By Tausi Nakato
An investigation has found that women and girls seeking care after miscarriages and unsafe abortions across Uganda’s Busoga subregion face delays in accessing lifesaving treatment because of shortages of equipment, blood, trained health workers and reliable referral services. The gaps leave many at risk of preventable complications and death.
When a 17-year-old Senior Three student arrived at Kiyunga Health Centre IV in Luuka District after attempting to terminate a pregnancy using herbal medicine, health workers knew they were racing against time.
But the facility lacked an ultrasound machine to determine the extent of her condition. She was referred to a private clinic for a scan, then transferred to Nakavule Hospital in Iganga and later to Kiruddu National Referral Hospital in Kampala, where she died.
A post-mortem examination revealed placenta accreta, a condition in which the placenta grows too deeply into the uterine wall. For Nursing Officer Janet Mudodo, the girl’s death illustrates the consequences of gaps in emergency obstetric care.
“If we had an ultrasound machine, we would have identified the problem much earlier and made the right decision in time. Five years later, we still don’t have one,” she said.
Her death mirrors the experiences of many women across Busoga, where health facilities continue to struggle to provide timely post-abortion care (PAC) because of shortages of essential equipment, blood, skilled personnel, ambulances and dedicated treatment spaces.
According to the 2024/2025 Maternal and Perinatal Death Surveillance and Response Report, abortion-related complications account for 7 per cent of maternal deaths in Busoga, compared with 4 per cent nationally, highlighting the disproportionate burden borne by the region.
At Jinja Regional Referral Hospital, the main referral facility for Busoga, doctors handle at least five pregnancy-loss cases every day, about 150 every month or 1,825 annually. Yet the hospital has only three Manual Vacuum Aspiration (MVA) kits, despite occasionally receiving up to 10 patients requiring uterine evacuation in a single day.
In Uganda, abortion is generally prohibited except where continuing the pregnancy threatens a woman’s life or health. Medically, however, abortion refers to any pregnancy loss before the foetus is viable, whether spontaneous (miscarriage) or induced. Post-abortion care is the emergency treatment provided to women experiencing complications following either type of pregnancy loss.
Equipment shortages
Across the sub-region, health workers say shortages of ultrasound machines and Manual Vacuum Aspiration (MVA) kits remain among the biggest barriers to timely treatment.
MVA is a World Health Organization-recommended procedure used to remove tissue remaining in the uterus after a miscarriage or abortion, helping prevent severe bleeding and infection.
At Mayuge Health Centre IV, Medical Officer Dr Ismail Wangubo said the facility treats more than 40 women with abortion-related complications every month, most of them in their twenties.
Although the hospital has trained staff, theatre services, blood transfusion services and an ambulance, the absence of an ultrasound machine continues to delay diagnosis.
“Without ultrasound services, diagnosis and intervention can be delayed. When maternity cases coincide with abortion emergencies, priority is often goes to women in labour,” Dr Wangubo said.
He added that periodic shortages of medicines and surgical equipment, including speculums and sponge-holding forceps, further affect service delivery.
The situation is similar at Jinja Regional Referral Hospital, where Head of Obstetrics and Gynaecology Dr Angella Namala said demand for post-abortion care has outgrown available resources.
“Sometimes we receive up to 10 patients requiring evacuation in a single day. We also face shortages of disinfectants needed to sterilise the MVA equipment,” she said.
Dr Namala called for increased investment in lower-level health facilities, saying better-equipped Health Centre IIIs and IVs would reduce referrals and enable women to receive timely care closer to home.
Delayed referrals
Even where trained staff and essential supplies are available, getting critically ill patients to higher-level facilities remains a challenge.
At Kiyunga Health Centre IV, Senior Nursing Officer Ms Ruth Nafula said emergency referrals are often delayed because one ambulance serves several health facilities and fuel is frequently inadequate.
According to Nafula , the facility also lacks a dedicated post-abortion care unit, forcing women with severe infections to share maternity wards with mothers recovering after childbirth.
Transport barriers persist.
At Kidera Health Centre IV in Buyende District, District Health Officer Dr Anthony Okwiri said the hospital has trained staff, blood transfusion services, an ambulance and MVA kits, but inadequate fuel continues to delay emergency referrals.
“Sometimes patients are delayed due to transport challenges and are forced to walk or use expensive private transport,” he said.
In Iganga District, District Health Officer Dr Patrick Kitimbo said the regional ambulance network serving Iganga, Mayuge and Bugiri districts has improved referrals, although severe staffing shortages and inadequate emergency supplies continue to affect care.
Blood shortages and staffing gaps
Health workers say shortages of blood remain one of the biggest threats to women arriving with severe bleeding after miscarriages and unsafe abortions.
At Kityerera Health Centre IV in Mayuge District, Senior Medical Officer Dr Haji Ebogga said the facility regularly receives women with complications after undergoing abortions in communities and unregulated private clinics.
“Some arrive with severe bleeding or infections after unsafe procedures carried out elsewhere,” he said.
Dr Ebogga said although the facility has trained staff, emergency medicines, blood transfusion services and an ambulance, periodic shortages of blood, normal saline and ketamine continue to undermine emergency care.
In Luuka District, District Health Officer Dr Christopher Wandira said post-abortion care has been decentralised to lower health facilities, allowing trained midwives to manage pregnancies below 12 weeks using MVA kits while referring complicated cases.
However, he said continuous refresher training remains critical.
“Health workers change over time, so training must continue to ensure new staff can safely provide post-abortion care,” he said.
Meanwhile, Iganga District is operating at only 44.7 per cent staffing capacity, despite the district hospital serving more than 1,000 patients with only a 100-bed capacity, according to District Health Officer Dr Patrick Kitimbo.
Health-workers-at-Buwenge-General-Hospital-in-Jinja-District-.Many-Busoga-health-facilities-struggle-to-provide-post-abortion-care
Stigma keeps women away
Even where services are available, fear of stigma continues to discourage many women from seeking treatment until complications become life-threatening.
Ms Joan*, who was treated for complications following a miscarriage at Bugembe Health Centre IV in Jinja City, said she delayed seeking care because she feared being judged.
“I thought people would think I had induced the abortion. By the time I came to hospital, I was already bleeding heavily,” she said.
Another patient at Kiyunga Health Centre IV, who requested anonymity, said the lack of privacy almost cost her life.
“I left without treatment because there was no privacy. When I returned, I was bleeding heavily and in severe pain,” she said.
At Nankandulo Health Centre IV in Kamuli District, Senior Midwife Ms Lillian Nabalyango said post-abortion care is provided in the labour ward because the facility lacks a dedicated treatment room.
“A separate room would improve privacy, reduce stigma and strengthen infection prevention,” she said.
At Buwenge General Hospital, consultant obstetrician-gynaecologist Dr Aggrey Bameka said health workers also need training in Values Clarification and Attitude Transformation (VCAT) to eliminate stigma within health facilities.
“Without such training, some mothers are still judged instead of being supported,” he said.
Health workers say stigma, coupled with restrictive abortion laws, poverty and limited access to reproductive health services, continues to drive many women to unsafe procedures and delays treatment when complications arise.
Districts step up response
Despite the challenges, some districts are strengthening post-abortion care services.
Luuka District has decentralised services to lower health facilities, enabling trained midwives to manage uncomplicated cases closer to communities.
Iganga has strengthened its regional ambulance referral network serving Iganga, Mayuge and Bugiri districts to improve emergency referrals.
Kamuli District continues to conduct refresher training for health workers, while Namayingo District is promoting family planning to reduce unintended pregnancies and abortion-related complications.
District Health Officer Dr Mathias Mangeni said preventing unintended pregnancies is not only safer for women but also reduces pressure on the health system.
“Managing abortion-related complications is expensive because many of these conditions are preventable. That is why we continue to promote family planning and discourage unsafe abortions,” he said.
Ministry promises improvements
Responding to the findings, the Ministry of Health said it is strengthening post-abortion care through increased investment in equipment, health worker training and family planning.
The Commissioner for Reproductive Health, Dr Richard Mugahi, said while ultrasound machines are not mandatory for post-abortion care, government is progressively equipping Health Centre IIIs after completing nearly all Health Centre IVs.
“Post-abortion care can still be provided without an ultrasound machine, but we are expanding the rollout of ultrasound machines to Health Centre IIIs and above,” he said.
Dr Mugahi said abortion-related complications account for about 28 per cent of maternal deaths among women aged 15 to 24 years, making post-abortion care one of the ministry’s priority interventions.
He said government has procured about 2,000 Manual Vacuum Aspiration (MVA) kits and plans to increase the number to about 6,000 as funding becomes available.
“Training has to be continuous because the health workforce is dynamic, but funding remains a challenge,” he said.
According to Dr Mugahi, the ministry’s strategy focuses on expanding access to quality post-abortion care, strengthening family planning services to reduce unintended pregnancies and improving antenatal care to reduce pregnancy loss.
Expert: PAC Investment Saves Lives
Public health specialist Dr Wilson Mwanja of Buwenge General Hospital in Jinja District said strengthening post-abortion care is one of the most cost-effective investments government can make to reduce preventable maternal deaths.
He said prompt treatment prevents severe bleeding, infection and prolonged hospitalisation while reducing the cost of emergency care.
“Providing timely post-abortion care is far cheaper than treating life-threatening complications. Every lower health facility should be equipped to provide these services,” Dr Mwanja said.
For women facing post-abortion complications, survival depends on more than medical knowledge. It depends on whether the health system can provide timely, lifesaving care when it is needed most.
