Protecting the Right to Choose During a Once-in-a-century Pandemic

This is part two of a series on sexual and reproductive health access during COVID-19, featuring an interview with Ugandan pro-choice activist and GHC alumna, Dinnah Nabwire. Check out part one here, featuring Global Health Corps (GHC) CEO Heather Anderson.

Dinnah with community members in her home village

Brittany: It’s a tough time to be an SRHR advocate. How did you get your start?

Dinnah: My home village here in Uganda has 250–300 residents, with fewer than five female graduates to date. An estimated 80 percent of girls who married before the age of 18 have hushed cases of unsafe abortions, some which have claimed the lives of girls we knew. Being a pro-choice feminist was never an option for me. My family’s socioeconomic privilege gave me a different path from these girls’, but each day the responsibility I have towards shifting the status quo is amplified and inspired by stories, faces, and names I know by heart.

Brittany: Since Uganda went on lockdown over a month ago, what’s life been like for you?

Dinnah: The words stretch and flexibility sum it. I am locked down here in our small village in rural Eastern Uganda bordering Kenya. As in many rural areas in the country, we are at the periphery of socioeconomic services, worsened by limited physical movements. Whenever I am here (even before COVID-19), I co-host sexual SRHR discussions with the village health team (VHT) member targeting adolescents. Recently it has become more difficult to mobilize girls. Attendance at our bi-weekly community discussions has gone from an average of 12 participants to about four. We have moved from meeting at one location to one-on-one visits while still managing physical distancing, handwashing, and other precautions. Here we can disseminate information, offer counseling and for the VHT, distribute contraceptives. I plan to join the VHT at the health center to serve more women.

Brittany: How exactly is contraception access being affected in the village?

Dinnah: From January through February, there were limited supplies at the health center that serves the village where I’m based. Women who conveniently accessed short-term methods were affected. Despite stock-up of commodities in March, community and national attention dramatically shifted to the pandemic, neglecting its intersectional impact on SRHR and other health needs. So far, the lockdown period has mostly been rainy which means more farm work for women in rural areas, in addition to increased care work and a curfew at end of day. Uncertainty around how long the lockdown will last is triggering anxiety for consumers and threatening continuity of short-term contraception methods. While this has not translated into a tangible uptake shift for long-term methods, it is unveiling an opportunity to rethink how we work to avoid unsafe abortions.

Brittany: There are some legal provisions for abortion in Uganda, but we know unsafe abortion continues to be common. Why is that the case and is it shifting at all now?

Dinnah: The legal provisions granting safe abortion are not fully understood. Given the context of stigma and silence, many younger women and adolescents pursue unsafe abortions and experience severe complications. Prior to the pandemic, an estimated 10 percent of all maternal deaths in the country were associated with unsafe abortions. Increased physical and economic barriers to access and uptake of SRHR services like contraception during the pandemic means higher risk, as the majority of abortions in the country are attributed to unwanted and unintended pregnancies.

Digital access to abortion care is a huge opportunity, however, it is dependent on functionality of a wider health system to address inequalities in access and utilization of services. Currently it is only reaching those with a smart phone, often in urban areas. It is different in rural areas where fewer women own a mobile phone, and have lower economic ability to access a skilled provider, among other factors.

Brittany: Lockdowns, while an important public health measure to contain COVID-19, are hindering access to critical SRH services globally. What is the situation like in Uganda?

Dinnah: Anecdotal evidence from one of the violence against women coordinating platforms led by UN agencies shows that 480 cases of gender-based violence were reported by the police family and child protection unit in Kampala just two weeks after lockdown. It is a fragile environment for miscarriages and unsafe abortions worsened by increased economic pressures, growing emotional needs and limited psychosocial support.

We cannot deem SRH services essential only for those experiencing visible pregnancy in Uganda. This minimizes care-seeking behaviors and shortens the window of response especially for life-threatening needs associated with miscarriages and abortion. From a rise in unwanted pregnancies to an overwhelmed healthcare system dealing with these suppressed life-threatening issues months later…I worry about what our post COVID-19 SRHR scope of needs may be.

Brittany: What are you reading/listening to/loving right now, outside of work?

Dinnah: I am reading the Feminist Manifesto and rereading Mark Mason’s The Subtle Art of Not Giving a Fuck. And I love cycling in the village, there’s zero traffic jam!

Dinnah Nabwire was a 2015–2016 Global Health Corps fellow at Marie Stopes International. She is currently Knowledge Management Specialist at African Women’s Development Fund (AWDF). She is also a member of a team of GHC alumni leading KOIKOI Stories Uganda, an initiative to equip and train traditional birth attendants to administer misoprostol to treat postpartum hemorrhage, a leading and preventable cause of maternal death in Uganda. The intervention will begin in Moroto District, where over 60% of laboring women deliver their babies at home with the help of traditional birth attendants. The team plans to scale the model nationally in the next five years.

Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.