A more pertinent inquiry in light of the above state of SRH and the impact of the recently invoked global gag rule is on Uganda government’s readiness to protect the gains registered through increased uptake of FP, Anti Retroviral Treatment (ARVs) and other SRH services.
The WHO initiated studies to establish whether a relationship exists between the re-instatement of the Mexico City Policy and a reduction in the rate of induced abortion. While relying on data from Demographic Health Surveys (DHS) of 20 sub-Saharan countries between 1994 and 2008, it was found that during the Bush administration, the abortion rate increased from 10.4 per 10,000 women-years to 14.5 per 10,000 women-years. The report indicated timing of the rise being consistent with the reinstatement of the Mexico City Policy in early 2001. The rate was stable between 1994 and 2001 during the Clinton administration and then steadily rose from 2002 to 2008.
An analysis of Ugandan specific trends in the UDHS equally reveals Uganda’s mean annual rate of 13 abortions per 10,000 women – years and ranged from 8 per 10,000 in 1996 to 27 per 10,000 in 2007. The study indicates a drastic increase in the number of women seeking abortion services during the Bush administration (2001 to 2008) as compared to the Clinton administration (1993 to 2001). The number of women seeking abortion services almost doubled from 4628 in 2000 to 8997 in 2001. These statistics therefore counter the argument that the gag rule works to reduce cases of abortion. Additionally, Uganda as a sovereign state has not done enough investment in preventing early, unplanned or unwanted pregnancies that hike abortion cases.
It is therefore somewhat self-defeating for the government of Uganda that has set clear targets, and even enacted various policies to improve the state of Sexual and Reproductive Health Rights (SRHRs) indicators, to have not anticipated the health impact of having a Republican US President in office. Since President Trump’s executive order, there has been no official statement from the Ugandan government about how it plans to deal with the shortfalls in funding. Instead, the recently released budget sector framework paper FY 2017/2018 proposes an over Shs500 billion cut from an already under funded sector.
As past studies indicate, Uganda is likely to experience a loss in the gains that had been made in SRH and experience a spike in numbers of unplanned pregnancies due to inadequate access to FP, resulting into more induced abortions with many women and girls dying or suffering illness from the same. Such retrogression is inexcusable given that Uganda is a sovereign state that should be able to guarantee the right to health of its citizens and indeed ensure access to health services for all as stipulated under the national objectives and Directive principles of state policy of Uganda’s 1995 constitution.
Uganda has s number of opportunities to remedy the pending challenges that maybe experienced due to the effect of the global gag rule; these include the Global Financing Facility grant that Uganda is writing and other grants and foreign health assistance from other partners states. Such opportunities can be leveraged to ensure that the progress gained is not lost. Certainly, more can be gained from our Government’s analysis of regional and global trends and planning to ensure that the progress made is not lost.
Joy Asasira is a SRHR Expert CEHURD and Dennis Jjuuko is a Researcher CEHURD