Appraising Legal Instruments supporting Sexual and Reproductive Health Rights in Uganda.
By Cohort 5 of the Advocacy for Reproductive Justice in Africa Short Course
Uganda has made significant strides in promoting sexual and Reproductive Health Rights (SRHR) through various legal frameworks. This write-up assesses the current state of these instruments, highlighting strengths, weaknesses, and areas for improvement.
The Constitution of the Republic of Uganda, 1995, as amended.
The Constitution of Uganda provides for the right to health and enjoins the state to take all practical measures to ensure access to health services.1 This right provides a basis for providing SRHR services, information and commodities. The Constitution also protects the rights of women. Articles 33(3) and (5) oblige the government to protect women and their rights, considering their unique status and natural maternal functions. It further prohibits any laws, cultural practices, and customs that are against women’s welfare, interests, and dignity. The Constitution protects the right to life, including the life of an unborn child, and only permits its termination in exceptional circumstances.2 This provision restricts abortion and lends support to the criminalization of abortion under the penal code.3 The Constitution provides for equality and non-discrimination 4. However, it does not contain explicit provisions on the protection of key populations, yet this population group is marginalized and disproportionally affected by discrimination, violence and HIV.
The HIV and AIDS Control Act, 2014
The Act promotes universal access to HIV/AIDS services by regulating access to facilities, goods and facilities related to HIV prevention, counselling, testing and care, as well as outlines state obligations as well as duties of individuals. The Act embodies the principle of equality and non-discrimination and mandates the state to promote the rights of PLHIV and an enabling environment that is stigma-free. The Act specifically prohibits discrimination in healthcare, thus ensuring that access to SRHR services is not impeded on grounds of a person’s HIV status, whether actual or perceived. The Act calls explicitly for prioritizing the most at-risk populations in all interventions, which is commendable. The Act defines these communities as fishing communities, persons in prisons, migrants and other populations. While the law calls for greater access to these groups, it leaves out key and vulnerable groups highlighted by UNAIDS, including transgender persons, persons who use and inject drugs, sex workers and Men who sleep with Men. The omission of these groups from the Act has the effect of invisibilizing them regarding access to services, information and commodities. The Act also criminalizes the intentional transmission of HIV with
or without intent, a provision which discourages people from testing and disclosing their HIV status.
The Female Genital Mutilation Act (2010).
The Act prohibits female genital mutilation as being an inhuman cultural practice which violates women’s rights and is inconsistent with the provisions of the Constitution of the Republic of Uganda, 1995.
The Public Health Act, Cap 281
This obliges the Ministry of Health to ensure the effective provision of good health care to the people of Uganda, including women. It also encourages the provision of better reproductive health services to women. However, the Act is silent on key and vulnerable populations, including sexual minorities.
The Health Service Commission Act, 2001
The Act mandates health workers to prioritize and consider the health, safety, and interest of the patient and due respect to each patient at all times and in all circumstances5. The Act also obligates medical practitioners to provide patients with relevant, clear and accurate information to patients.6 Similarly, the Act requires the patient to provide informed consent prior to testing and treatment unless it is in emergencies. The Act obliges health workers to observe clients’ confidentiality and not disclose information without the patient’s consent. However, the Act allows a breach of confidentiality where disclosure is in the patient’s best interest. This provision undermines patient autonomy and agency while encouraging health workers’ paternalism to decide what is in the patient’s best interest. Such provisions promote avoidance of health behaviour, including testing and treatments.
The Employment Act (2006).
The Act emphasizes employees’ right to maternity leave and equal treatment at work, as stipulated under Sec. 56 of the Act. It also encourages the provision of protective gear to employees, including women, as stated under Sec. This, therefore, protects women from hazardous chemicals that may hinder their health.
Other Acts that affect SRHR include the Domestic Violence Act, 2010; the Education (Pre-Primary, Primary and Post-Primary) Act, 2008, which emphasizes access to the Universal Primary and Post-Primary Education Policy of Government; and the Children Act, 2003, as amended in 2016.
The National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights (2012)
The policy guidelines spell out the general rules and regulations governing reproductive health services, components of reproductive health services, target groups for services and appropriate primary information education and communication. To standardize the delivery of reproductive health services and the promotion of SRHR, the policy stipulates the roles of Ministries, Development Partners, communities and stakeholders engaged in the “planning, implementation, monitoring, and evaluation of quality, integrated, gender-sensitive and rights-based reproductive health services.7”
The policy introduced the safe motherhood program, which aimed at addressing the persisting sexual and reproductive health issues.
The motherhood program was developed to ensure that no woman or newborn dies or incurs
injuries during pregnancy or childbirth.
The policy targets integrated service delivery such as commercial sex workers, adolescents and
homosexuals. Still, it does not include the broad range of key populations, people living with HIV
and priority groups such as persons who inject drugs, people with disabilities, older people and
children.8
National Health Policy (2010).
The policy prioritizes reproductive health, maternal and child health, and HIV/AIDS control. It further emphasizes access to essential health services, including SRHR, such as safe motherhood, family planning, and adolescent health services
The MARPS Priority Action Plan, 2020: The Key Population Priority Action Plan guides access to services for key populations. The plan of action guides which services are available and how they should be provided. Like many others formulated post-2015, this action is inclusive and protects key populations and other vulnerable populations, including those explicitly criminalized.
Weaknesses:
Whereas policies on SRHR are mostly progressive and enabling, especially guaranteeing access to SRHR services and information and commodities for all persons, including population groups that are criminalized, there is still a multitude of provisions in legislation such as the Anti Homosexuality Act 2023, the Penal Code Act, cap 120 as amended, The HIV Prevention and Control Act, that criminalize the exercise of individual autonomy and choice thus impeding the enjoyment of SRHR. The Penal Code Act proscribes abortion and prevents women and girls from accessing safe abortions.9 The penalization of abortion increases the risks of maternal mortality as women and girls resort to unsafe and clandestine abortions and overall hinders the exercise of SRHR. Similarly, the Anti-Homosexuality Act also impedes SRHR by criminalization consensual sex act relations, thereby restricting access to SRHR services and commodities by gender and sexual minorities. 10 While the recent nullification of some sections of the AHA by the Constitutional Court of Uganda, including the imposition of mandatory reporting obligations on all persons, is expected to increase access to SRHR services by gender and sexual minorities 11 The constitutional court’s reliance on Dobbs B. Jackson Women’s Health Organization was deeply troubling.12 Such decisions demonstrate the far-reaching effects of the anti-rights movement and the rollback of gains in SRHR in Uganda.
There is limited access to safe abortion services due to restrictive laws and cultural and societal barriers, and this hinders the right to reproductive health rights.
There is limited awareness and education about sexual and Reproductive Health Rights among public healthcare providers, policymakers and the general public. Thus, there is a need to provide free access to information regarding SRHR.
Recommendations;
>There is a need to harmonize laws and policies to ensure consistency and effectiveness in achieving better SRHR outcomes.
>Increasing funding and resources for the health sector to provide better reproductive health care for women.
>The government and other stakeholders should conduct comprehensive education and awareness campaigns on SRHR.
>Provision of free access to information regarding SRHR.
In conclusion, Uganda has made significant progress in promoting SRHR through its legal frameworks. However, challenges persist, and addressing these gaps is crucial to ensuring the full realization of SRHR for all individuals, particularly women. Strengthening these legal frameworks and addressing the cultural and social barriers within a short period of time is most likely to resolve
issues relating to SRHR.
1 Constitution of Uganda, Objective Xiv(b)
2 Art 22(1)(2) of the Constitution of Uganda
3 Sections 141-143,212 and 224 of the Penal Code Act cap 120 as amended by
4 Article 21 of the Constitution, 1995
5 Section 30 of the Health Service Commission Act, 2001
6 Section 30(3)
7 Ministry of Health(MoH), The National Policy Guidelines and Service Standards for Sexual and Reproductive Health Rights, 12
8 Ibid 65
9 Section 141-143, 212 and 224 of the Penal Code Act cap 120
10 Sections 2 and 3 of the Anti-Homosexuality Act, 2023
11 Sections 3(2)(c), 9,11(2)(d) and 14 of AHA in consolidated petitions no 14, 15, 16 and 85.
12 No. 19 1392 597
good work