The Alliance of Women Advocating for Change (AWAC) has urged sex workers in Jambula Zone, Bwaise, Kampala, to embrace family planning and seek timely medical care to prevent unintended pregnancies and complications arising from unsafe abortions.
The call was made during a safe motherhood engagement organised by AWAC in partnership with the police, health professionals and local leaders to equip sex workers with information on family planning, post-abortion care and their reproductive health rights.
The engagement came amid concerns about unintended pregnancies among sex workers, which participants attributed to sexual violence, limited access to contraceptives and inadequate information about family planning services.
During the meeting, sex workers identified rape as one of the major challenges they face, noting that some unintended pregnancies result from sexual assault.
Hannifah Namubiru, a sex worker in Jambula Zone, said some men sexually assault women in their ghettos, particularly as they make their way to work.
“Men rape us because they don't see us as people in their view, and most of these are influenced by drugs. In most cases, many women get pregnant out of rape and they don't want to bear these children, which forces them to abort. Most abortion practices are unsafe, which sometimes lead to loss of lives and other health complications,” Namubiru said.
She also raised concerns about the cost of contraceptives, saying some sex workers struggle to afford family planning services because of their low and unpredictable incomes.
“When we go to health facilities, we find family planning methods expensive, which makes it hard for us to sometimes get them because we don't earn much. Also, condoms nowadays are for sale, making it hard for us to have protected sex,” she said.
Namubiru called on the Government and organisations supporting women to bring family planning services closer to sex workers and make them freely accessible within their communities.
“We ask government and organisations to help us bring those family planning methods down to the ghettos for us to access and also to make them free of charge,” she said.
Another sex worker, Angel Kobusingye, said some women avoid family planning because they experience complications or adverse effects from certain contraceptive methods.
She urged health workers to assess women before recommending contraceptives and called for free services.
“Health facilities should first test us before putting us on those doses because some of them mistreat us. Also, we ask government to make them free of charge for easy access,” Kobusingye said.
Gynaecologist Explains Available Services
Dr Dan Kaye, a gynaecologist at Kawempe National Referral Hospital, told the participants that sex workers have a right to access family planning and other reproductive health services.
He said sex workers face risks including sexual assault, unintended pregnancies and HIV, but can access family planning methods and seek medical attention whenever they experience complications.
“Sex workers face a number of challenges compared to other women or men, and most of these challenges have to do with sexual assault, which in most cases leads to unwanted pregnancies and also HIV,” Kaye said.
He encouraged women to seek medical attention following sexual violence, suspected infections or other reproductive health complications, noting that services are available at public health facilities.
“Family planning is available as methods to prevent unplanned pregnancy. Secondly, they can also get other problems like violence or infections. But even if those things happen, health workers have facilities available where they can go and get services in all public health facilities in Uganda. This service is free,” he said.
Kaye also explained the importance of post-abortion care, urging women who experience complications following an abortion to seek treatment rather than avoid health facilities for fear of stigma or arrest.
He said the health sector was increasingly promoting a harm-reduction approach to ensure that women receive medical support, including in situations involving unsafe abortion.
“What we are encouraging people to do is that in case something has happened, they should go to health facilities. They can get support, they can get all the help and counselling for their situation to be turned to normal,” Kaye said.
He added that health workers were being trained in harm reduction and that post-abortion care was available at public health facilities.
“We don't support breaking the law, but we know that even if the law exists, people break it. But if people break it, they should not suffer severe consequences, including death after going through such complications. So that is the reason why we promote harm reduction,” he said.
Kaye said family planning should ideally be offered before an unintended pregnancy occurs, but women who have experienced an abortion can also receive contraceptive services alongside post-abortion care.
Michael Ssemakula, AWAC's Director of Programmes, said the organisation had taken the safe motherhood campaign to Bwaise to engage women directly in the communities where they face reproductive health challenges.
He said the campaign focuses on helping women make informed reproductive health decisions, particularly regarding contraception, unintended pregnancies and post-abortion care.
“Pregnancy does not happen by accident, not by chance but by choice. People can access family planning and they can access maternal care services. In case of an emergency, for example, obstetric care, people should get this treatment,” Ssemakula said.
He noted that sex workers and other vulnerable women were particularly exposed to sexual and gender-based violence, which could result in unintended pregnancies.
“When we look at all these issues, this is forcing someone into having unintended pregnancy, especially when it comes to violence like SGBV,” he said.
Ssemakula added that inadequate information about available services and what to do following an unintended pregnancy could push women towards unsafe abortion practices.
He called for wider dissemination of Uganda's self-care and post-abortion care guidelines to ensure that communities, health workers and law enforcement officers understand the services available to women.
“One of the things we would advise is to cascade the dissemination, but also create more awareness around the self-care guidelines and post-abortion care guidelines that Uganda has adopted from the World Health Organisation,” he said.
He added that greater awareness among police officers was necessary to help prevent women and health workers from being unfairly treated when seeking or providing post-abortion care.
ASP Muteera Asiimwe of Kawempe Police Station welcomed the engagement, saying it was timely amid concerns about cases of women abandoning or killing newborn babies following unintended pregnancies.
He urged sex workers to use family planning methods to prevent pregnancies they were not prepared to raise.
“Family planning doesn't mean not to give birth. Some of you throw babies in pit latrines because you didn't like the pregnancies. I urge you to give birth to children you can take care of. We don't want you to have children you don't like,” Asiimwe said.
He warned that children born into circumstances in which their parents struggle to provide for their basic needs could face significant challenges.
“When you give birth to unplanned children, they will become lawbreakers because you will not have what to feed them, so they will engage in activities like theft, among others,” he said.
Asiimwe also encouraged sex workers who experience rape or other forms of violence to report the incidents and seek medical assistance rather than resort to self-medication.
“We also urge you to seek justice in case of any cases like rape. Go to medical facilities for support, not self-medication,” he said.
AWAC said it would continue working with communities, health workers, police and local leaders to improve access to reproductive health information and services, with particular emphasis on preventing unintended pregnancies and reducing complications associated with unsafe abortions.