost of post-abortion medical care in Uganda, experts say.

Although there are few studies on the subject, experts estimate that some 297,000 abortions are performed annually, with 85,000 women treated for complications.

"Post-abortion care is estimated to cost nearly US$14 million annually in Uganda... The epidemic of unsafe abortion takes a tragic toll on women and their families. It poses a significant, avoidable economic burden on Uganda's already underfinanced health system," Moses Mulumba, director of the Kampala-based Centre for Human Rights and Development (CEHURD), told IRIN.

A recent brief by the Guttmacher Institute, a reproductive health think tank, and CEHURD estimates that post-abortion care costs nearly $130 per patient. "Most of the costs of post-abortion care arise from treating incomplete abortion; however, a significant proportion can be attributed to more serious complications, such as sepsis, shock, lacerations and perforations," the authors said.

Understanding the law

A major problem is poor understanding of Uganda’s abortion laws. A 2012 Technical Guide to Understanding the Legal and Policy Framework on Termination of Pregnancy in Uganda, by the US-based Center for Reproductive Rights, found the country's abortion laws to be "inconsistent, unclear and often contradictory".

"The confusing content of these laws and policies is compounded by their limited interpretations by Ugandan courts and other government authorities, such as the statutory councils established to regulate the healthcare professions," the report found. "As a result, women, healthcare providers and regulators often lack comprehensive information about the content of the law and what it permits."

The guide found that, contrary to the widely held belief that abortion is illegal across the board in Uganda, "Uganda's laws and policies are more expansive than most believe, and the current legal and policy framework offers ample opportunities for increasing access to safe abortion services". For instance, abortion is not illegal when a woman's life is in danger.

According to Annociata Kampire, director of the Alliance for Integrated Development and Empowerment (AIDE), the government has a responsibility to ensure medical professionals and women understand the country's abortion policy.

"One easy step that Uganda should take to reduce death and disability from unsafe abortion is disseminating information about the existing law and implementing existing guidelines... [This] urgently needed step would dramatically improve the health and save the lives of Ugandan women," she said. "They can start by widely disseminating and popularizing the 2012 Ministry of Health's National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, which describe circumstances under which abortion is permitted in Uganda."

"Making abortion illegal does not stop it from a occurring; it simply forces women to turn to risky procedures and methods... It is just matter of whether it is safe or clandestine and dangerous," Mulumba said. "Unsafe abortion needs to be recognized as a health crisis in Uganda that must be confronted by our policy makers, healthcare workers and communities."

Boosting contraceptive use

According to the Guttmacher brief, one of the key reasons for the high number of abortions is unplanned pregnancy. Uganda's unmet need for family planning stands at 34.3 percent, according to the 2011 Demographic and Health Survey (DHS); women are considered to have an unmet need if they wish to space their children's births or limit childbearing but are not using contraception. Just 30 percent of married women of reproductive age use any form of contraception, according to the 2011 DHS, and only 26 percent of married women and 43 percent of sexually active unmarried women use a modern method.

"Closing the gap in access to contraceptives would save thousands of lives, promote economic development and advance the rights of women, especially in rural areas, among young women, and among women with less formal education," Peter Ibembe, director of programmes at Reproductive Health Uganda (RHU), told IRIN. "Women and men need appropriate counselling so they understand the facts about modern contraception and are not influenced by myths. They also need a choice of affordable contraceptive methods that meet their needs."

"Government should also actively promote the use of contraceptives by women and men in Uganda rather than sending conflicting messages about family planning," he added.

Advocates of family planning have accused Uganda's President Museveni of working against efforts to promote more manageable family sizes.

However, at a global family-planning summit in July 2012, Museveni announced that his government would increase its annual expenditure on family planning supplies from $3.3 million to $5 million for the next five years. The Ministry of Health has also laid out a roadmap for providing universal access to family planning, involving the integration of family planning into other health services, and it plans to reduce the 'unmet need' for family planning to 10 percent by 2022. - See more at: http://www.irinnews.org/Report/97543/The-high-cost-of-unsafe-abortion-in-Uganda#sthash.QqWO050T.dpuf

A small team of HIV/AIDS activists is trailing Kenyan presidential candidates as they crisscross the country, pressing them to increase their commitment to the care and treatment of people living with HIV.

With just days until what is likely to be a close election, the activists are saying they can help deliver votes from many of the more than one million Kenyans living with HIV to the candidates most willing to address their concerns.

The 17 activists, who come from a range of civil society organizations, are calling on each of the eight presidential candidates to sign a manifesto guaranteeing a scale-up of HIV-testing, the elimination of mother-to-child transmission, and accelerated rollout of antiretroviral therapy (ART). After publishing their demands, the activists hit the campaign trail; they are prepared to dog candidates and disrupt rallies to secure those commitments.

Forgotten

"Many leaders, they do forget about us," said Loise Wanjiku, an HIV-positive woman from southwestern Kenya, where she says drug shortages are inhibiting the treatment of opportunistic infections associated with HIV.

Wanjiku was one of 17 activists who showed up at a recent rally by Prime Minister Raila Odinga - one of the frontrunners in the presidential race - in Bomet, Rift Valley Province, an hour and a half from her home.

"They've been attending campaign rallies from all the candidates to raise their voices, to hold up signs, to chant… and to try to urge the candidates to do more and say more about HIV, based on the demands in the manifesto," said Paul Davis, the director of global campaigns for Health Global Access Project (Health GAP), a US-based activist group.

Kenya faces a funding gap for its HIV programmes estimated at $1.67 billion. And although the country has steadily increased the number of people on ART, more than 100,000 HIV-positive Kenyans who need the drugs have no access to them.

Yet the presidential candidates have largely been silent on the issue.

In the country's first-ever presidential debate, hosted in early February, HIV/AIDS was not mentioned until the last question, when candidates addressed it as part of the broader need for improvements in health care. In the two leading candidates’ coalition manifestos, the proposed response to HIV is even less detailed: Deputy Prime Minister Uhuru Kenyatta's Jubilee Coalition mentions HIV/AIDS patients as part of the plan for universal healthcare. Prime Minister Raila Odinga's Coalition for Reforms and Democracy does not mention HIV at all.

Promises

The rally in Bomet was the first major success of the AIDS activists' campaign. Positioning themselves around the speaker's platform with a range of hand-drawn posters, the organizers threatened to interrupt Odinga if he did not mention HIV within the first half of his speech. He responded by promising free ART to all HIV-positive Kenyans and pledging to increase the health budget to 15 percent, as African leaders promised in the Abuja Declaration in 2001.

HIV-positive people are "part of our society", Odinga told the massive crowd, adding that "we all deserve to be healthy". Odinga's team said he did not feel pressured by the activists, but welcomed the opportunity to interact with them.

The activists staged a similar demonstration at a Kenyatta campaign two days later in Kisii, but the candidate failed to address them. They are hopeful, however, that he will eventually respond to their demands based on his record - when Kenyatta was finance minister in 2009, he signed an agreement to increase overall health funding by 40 percent by 2013.

A Kenyatta campaign spokesperson said the team is putting together a detailed HIV/AIDS response plan, which they will release before the election.

At a rally earlier this month, Deputy Prime Minister Musalia Mudavadi, another presidential candidate, promised more funding for the health sector, saying the "nation needs healthy people to run it".

Health GAP's Davis said Odinga's promise has potential implications for the campaign. "Now the ball is in the court of the Jubilee candidates… to see if they're going to step up or run the risk of losing [the votes of] 1.6 million people with HIV, their families, their friends, their loved ones, their co-workers."

He said HIV patients were prepared to transcend the ethnic affiliations that often determine voting patterns in Kenya and vote instead for the candidate most likely to respond to their needs. In Wanjiku's case, Odinga's rally helped her make up her mind. Because he was the first candidate to commit to meeting the activists’ demands, he won her vote.

"They want somebody who will care for them," she said. "Not a tribe, but a person who is caring." - See more at: http://www.irinnews.org/Report/97539/Activists-pressure-Kenya-s-presidential-candidates-to-act-on-HIV#sthash.dAijC5yA.dpuf