KAMPALA, Uganda: Health workers across Uganda remain fearful of offering any abortion-related services because they risk arrest, imprisonment, and loss of their professional licenses. According to feminist lawyer Nancy Caroline Ayot, this fear is rooted in unclear and outdated laws that criminalize abortion while offering only narrow exceptions.
In an exclusive interview with Uganda Newsline (https://www.ugnewsline.com/), Ayot, a Programs Officer at the Center for Constitutional Governance unpacked the confusing legal landscape surrounding abortion in Uganda and why it continues to endanger both women and health professionals.
A Legal Framework Full of Contradictions
Ayot explains that Uganda’s Constitution takes a restrictive stance but leaves room for interpretation.
“Article 22(2) says no one has the right to terminate the life of an unborn child except as may be authorized by law but it never tells us what those circumstances are,” she said.
The Penal Code Act further criminalizes abortion through Sections 141, 142, and 145, which outlaw attempts to procure an abortion, the act itself, and supplying drugs to cause a miscarriage, offences often applied to both women and health workers.
However, Ayot notes an important exception:
“Section 222 allows abortions performed in good faith to preserve the mother’s life. Section 205 echoes the same. But these provisions are vague and rarely understood,” she added.
She points out that Uganda’s position mirrors the influential 1938 British case Rex v. Bourne, where a doctor was acquitted after performing an abortion for a 15-year-old rape survivor.
“The judge ruled that preserving a woman’s life includes her mental health. That case shaped many former British colonies, Uganda included,” Ayot explained.
Outdated Guidelines vs. Harsh Penal Code
Uganda’s Ministry of Health has previously issued guidelines permitting abortion in cases of rape, incest, severe fetal abnormality, and danger to the mother’s life. But these guidelines have never been fully implemented.
“The guidelines are outdated and clash with the Penal Code. So even if the Ministry intended to offer safe services, health workers still fear prison,” Ayot said.
She emphasizes that this mixed messaging has real consequences:
“When policies say one thing and the law says another, health workers choose safety, and that often means refusing care.”
Colonial Laws Still Shape Uganda’s Reality
Ayot highlights that Uganda’s abortion laws are rooted in colonial-era legislation dating back to the 1950 Penal Code.
“These are very ancient, foreign laws imposed during colonial rule. Yet they continue to determine women’s bodies and choices in 2025,” she noted.
“Uganda is not a Christian state. We have many religions, so laws should not be based on one moral standpoint.”
She adds that the debate is often distorted by religious or moral arguments rather than human rights considerations.
Court Rulings Reinforce Restrictions
Ayot referenced the Constitutional Petition No. 25 of 2020 (Human Rights Awareness and Promotion Forum (HRAPF) & Center for Health, Human Rights and Development (CEHURD) vs. Attorney General), where the court dismissed calls to protect abortion rights.
“The judges ruled 3–2 that protecting the fetus overrides protecting the pregnant woman. That was very telling — it shows the pro-life view dominates legal interpretation,” she said.
Fear Among Health Workers
Ayot stressed that health workers are the most affected by legal uncertainty.
“A doctor can go to prison for up to three years or lose their license. That’s enough to end someone’s livelihood,” she explained.
This fear persists even when women seek post-abortion care, which is legal and widely practised.
Yet criminalization creates a dangerous challenge:
“Women lie about what caused the abortion because they fear the law. But medically, lying is dangerous — doctors need accurate information to save lives,” Ayot warned.
Because of this, health workers must treat complications without knowing what was done to the woman, leading to misdiagnosis or incomplete care.
Women and Girls Lack Accurate Information
Ayot says most Ugandan women do not know their rights.
“Even educated women only know what they’ve heard through fear that abortion is a sin, murder, or demonic. Very few understand the law or safe options,” she said.
Only those working in reproductive health or with access to reliable information know the legal nuances.
Criminalization Is Causing Preventable Deaths
Global research supports Ayot’s concerns. The World Health Organization reports that criminalizing abortion does not stop abortions; it only drives them underground. Restrictive laws often lead to dangerous self-managed procedures, delays in care, and preventable maternal deaths, especially in low-income settings with limited access to contraception.
Ayot says this reality is visible in Uganda:
“Girls use hangers, herbs, and unsafe methods. Many lose their fertility. Some die. As long as abortion is criminalized, unsafe abortion will continue,” she said.
A Call for Reform
Ayot believes Uganda needs a clear, humane legal framework that prioritizes women’s health and autonomy.
“Everyone has a right to decide the path of their own life. It shouldn’t be a moral argument. It’s about human rights and safety,” she emphasized.
She says legal clarity would protect both women and health workers and drastically reduce maternal injuries and deaths.
Uganda’s Ministry of Health and related studies show unsafe abortions are a major cause of maternal deaths, with figures suggesting they cause around 5-8% of maternal deaths, though some estimates place it much higher (26%), with young girls disproportionately affected. Specific data highlights that adolescent girls face higher risks and complications, with one report indicating 55% of abortions occurred in adolescents (17-20 years old). Complications like haemorrhage and infections are common, leading to significant morbidity and mortality, often due to lack of access to safe procedures and contraception.
