/ 24 February 2020

Inside Uganda’s controversial ‘pregnancy crisis centres’, where contraception is discouraged

Adolescent Girls At Community Center In Uganda
Girls read an educational book at an adolescent youth center in Uganda. The girls are offered critical life skills training to help them manage socail issues. Low contraceptive usage has fuelled fertility with 59% of girls pregnant by the age of 20. (Neil Thomas/Corbis via Getty Images)

“Crisis pregnancy centres” with links to the United States have been condemned by Uganda’s top reproductive health official for opposing contraception, and instead telling pregnant women and teenagers that they should abstain from having sex.

An undercover investigation, co-published today by Open Democracy and the Mail & Guardian, has confirmed that these centres are discouraging contraception — in violation of Uganda government policy.

Dr Jesca Nsungwa Sabiiti, Uganda’s reproductive health commissioner, said these centres are not regulated by the ministry of health and are undermining government policy, which encourages contraceptive use. 

She also expressed concern about centres that provide services for survivors of sexual and domestic abuse without oversight from public institutions. Staff at one centre in Kampala told a teenager she had “consented in a way” to incestuous rape.

Uganda has one of the highest rates of teenage pregnancy Africa, and  almost a third of maternal deaths are of girls and women between 15 and 24 years old. Abortion is illegal in almost all cases, but the government strongly promotes contraception. 

In contrast to state policy, each of the three Ugandan centres contacted by an undercover reporter opposed contraception and promoted abstinence. One centre also warned, incorrectly, that birth control pills manufactured abroad could cause cancer.

Each of these centres is affiliated with the religious-right group Heartbeat International. Last week, Open Democracy revealed numerous examples of “disinformation, emotional manipulation and outright deceit” in its global network. 

“There are thousands of such centres in the US. Many have been criticised for posing as neutral health facilities for women with crisis pregnancies, while hiding their anti-abortion and religious agendas. But the global scale of these controversial activities has not been mapped until now,” Open Democracy reported.

Sympathy and blame

At the Ugandan ministry of health, Sabiiti said the government supervises many faith-based health facilities but that these centres are not among them. She said she was surprised to learn that they existed. She was also alarmed. 

“If the girls are already expecting and are being counselled against contraception, that is wrong,” said Sabiiti, who explained that the ministry has a specific policy to teach mothers and pregnant women and girls about modern contraception.

Survivors of abuse meanwhile need “holistic” support and “cross-referral to other sectors like justice, education and gender”, she said. Although she hadn’t known about these centres before, Sabiita said, “We need a mechanism to apprehend them.”

There are at least 16 of these centres in Uganda, according to Open Democracy research. Nine are affiliates of the US group Heartbeat. 

One of these, Wakisa Ministries, has been celebrated for sheltering pregnant teenagers. But even its own website casts doubt on the difference it is really making: it says that only 137 of the 1 720 girls sheltered since 2005 returned to school after giving birth.

In an interview with Open Democracy, Vivian Kityo, Wakisa’s director, said the centre has also sheltered at least 20 pregnant pre-teens, about 40% of whom had survived incestuous rape. She opposes abortion even in these cases, she confirmed. 

Kityo was one of the people who spoke to a teenager who accompanied our undercover reporter to Wakisa. The teenager said she was pregnant after having sex with her uncle because she was scared he would stop paying her school fees. The age of consent in Uganda is 18, and the teenager said she was 15 years old. This would be classified as statutory rape under the law, as well as incest. 

Kityo expressed empathy, telling the girl, for example: “The incest is not your fault.” But she also said: “You consented, in a way.” Another counsellor asked: “Did he force you to have sex with him?” and: “How does your auntie feel about you now?”

Their visit to Wakisa was secretly recorded. Afterwards, Elizabeth Kibuka-Musoke, a Ugandan clinical psychologist, read the transcript and was taken aback. At some points, she said, “the counsellor seemed to be blaming the victim”.

Overall, she described the session as flipping between emphases of “God loves you” and “You’ve been a bad girl and you need to be punished.” 

When the teenager said she didn’t want to continue the pregnancy, and was considering an abortion, Wakisa’s counselling became more confrontational. “You should have thought about that in the first place,” the counsellor said.

“If the law catches up with you,” the teenager was warned, she could be sent to a juvenile jail and then a maximum-security prison. She was also told, incorrectly, that any abortion carries severe health risks and: “You want to abort, you die.”

Despite the near-complete criminalisation of abortion, hundreds of thousands of abortions are estimated to happen in Uganda each year. In almost all cases, these are illegal procedures and are often carried out in unsafe conditions. 

Wakisa appears to capitalise on this fact. Staff at the centre described all abortions, incorrectly, in graphic terms. “They can even cut your intestines,” the counsellor said, while dismissing the teenager’s knowledge about safe abortion practices as hearsay. 

“Girls are getting fistula so you never know what they’ll cut inside,” the counsellor continued ― apparently suggesting that fistula is a common consequence of abortions. In fact, fistula often affects teenagers whose bodies are not quite ready for childbirth.

‘What if this is the future president?’

Founded in 1971, the US group Heartbeat now has a presence on “every inhabited continent” and says it is a “nonprofit federation of faith-based pregnancy resource centres, medical clinics, maternity homes and nonprofit adoption agencies”. 

As part of a global Open Democracy investigation, over the past nine months undercover reporters have contacted Heartbeat affiliates in 18 countries, posing as vulnerable women with unwanted pregnancies looking for help.

Around the world, many of these reporters were made to feel guilty for considering abortions and were given misleading information about psychological and physical health risks. Some reporters were told strikingly similar things. 

In South Africa, a reporter was told that she could be “killing the future president” and warned she could face “post-abortion syndrome” (which many medical experts say does not exist). At Wakisa in Kampala, staff also asked: “What if this is the future president you want to abort?” and warned about “post-abortion syndrome”. 

She was further urged to carry the babies of young mothers who live in Wakisa’s shelter. “Do you feel this baby has any faults?” asked the counsellor, telling the teenager she had “no right to take away the life” of her “baby”. 

Wakisa does not hide its anti-abortion stance online, and its staff also discouraged the teenager from using contraception, saying: “I tell people not to get on family planning because you don’t know what you’re putting in your body.”

Another of Heartbeat’s affiliates in Kampala, Comforters Centre Uganda, has a sign by the main road that reads “Are you pregnant and scared?” — much like the billboards of US centres that advertising to women with unplanned pregnancies. 

Comforters’ sign specifically says it offers “abortion information”, together with “abstinence education” and “natural family planning” (eshewing modern contraception and having sex only on certain days to avoid pregnancy). 

This centre’s staff gave our reporter, who said she was a university student who feared she was pregnant, misinformation about contraception as well as abortion. 

They told her, incorrectly, that she could “catch” cervical cancer from an abortion and find it difficult to conceive after — and warned her, also incorrectly, that contraception that is manufactured overseas could cause cancer. 

There is no credible evidence of links between women’s risks of cancer and abortion or contraception, according to most medical experts. There is also no credible evidence that abortions cause future reproductive problems.

The third Heartbeat affiliate our reporter contacted in Kampala, the Alma Family Center, is also openly anti-abortion, and anti-contraception, on its Facebook page. In one 2018 post, for example, it said that teenagers should receive “preventive knowledge around abstinence and faithfulness” instead of access to contraception. 

Staff at this centre told our reporter, who said she needed advice for her 14-year-old sister, not to give her emergency contraception (which is legal in Uganda and supported by national reproductive health policies). 

The staff also incorrectly called it “early abortion”. (The World Health Organisation explains that emergency contraception prevents pregnancy.)

Heartbeat affiliates, like the centres our reporters contacted, are required to follow its “Commitment of Care” — a document that says affiliates will “not offer, recommend or refer for abortions, abortifacients or contraceptives”, but that that they will provide women with “accurate information” about these matters. 

In response to questions from Open Democracy, Heartbeat said its affiliates must follow these “basic principles … but all other matters of policy and management remain under the direction of the centres’ local leadership, allowing for autonomy”.

“Public mischaracterisations of Heartbeat-affiliated pregnancy help centres have consistently not withstood scrutiny when brought into a court of law,” it said, adding that, “A recent survey of pregnancy help centre clients revealed a 99% satisfaction score.”

Follow the money

Many of the centres Open Democracy investigated internationally are also part of regional networks that have received Heartbeat money. These include both the Comforters and Alma Family centres in Kampala that are part of the Association for Life of Africa (Afla) network, which has received at least $50 000 since 2013. 

It is unclear if either centre benefited from this funding, however. Neither Comforters, the Alma Family Centre nor the Afla regional network responded to Open Democracy’s questions and requests for comment for this article.

Kityo, Wakisa’s director, said over email that her centre has nothing to hide. She said: “We are firm as believers in Christ in what we do and believe.”  

There have been efforts to change Uganda’s near-complete ban on abortion. In 2006, the health ministry expanded abortion access to survivors of rape and incest. But its guidelines were quickly recalled following a backlash from religious leaders. 

The health ministry is staffed by experts that are unable to make their own decisions because “the powers that be are accountable to the church”, says Kampala-based human rights lawyer, Joy Asasira.

She also points to other examples of foreign religious conservative activists visiting the country. For instance, she says that US and Spanish organisations met with Ugandan MPs who then established a “pro-life” parliamentary caucus in 2018.

The US government has itself funded abstinence-only programmes in Uganda since at least the early 2000s, which the international nongovernmental organisation (NGO) Human Rights Watch says “are jeopardising Uganda’s successful fight against HIV/Aids”.

At the Ministry of Health, Sabiiti said “the time has come” for legal change to enable more women and girls to access legal and safe abortions. 

But to achieve that change, Asasira says Uganda needs greater “separation between church and state”, so that its professionals and politicians can act in the interests of the population and not feel the need to be “in good standing with religious leaders”.