Lillian’s story: abortion, family planning and HIV

In 2010, when Lillian’s baby was four-months-old she fell pregnant again. The young mother from Kampala, Uganda was breastfeeding at the time and did not intend to get pregnant again so soon.

In 2010, when Lillian’s baby was four-months-old she fell pregnant again. The young mother from Kampala, Uganda was breastfeeding at the time and did not intend to get pregnant again so soon.

“I was totally confused, because my baby had hardly grown. It was still very tiny and it needed all my attention,” says Lillian. “This second pregnancy was totally unplanned for, and much as my husband was also surprised, he took it more lightly than I did. But the immediate option available to us was an abortion.”

Face to face with abortion

After agreeing that they should abort, the couple went to Mukono, a suburb in the east of Kampala to consult a private abortion clinic owned by a specialist from Mulago hospital. The couple found that the specialist charged about 250 US dollars per abortion, which they could not afford, so negotiated with the clinic’s assistants to carry out the abortion instead at 50 US dollars.

Lillian says: “After payments were made, it was a complex issue. The assistants were working hurriedly to finish up the work before their boss arrived. They first induced the labour; they then brought a metallic stripe, told me to open my legs wide and started extracting the foetus from my body. They would hit, knock, drag, and later on pulled out the remnants of the foetus. This process was very painful to me.”

Lillian says she returned to health after one week then decided on an injectable contraceptive.

“Ever since I went on this form of contraceptives I became very dry,” she says. “There is almost no lubrication during sex and it is very painful for me. I fear my husband could have noticed that I have lost interest due to the dry [non- lubricated] sex.”

Fear of HIV

More recently Lillian was distressed to discover that her husband had fathered two children outside their marriage, which has also brought the fear of HIV into her world.

She says her husband’s infidelity “is risky for us because this increases out sexual networks and the risks to HIV. The fact that he has fathered children with another woman shows that he is not using a condom wherever he is having sex outside marriage and [there] could be more [children] elsewhere with other women. We are all at a higher risk of acquiring HIV.”

For Lillian, she does not know whether she took the right decision to abort. She carried out an abortion that put her life at great risk. She suffered side effects in using contraceptives, which led her into loss of sexual interest and worries that this could have led her husband to get a “younger and juicy girl”. She blames these circumstances for her being at higher risk of acquiring HIV. She cannot leave her husband because they have worked hard together to bring up a family. Yet she believes that she does not have the power to control his sexual lifestyle.

Policy on abortion and post abortion care

The increased interest on the links between sexual reproductive health (SRH), family planning and HIV is an important one. There is greater need to integrate the provision of services such as abortion and post abortion care in health facilities for both people living with HIV and those who are currently HIV negative.

Interventions that integrate SRH, family planning and HIV have been explored by organisations such as the International Planned Parenthood Federation in the Integra Initiative but the Centre for Reproductive Rights has observed that the obscurity in understanding the policy on abortion creates more confusion in implementing certain SRH programmes:

“Abortion is legal in Uganda when done to preserve the life or mental or physical health of the pregnant woman, understood to include cases of sexual violence. However, unclear and often confusing abortion laws and policies mean that many people are not aware that abortions can be legally obtained in these circumstances. As a result, many women turn to unsafe, clandestine abortion with devastating consequences. Twenty six percent of maternal deaths in Uganda are attributed to unsafe abortion.”

Dr. Peter Ibembe, a programme director at Reproductive Health Uganda is in agreement with the Center for Reproductive Rights.

“Abortion policies in Uganda are merely restrictive and they do not necessarily make abortion illegal. But because of the little awareness about the law, the law is abused and induced abortions have continued to be carried out in an illegal context,” he says.

He notes that Reproductive Health Uganda offers a wide range of SRH services, including family planning, post abortion care and HIV based interventions.

What can be done?

Research conducted in Nyanza province of Kenya by Harrington, E.K, et al (2012), published in the Journal of Infectious Diseases in Obstetrics and Gynaecology, finds the integration of family planning services into HIV care to be a promising strategy for reducing the unmet need for contraception among women living with HIV. However, the researchers emphasise that health systems alone cannot address other determinants relating to access and choice, such as the balance of power in intimate relationships and fears regarding the safety of contraceptives.

To save mothers that die in backstreet abortion clinics or suffer long term health consequences after visiting them there is need for advocacy groups to help bring abortion and post abortion related issues into the limelight, with a strong focus on what is happening in private clinics. Indeed, evidence from research conducted in Nigeria by Ogu, R, et al (2012), also published in the Journal of Infectious Diseases in Obstetrics and Gynaecology, suggests that “the private provision of quality post abortion care services holds the key to increasing women’s access to safe abortion care.”



  • comment-avatar
    Joy Namyalo 5 years

    Well done James,its really absurd that young mothers up to today get un planned pregnancies,its high time the government did its role of sensitizing the nation