For many women, pregnancy begins with hope and dreams of welcoming a new life. But for some, that journey ends in the heartbreak of miscarriage. Instead of finding immediate medical care and emotional support, many women in rural Amuru district are forced to endure long walks to health facilities before receiving treatment.
These delays often expose the women to severe bleeding, infections and other life-threatening complications that could have been prevented through timely professional care.
Lamunu, an 18-year-old resident of Wing Julu Village in Pabbo subcounty in Amuru district, says the loss of her first pregnancy remains a painful memory.
Lamunu conceived in May 2026. By the second month, she started experiencing severe abdominal pain. One day while working in her garden, she suddenly began bleeding. Believing it was her normal menstrual period, she stayed home for several days before realizing something was seriously wrong.
“I delayed seeking medical attention because I thought I was having my period. I didn’t even know I was pregnant,” she recalls.
As the pain worsened, Lamunu had no choice but to walk for nearly two hours to Otong Health Centre II.
“I started walking at 8 am and reached at around 10 am because I had no money for transport,” she narrates, her tears rolling down her cheeks.
Health workers later informed her that she had suffered a miscarriage and advised her to seek further treatment to completely clear the uterus of clots and other tissues. Unfortunately, she never returned because she could not afford the medical expenses.
“If only I had been attending antenatal care, I would have known how to take care of my pregnancy and recognized the danger signs earlier,” she says.
Lamunu says throughout the ordeal, her husband offered little support.
“When I asked him to accompany me to the hospital, he always said his clothes were dirty. Instead, it was my mother who paid for all my hospital visits.”
Lamunu says if she gets money, she will go for proper medical care to understand more and know what could have caused the miscarriage.
Her experience reflects the reality faced by many women in Amuru District, where long distances to health facilities and lack of transport delay access to life-saving post-abortion care.
A week of bleeding
Adyero, a 21-year-old resident of Otong village in the same subcounty, who was two-and-a-half months pregnant, bled for an entire week without seeking medical attention.
“I didn’t go to the hospital immediately because I had no money. I’m a farmer, and we had to wait until my husband sold some produce to get money,” she says.
When she eventually reached Lacor Pabbo Health Centre III, health workers confirmed that the pregnancy could no longer be saved.
“They told me the pregnancy was no more. I was given medicine and injections to help expel it from my uterus,” Adyero narrates.
Although she eventually recovered, she believes things could have been different.
“If I had gone to the hospital immediately when I started bleeding, maybe the pregnancy could have been saved. The biggest challenge was lack of money because without it, they would not work on you,” she says, before pausing to clear her tears.
A painful first pregnancy
For Anena, an 18-year-old mother, the loss came during her first pregnancy.
She developed severe abdominal pain when she was three months pregnant. Her mother-in-law rushed her to Otong Health Centre II, where she was told she had miscarried.
Health workers advised her to avoid strenuous work during future pregnancies.
Although the nearest health facility is only about two kilometers from her home, Anena says she had not yet attended her first antenatal visit.
“I was planning to start antenatal care, but I lost the pregnancy before I could begin,” she says.
Unlike many women, Atim, a 23-year-old mother, had strong support from her husband.
When she began experiencing abdominal pain during her third pregnancy, her husband, who is also a Village Health Team (VHT), immediately rushed her to Lacor Pabbo Health Centre III.
She was admitted, treated, and later referred by ambulance to St. Mary’s Hospital Lacor after repeated ultrasound scans showed that the pregnancy had failed.
After several days of treatment, she finally miscarried.
“When I was told I had lost the pregnancy, I was heartbroken,” Atim recalls.
She praises her husband for standing by her throughout the ordeal.
“He supported me financially and emotionally. He never gave up on me despite the expensive medical bills.”
However, she criticizes the attitude of some health workers.
“The nurses at Lacor Pabbo shouted at us patients and made us feel like we were burdening them. At St. Mary’s Hospital Lacor, the medical team treated me with kindness and respect.”
She now encourages pregnant women to seek medical care immediately whenever they experience bleeding or severe pain.
The cost of seeking care
Atim’s husband, Doctor Oyet, says distance and poverty continue to prevent many women from seeking timely care.
“From here to Lacor Pabbo Health Centre III, a bodaboda ride costs about Shs 5,000 one way. When you add transport, hospital bills, and feeding for both the patient and caretaker, many families simply cannot afford it,” he says.
Oyet believes the government should upgrade lower-level health centres so women do not have to travel long distances for emergency obstetric services.
“The government should improve our roads and equip nearby health facilities so women can receive treatment closer to home,” he says.
He also urges health workers to treat patients respectfully.
“Some nurses shout at women instead of comforting them. That scares many of them away from seeking care,” Oyet adds.
According to the Assistant District Health Officer in charge of Maternal and Child Health in Amuru district, Sister Jane Chandiru, health facilities already provide comprehensive post-abortion care, including treatment for miscarriages and incomplete abortions.
However, she notes that many women arrive late because they fear being stigmatized or accused of procuring an illegal abortion.
Sister Chandiru is calling for increased community awareness to encourage women to seek medical attention immediately after any pregnancy loss.
Why post-abortion care matters
According to Dr Jimmy Opee, an obstetrician and gynaecologist as well as a public health specialist and Head of the Department of Obstetrics and Gynaecology at Gulu University Faculty of Medicine, abortion refers to the loss of a pregnancy before 26 weeks of gestation, regardless of whether it occurs naturally or induced.
“Most cases of abortion are actually unintended. Those are what we call spontaneous abortions or miscarriages,” Dr. Opee says.
He explains that every woman who experiences pregnancy loss should receive comprehensive post-abortion care.
“Post-abortion care means that the abortion process has already started or has already been completed, but the woman still needs care to prevent complications,” he says.
According to Dr. Opee, post-abortion care includes treatment of incomplete abortion through uterine evacuation where necessary, counseling, post-abortion family planning, referral to other sexual and reproductive health services, and community support to reduce stigma.
He warns that delaying treatment can have devastating consequences.
“Many women die because of significant blood loss, infections and complications resulting from unsafe abortion,” he cautions.
Dr. Opee says miscarriages are commonly caused by chromosomal abnormalities, hormonal disorders, environmental factors and certain maternal medical conditions.
He advises women to wait until the uterus has healed, generally about six months, before attempting another pregnancy and to seek preconception counselling from a healthcare provider.
A call for action
Dr. Opee also urges men to play a greater role in supporting women before, during, and after pregnancy.
“Male involvement should be encouraged, health education should be promoted, and women should receive respectful care with privacy, confidentiality and empathy,” he advises.
He further calls on the government to ensure health facilities are stocked with medicines, equipment, and supplies needed to provide quality post-abortion care.
“We need post-abortion care services with all the necessary supplies, equipment and drugs available at all times. Healthcare providers have the knowledge and skills, but without these essentials, we cannot do the best for our people,” he says.
For the women of Amuru, the journey to recovery after miscarriage is often measured not only by emotional pain but also by kilometers walked, transport fares they cannot afford and the long wait for quality healthcare. Until essential post-abortion services are brought closer to communities, many women will continue to risk their lives simply trying to reach the care they need.
Abortion in Uganda
In Uganda, unsafe abortions account for an estimated 5% to 10% of all maternal deaths. Studies also suggest that between 35.2% and 47.8% of induced abortions are carried out outside safe medical environments, exposing women to life-threatening complications.
Legally, abortion in Uganda is highly restricted but is permitted under certain circumstances, such as when it is necessary to save the life of the mother, including cases involving severe medical conditions like high blood pressure, as well as in situations involving rape, incest, or severe fetal abnormalities. In such cases, the procedure must be performed by a qualified medical professional.
Despite these legal provisions, many Ugandans believe that abortion is completely illegal and criminalized under all circumstances. As a result, women often seek abortion services in secrecy from unskilled health workers, who frequently lack the training and equipment to perform the procedure safely. This exposes women to serious complications that can threaten their lives and long-term health.
Unfortunately, when complications become severe, these unskilled providers often refer patients to health facilities for post-abortion care (PAC). In many cases, however, the referral comes too late to save the woman’s life or to prevent permanent, life-altering complications.
This story was done with grant support from the Health Journalism Network Uganda (HEJNU).
