Uganda continues to face a major public health and human rights challenge related to unsafe abortion and limited access to comprehensive Sexual and Reproductive Health and Rights (SRHR) services, particularly among adolescents, rural women, refugees, migrants, and low-income communities. Despite progress in reducing maternal mortality nationally, unsafe abortion remains a significant contributor to preventable illness, disability, and death among women and girls.
According to Uganda’s 2024/2025 Maternal, Newborn and Child Health (MNCH) and Maternal and Perinatal Death Surveillance and Response (MPDSR) report, the national maternal mortality ratio stands at 189 deaths per 100,000 live births, with approximately 4% of maternal deaths linked to abortion-related complications. Estimates from the Guttmacher Institute further indicate that nearly 297,000 induced abortions occur annually in Uganda, equivalent to approximately 54 abortions per 1,000 women aged 15–49 years. A large proportion of these abortions occur under unsafe and unregulated conditions due to stigma, poverty, restrictive interpretations of abortion laws, inadequate contraceptive access, and limited SRHR information and services.
Adolescent girls and young women remain disproportionately affected. Uganda continues to record high teenage pregnancy rates, with nearly one in four girls aged 15–19 either pregnant or already mothers. Many of these pregnancies are unintended, increasing vulnerability to unsafe abortion, school dropout, child marriage, gender-based violence, and severe maternal health complications. Young women in rural and underserved communities face additional barriers including limited access to youth-friendly services, low reproductive health literacy, social stigma, and fear of discrimination when seeking care.
The situation is particularly severe in remote and underserved regions such as the Albertine region, where women and girls continue to experience major barriers in accessing SRHR services. These barriers include inadequate youth-friendly health services, shortages of trained health workers, weak referral systems, low contraceptive uptake, misinformation, restrictive social and cultural norms, poverty, and transport challenges. Fear of stigma, criminalization, and mistreatment within communities and health facilities further discourages many women and girls from seeking contraception, safe abortion information within Uganda’s legal framework, and post-abortion care services. As a result, health facilities continue to report preventable complications including severe bleeding, infections, infertility, and maternal deaths associated with unsafe abortion practices.
Beyond health service limitations, SRHR advocacy and coordination in the Albertine region remain weak, fragmented, and underrepresented at community level. Although several organizations and coalitions working on SRHR exist in Uganda, most are concentrated in Kampala and other urban centers. Consequently, rural communities where the burden of unintended pregnancies, unsafe abortion, poor maternal health outcomes, and limited family planning access is highest remain underserved and largely excluded from national advocacy and policy discussions.
Many national and international organizations rarely maintain a sustained presence in hard-to-reach rural communities. In most cases, communities are engaged as temporary project sites rather than long-term partners, with organizations entering during project implementation periods and withdrawing once funding cycles end. This has contributed to short-term and unsustainable SRHR interventions that fail to establish durable systems, community ownership, or long-term advocacy structures.
In addition, many top-level organizations and urban-based coalitions have limited understanding of the unique realities affecting SRHR access in rural communities. Issues such as poverty, low literacy levels, transport barriers, cultural silence around sexuality, religious conservatism, and fear of discussing sensitive issues such as family planning, post-abortion care, and unsafe abortion prevention are often more deeply experienced in rural settings than in urban areas. Grassroots organizations, women-led groups, youth networks, community health advocates, and local leaders living and working directly within these communities are therefore better positioned to understand local realities, build trust, facilitate dialogue, and sustain culturally responsive SRHR advocacy and service delivery efforts.
Despite their critical role, many grassroots organizations and local actors in the Albertine region lack the technical capacity, coordination mechanisms, funding, and advocacy platforms needed to effectively influence SRHR policy, accountability, financing, and service delivery systems. Fear of backlash, stigma, political sensitivity, and restrictive social norms surrounding SRHR issues further discourage many organizations and community leaders from openly discussing or advocating for family planning access, unsafe abortion prevention, safe abortion within Uganda’s legal framework, and post-abortion care services.
Before Access Coalition , there was no regional community coalition uniting community-based organizations, youth groups, women-led organizations, health advocates, local leaders, and grassroots networks around a shared SRHR agenda in the Albertine region. Existing advocacy efforts are often isolated, fragmented, and implemented in silos, resulting in duplication of efforts, inconsistent messaging, weak grassroots mobilization, and limited influence on district and national policy reforms. The absence of a coordinated regional advocacy platform has weakened collective action and reduced opportunities for local organizations to meaningfully participate in shaping reproductive health policies and accountability processes.
Unsafe abortion therefore remains both a major public health crisis and a broader social justice and human rights issue in Uganda. Women and girls, especially those living in remote rural communities, continue to suffer preventable illness, discrimination, and death due to inadequate access to comprehensive SRHR information and services. Addressing these challenges requires strengthened SRHR awareness, improved access to contraception and post-abortion care, community-led advocacy, stronger referral and health systems, and sustained investment in locally driven and culturally responsive interventions.
There was an urgent need to establish and strengthen a locally led, community-rooted regional SRHR coalition in the Albertine region to amplify grassroots voices, coordinate advocacy efforts, strengthen community knowledge and leadership, promote sustainable and rights-based interventions, and collectively influence policies, financing, accountability, and service delivery systems aimed at protecting the health, dignity, and reproductive rights of women and girls. Such a coalition would help bridge the gap between national advocacy efforts and the realities faced by rural communities while ensuring that local actors and affected populations are at the center of SRHR solutions and decision-making processes. This led formation of the ACCESS Coalition!