KAMPALA, UGANDA — Ever since her near-death experience, Christine has felt haunted.
During a holiday break from secondary school, she discovered she was pregnant. Christine, 16, confided in her mother. She works in health services and gave her daughter misoprostol tablets to induce a medical abortion – a procedure that is illegal and only permitted when the mother’s life is in danger.
But something went wrong, and Christine was admitted to the hospital.
“I bled for a full week,” Christine says. “My mother got alarmed and took me to China-Uganda Friendship Hospital, where she had midwife friends. They gave me pads and cotton wool, but it did not change. Instead I felt my life floating away.”
She later recovered, but her situation is not unusual here. Between July 2018 and July 2019, the same hospital reported 39 cases of girls admitted after attempting abortions at home.
Still, teen pregnancy remains at the center of an ongoing debate over sex education in Ugandan schools.
Across Uganda, scores of parents do not want schools to teach their teenagers about sex, because they fear it will encourage girls to become sexually active. But in the absence of sex education, girls are still becoming pregnant, local officials point out. It’s become common for mothers to help their daughters obtain illegal abortions rather than endure the stigma that comes with being an unwed teenage mother.
In 2018, the Ugandan government introduced the National Sexuality Education Framework in hopes of decreasing pregnant teen dropout rates. The program teaches teenagers about their changing bodies and introduces the topic of birth control.
But in a country where 84% of the population identifies as Christian, adamant opposition to the framework remains. Parents say they prefer an abstinence-only focus.
“Ugandans are hiding their heads in the sand. They are living in denial,” says Mulindwa Ismael, director of basic and secondary education in Uganda. “We have talked, but nothing is changing, so we must take the bull by the horn.”
A report by the Forum for African Women Educationalists, Uganda Chapter found that 21% of the girls age 14 to 18 who drop out of school do so due to pregnancy. In rural areas the figure climbs to 30% and as high as 43% in eastern Uganda.
Ismael says he what helped Uganda turn the tide on its HIV epidemic was the president’s openness about it. Ismael believes the same level of openness is needed to address teen pregnancy.
But some on the front lines of helping pregnant teens do not agree.
Wakisa Ministries, a pregnancy crisis center, currently houses 25 pregnant girls. Its founder, Olive Kigozi, opposes sex education. “It has nuggets that are harmful to the growing up child,” he says.
But being forced to drop out of school also harms girls, educators say.
Ugandan schools require students to submit evidence that they do not have malaria or typhoid at the start of each term. Girls are also required to prove they are not pregnant before each term.
If a student is pregnant, she is expelled.
Teachers say these expulsions prevent school-year disruptions.
“We ask the girl to go home until her life is sorted, and we advise her to change school for stigma from her peers, and also she is not a good example to the rest of the girls,” says Winfred Ogwok, a teacher responsible for addressing girls’ issues at her school in Kampala.
Some opt for abortion.
Loyce Musisi says abortion was the right decision for her daughter.
“Those who say they would not help their daughters have not been confronted by that situation,” she says. “There is societal stigma to the girl and the mother. There is also added economic pressure on the entire family since both the girl and the child would have to be dependents.”
Harriet Nyakato says she would not seek an illegal abortion for any of her four daughters if they became pregnant. “Our children must learn to be accountable for their actions. They should know that for every action there is a consequence, so I would let her give birth. I would then help her to go back to school after delivery.”
John Wanyama, a gynecologist, says it’s time for families, religious groups and the community to embrace sex education. He says it’s an economic imperative.
“We lose resources on treating girls with psychological trauma, fistula, still births, operations, obstructed labor,” he says, adding that sex education will lessen the economic toll of teen maternal health.
Mary Kayiza Nansubuga, a retired midwife and official secretary for women in Mutungo Zone 10, a suburb of Kampala, says there are also significant health costs and consequences of the growing rate of illegal abortion.
“There is no safe abortion in Uganda,” she says. “Girls use crude methods to terminate pregnancies, which are harmful to their lives. They use herbs, hooks, chemicals and detergents.”
She says she’s been called a traitor for criticizing Ugandans who oppose sex education.
Florence Nabuto was a midwife on duty when Christine came in with heavy bleeding.
“If she had not told me the truth – that her mother had procured an abortion for her – she would have died of over-bleeding in two days,” Nabuto says. “When girls come with complications, we are quick to help them because we are here to save lives, but many girls decide to shy away, and this can turn fatal for them.”
“My mother urged me to keep quiet,” Christine says. “But my life was hanging by a thread, and so I chose to speak the truth, and thanks to Florence. I think my grave would be growing weeds by now.”
Edna Namara, GPJ, translated some interviews from Luganda.