The young girl was sick, afraid, and ashamed when she came to the hospital. She had had an unwanted pregnancy. In Uganda, abortion is illegal.[1] Without access to safe, legal reproductive health care, she turned to a traditional healer.[2] The traditional healer helped her end the pregnancy but she developed an infection.[3] Given the legal jeopardy and social stigma of abortion, the girl tried to keep it a secret and delayed seeking care; by the time she came to the hospital, she was septic and needed surgery to survive.

My friend was serving as a visiting physician at the hospital, teaching obstetrics and gynecology to medical students and resident physicians. She quickly performed surgery to control the infection. But that was just the start of the girl’s treatment. Northern Uganda is under-served and remote. Public health resources are lacking and hygiene can be difficult to maintain. Surgery is dangerous, but so is post-operative care. The risk of infection remains high. So, the girl had to spend months in the hospital, where doctors and nurses monitored her and changed her surgical dressings on a daily basis until she healed. She had to go back to the operating room three more times during that period. Through care and great perseverance, the medical team avoided having to perform a hysterectomy to eliminate the infection. When she could finally go home, she left quickly and quietly. My friend said it was likely her youth, the resilience of a teenager’s body, that allowed her to survive.

It is a sad fact that she was one of the lucky ones. Experts estimate that four in ten pregnancies in Uganda are unintended. As a result, every year hundreds of thousands of women and girls turn to illegal and often unsafe abortions to end their pregnancies.[4] Uganda is a dangerous country for pregnant women, with one of the highest maternal mortality rates in the world. Experts believe unsafe abortions may be responsible for a fifth of those deaths.

But even after women safely bring an unplanned pregnancy to term, there is often tremendous hardship awaiting them. I worked with a women’s legal clinic just down the road from the hospital. The vast majority of our clients were raising children on their own. Just as some absent man-child was responsible for the pregnancy that put that young girl in the hospital, we were constantly working with women to address the absence of boys and men unready to be fathers. We spent our time chasing child support payments; cajoling police to execute protective orders against abusive partners; and mediating land conflicts in which vulnerable, usually single, mothers were expelled from their homes. Our clients loved their children, and they sacrificed for their children. But it rarely felt like the victory of life was won.

I’ve met people who hold truly consistent ethics of life. They oppose war, the death penalty, and violence in all its forms, even in self-defense. They also affirm life by advocating for policies that support the poor and enable all parents and children to thrive. While I don’t agree with their opposition to abortion, I can appreciate the integrity of their belief. But it’s hard for me to recognize that kind of integrity in laws that relegate women to dangerous, clandestine medical procedures or consign unintended families to lives of privation and struggle.

Where abortion is illegal, you find people weighing devastating prospects. They balance their dreams for the future with their fears of prosecution. And if the scale tips in the direction of their dreams, they may be forced—like that young girl in northern Uganda—to balance their choice of life with the risk of death.

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[1] Despite its legal status, induced abortion is common in Uganda, where the annual abortion rate was 54 per 1,000 in 2003. The abortion rate was highest in the northern region at 70 per 1,000 women. The North also has the highest proportion of women living in poverty (71%), the lowest level of modern contraceptive use (6%) and the smallest proportion of women with seven or more years of schooling (12%). For reference, in the U.S., the abortion rate in 2017 was 13.5 per 1,000.

[2] Even when it is legal, medical care can be prohibitively expensive. Many Ugandans seek the cheaper alternative of traditional medicine. Some of it is quite effective and relatively safe. Some of it is not.

[3] In this case, the traditional healer used herbs containing chemicals with abortifacient properties. They inserted the herbs into the young girl’s vagina to either dilate the cervix or contract the uterus, triggering a miscarriage. These methods are time-proven; they end pregnancies. But they are unsafe. They can cause infection and endanger girls’ women’s lives when the miscarriages are not completed. That is what happened to this young girl. For more, see: Herbal medicine use and linked suspected adverse drug reactions in a prospective cohort of Ugandan inpatients.

[4] Unintended Pregnancy and Induced Abortions in Uganda: Causes and Consequences

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Ian Ramsey-North is a third-year student at BC Law. Contact him at ramseyno@bc.edu.