US-linked ‘crisis centres’ have been condemned by Uganda’s top reproductive health official for opposing contraception and telling pregnant women and teenagers that they should abstain from having sex instead.
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 over centres that provide services for survivors of sexual and domestic abuse without oversight from public institutions. Staff at one centre an undercover reporter visited 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, while almost a third of maternal deaths are of girls and women between 15-24 years old. Abortion is illegal in almost all cases, but the government strongly promotes contraception including for teenagers.
In contrast to state policy, each of three Ugandan centres a reporter contacted opposed contraception and promoted abstinence. Staff at one of these centres also warned her, incorrectly, that birth control pills manufactured abroad could cause cancer.
Each of these three centres is affiliated with the US religious right group Heartbeat International. This month, openDemocracy revealed numerous examples of “disinformation, emotional manipulation and outright deceit” in its global network.
At the Ugandan Ministry of Health, Sabiiti said the government supervises many faith-based health facilities across the country 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 added. While she hadn’t known about these centres before, Sabiita said: “We need a mechanism to apprehend them.”
Sympathy and blame
In the US, there are thousands of ‘crisis pregnancy centres’, run by religious groups, that seek to stop women from having abortions. In Uganda, abortion is illegal even in cases of rape and incest, unless doctors deem the woman’s life is at risk.
But there are still at least sixteen of these centres in the country, according to openDemocracy research. Nine are affiliates of the US group Heartbeat.
One of these, Wakisa Ministries, has been celebrated for sheltering pregnant teens. Though its own website casts doubt on the difference it makes; it says that only 137 of the 1,720 girls sheltered since 2005 returned to school after giving birth.
In an interview with openDemocracy, Vivian Kityo, Wakisa’s director, said it has also sheltered at least twenty 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 that spoke to a teenager who accompanied our undercover reporter to Wakisa and 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 eighteen, and the teenager said she was fifteen 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 criminalization 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 capitalize on this fact. They 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,” she 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’s a “non-profit federation of faith-based pregnancy resource centres, medical clinics, maternity homes and non-profit adoption agencies.”
As part of a global openDemocracy investigation, over the past nine months undercover reporters have contacted Heartbeat affiliates in eighteen 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 that 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 Life Choices Centre, has a sign by the main road that says “Are you pregnant and scared?” – much like the billboards of US centres, advertising to women with unplanned pregnancies.
Comforters’ sign specifically says it offers “abortion information” along with “abstinence education” and “natural family planning” (eshewing modern contraception and having sex only on certain days).
This centre’s staff gave our undercover 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 hard 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 Centre, is also openly anti-abortion, and anti-contraception, on its Facebook page. In one 2018 post, for example, it said that teenagers should get “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 fourteen-year-old sister, not to give her emergency contraception (which is legal in Uganda and supported by national reproductive health policies).
Heartbeat affiliates like the centres our reporter contacted are required to follow its “Commitment of Care” – a standards 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 things.
In response to questions from openDemocracy, 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 mischaracterizations of Heartbeat-affiliated pregnancy help centres have consistently not withstood scrutiny when brought into a court of law,” it added, and “a recent survey of pregnancy help centre clients revealed a 99% satisfaction score.”
Many of the centres openDemocracy 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 openDemocracy’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.”
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 other examples of foreign religious conservative activists visiting the country. For instance, she says that US and Spanish organizations 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 NGO Human Rights Watch says “are jeopardizing 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.”
Khatondi Soita Wepukhulu is an Ugandan feminist, an SRHR advocate and co-founder of Free Inquiry Uganda, a secular organization advocating for the separation of church and state in Uganda. Lydia Namubiru is an Ugandan journalist.