Power, policy and abortion care in Uganda

Abstract

Unsafe abortion practices remain the major contributor to maternal death in Uganda, impeding the achievement of universal health coverage and quality of maternal health care. Using an ethnographic design and critical discourse analysis, we explored the operations of power in setting maternal healthcare priorities, as evident at the 2018 Reproductive, Maternal, Neonatal, Child and Adolescents Health Conference. Observational data were collected of the policy-making activities, processes and events and key informant interviews were conducted with 27 participants. We describe how neoliberal and state governance through the structure and organization of policy-making, epistemic governance and universal concepts of ‘high-impact’ interventions, results-based financing, cost-effectiveness and accountability converge to suppress the articulation of local conditions associated with unsafe and risky abortion. By defining maternity along the continuum of birth and emphasizing birthing women, priority-setting was directed towards interventions promoting women’s normative role as mothers while suppressing unmet abortion care needs. Finally, discursive and communicative materials controlled how women of reproductive age in Uganda managed reproduction.

Politics–evidence conflict in national health policy making in Africa: a scoping review

“…It also emerged that strong government leadership and empirical-based approaches, effective engagement of experienced stakeholders, policy alignment with political priorities and evidence-based interventions are effective in policy formulation [ 46 ]. Furthermore, social, political, economic and institutional factors influence the effectiveness of national policy processes [ 35 , 39 , 47 , 49 , 50 ]. Additionally, the integration of national policies into international ones and formulation of new policies were driven by stakeholder interests, advocacy and collaborative efforts from civil society and the global advocacy movements [ 34 , 47 , 66 ].…”

Preventing death following unsafe abortion: a case series from urban Uganda

“…Abortion access in Uganda was expanded in 2006 in the limited circumstances of rape, incest, and preexisting health conditions, such as HIV. However, in practice, abortion remains unobtainable for most Ugandan women 21 , 22 , 23 …”

Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

“…Besides influencing advocacy coalitions, core beliefs have an important influence on policy choices. Reforms that threaten the core beliefs of policy makers and the public such as religion, culture and morality are generally subjected to doubt, defiance and resistance as in the case of male circumcision in Uganda and Malawi84 85 and abortion in Ethiopia, Tanzania and Uganda 86–88. Core beliefs also reinforce political ideologies which significantly influence policy reforms through discursive practices that are shaped by history, including challenging dominant narratives and the pre-eminence of transnational actors.…”

“…Reforms that threaten the core beliefs of policy makers and the public such as religion, culture and morality are generally subjected to doubt, defiance and resistance as in the case of male circumcision in Uganda and Malawi 84 85 and abortion in Ethiopia, Tanzania and Uganda. [86][87][88] Core beliefs also reinforce political ideologies which significantly influence policy reforms through discursive practices that are shaped by history, including challenging dominant narratives and the pre-eminence of transnational actors. The framing of the cholera epidemic in Zimbabwe as a global health security necessitating some external intervention threatened the core belief that Zimbabwe was a sovereign country free from outside interference.…”