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Introduction Over 60% of unplanned pregnancies end up in abortion and an estimated 45% of these abortions are unsafe, contributing for 13% of all maternal death globally. This study aimed to determine the prevalence and factors associated with unsafe abortion among married women admitted to the gynecological ward at Lira Regional Referral Hospital, a public facility in Lira City, Northern Uganda. Methodology We conducted a cross-sectional study among married women admitted with abortion to the gynecological ward at Lira Regional Referral Hospital, Lira City, Northern Uganda from December 2022 to April 2023. We used a consecutive sampling technique to recruit 368 participants. We collected quantitative data using an interviewer-administered questionnaire, and we analyzed descriptive statistics using Statistical Package for Social Sciences version 29.0. We obtained ethical approval from the Gulu University Research Ethics Committee and Lira Regional Referral Hospital’s administration. We gained informed consent from the study participants. Results 203 (55.2%) of the respondents were aged 15–24 years, 160 (43.5%) were from a rural setting, 158 (42.9%) were Protestants by religion, 338 (91.8%) were Lango by tribe, 111 (30.2%) were peasants, and 229 (62.2%) had primary level of education. 176 (47.8%) respondents had unsafe abortions, while 192 (52.2%) had safe abortions. Respondents who were aged 15–24 years were less likely to have unsafe abortion (AOR: 0.685, 95% CI: 0.454–0.725, P  = 0.020) compared to respondents aged > 34 years. Respondents who were from rural settings were more likely to have unsafe abortion AOR: 2.559, 95% CI: 1.453–4.505, P  = 0.001) compared to those who were urban settings. Respondents who had monthly income of < 100,000 shillings (AOR: 2.677, 95% CI: 1.426–5.023, P  = 0.002), 100,000–250,000 shillings (AOR: 2.854, 95% CI: 1.463–5.567, P  = 0.002), and 250,000–500,000 shillings (AOR: 2.306, 95% CI: 1.031–5.158, P  = 0.042) were more likely to have unsafe abortions compared to those who had total monthly income of > 500,000 shillings. Conclusions There was a high prevalence of unsafe abortion in this study. Older age, coming from rural settings, and low monthly income were significantly associated with unsafe abortion practices. The Ministry of Health should launch a national campaign to educate the public about the risks of unsafe abortion and the availability of sexual and reproductive health services, such as family planning services, to prevent unsafe abortion from unplanned pregnancies.

ObjectivesTo critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting.DesignThis was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants.SettingThirteen primary healthcare centres, one general private-not-for-profit hospital, one regional referral hospital and one teaching hospital in northern Uganda.ParticipantsForty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling.ResultsAfter reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and-forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional.ConclusionOur findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes.

Unsafe abortion is a major problem in Uganda, being one of the leading causes of maternal morbidity and mortality. Abortions are performed mostly under unsafe conditions, by people without medical training. In rural areas in northern Uganda, women often resort to traditional providers, who use local herbs as abortion remedies, usually with adverse outcomes. Little is known about the biological properties of these herbs and their toxicity profile. Here, we present the case series of two women, of 31 and 24 years of age, who underwent unsafe abortion for unintended pregnancy by using herbal medicines, that is, Commelina Africana (wandering jew) and Vernonia amygdalina (bitter leaf), respectively. While the first case resulted in uterine necrosis and pelvic peritonitis, which required multiple surgical interventions and the use of reserve antibiotics, the second case resulted in liver and renal failure that led to the death of the patient. This case series describes the unusual severe toxicity of two herbal medicines that are frequently used to induce abortion in northern Uganda. It highlights possible associations of Commelina Africana (wandering jew) with uterine necrosis complicated by sepsis, and of Vernonia amygdalina (bitter leaf) with acute liver and renal failure.