As the world recently commemorated International Safe Abortion Day under the theme ‘Safe abortion is life-saving healthcare,’ the conversation inevitably turned to a related but often overlooked issue: the quality of post-abortion care (PAC). PAC is one of the most critical yet under-discussed health services in Uganda.
Every year, women face life-threatening complications from unsafe abortions, which the 2022 Uganda Demographic and Health Survey (UDHS) estimates contribute to 8-11 percent of maternal deaths. Yet the quality and availability of PAC remain inconsistent across health facilities. While Ugandan law permits PAC and recognises it as an essential health service, the reality is that many health centres lack the basic infrastructure, supplies, and skilled personnel needed to provide lifesaving care. At the heart of this issue is access.
For many women, the nearest facility for emergency obstetric care is a Health Centre (HC) III, the first line of care for most rural communities. These facilities are meant to provide basic emergency obstetric services, yet many are unequipped to handle complicated PAC cases. In my engagements with healthcare providers, I have come to learn that a woman who presents with heavy bleeding or sepsis may find that the HC has a dilapidated procedure bed, no electricity, or no trained provider.
Even when women reach hospitals, quality is not guaranteed. Essential supplies such as lignocaine (for pain management), vaginal specula, and manual vacuum aspiration (MVA) kits are not always available. While the Ministry of Health made progress in 2023 by adding the misoprostol/mifepristone combipack to the Essential Medicines and Supplies List, its use is restricted to HCIVs and above.
This restriction means that HCIIIs and IIs, the most accessible facilities for many rural women and girls, cannot provide this highly effective treatment for incomplete abortions. The problem is not just supplies, but also people. PAC requires skilled health workers who can provide care with both technical competence and compassion. Yet training gaps remain wide.
In several learning engagements, health workers have openly shared their hesitation to provide PAC due to stigma, fear of legal repercussions, or personal values. Others expressed the need for refresher training to manage complex complications. For women, these gaps translate into delays, judgmental attitudes, or outright denial of care, even when PAC is fully permitted by Ugandan law. Beyond the health system, different actors also shape the quality of PAC in Uganda.
Policy gaps remain a major challenge, for instance, police officers often do not understand what PAC entails and sometimes arrest health workers under the mistaken belief that they are performing illegal abortions, even though PAC is permitted by law. At the community level, harmful social norms and stigma discourage women from seeking timely care, while lack of family or peer support can leave them isolated at critical moments.
At individual level, limited knowledge and decision-making power among women and girls further restrict their ability to recognise emergency symptoms and demand quality PAC services. The human cost of these systemic weaknesses is sobering. Women continue to die not because PAC is unavailable in theory, but because in practice the service they receive is of poor quality.
A young woman who walks into a facility with heavy bleeding should not have to wait hours for a referral, endure a painful procedure without anaesthesia, or be turned away because supplies ran out. Yet these are realities many Ugandan women face, as shared repeatedly in learning meetings with health providers across districts. Improving quality of PAC requires investment on multiple fronts. First, infrastructure: facilities must be equipped with functional procedure beds, sterilisation equipment, and reliable power and water supply.
Second, every HC that provides PAC must be routinely stocked with lignocaine, MVA kits, specula, and the combipack, not just on paper, but in reality. Third, health workers need regular training and mentorship not only to provide PAC safely, but also to deliver it with dignity and respect. Uganda has made progress before, and it can do so again. But for women in villages far from district hospitals, progress will only matter if these medicines and supplies are available where they seek care. Every woman deserves the assurance that if complications arise, the health system will protect her, not fail her.