Susan Kipwola speaks on post abortion care in Gulu recently ,Photo By Simon Wokorach
By Simon Wokorach
Gulu:Three months had passed in the hospital, and the bills had accumulated, but her deceased mother had progressively shown recovery, though.
“When Covid came, my father abandoned us in Kampala and we returned to Gulu. My mother became sick, but we never heard of his whereabouts again”. A voice of a young girl-turned sex worker in Gulu.
Now 17-year-old Prosovia Lalaa, whose name has been altered, recalls how fighting to save her mother ended her goal of becoming a nurse and ultimately forced her onto the streets.
Her mother spent three months at one of the government hospitals in Gulu after being diagnosed with severe diabetes and high blood pressure.
Lalaa stated in a recent interview in the Gulu City suburbs that the invoices had grown to 430,000 shillings, but her mother’s roadside business had failed to pay them.
Before her husband left her and their three children in Kampala, her mother worked as a roadside food vendor. They later moved back to Gulu, where she lived until her death.
In addition to making treatment difficult, Lalaa was left without food for both her siblings at home and her ailing mother in the hospital.
Lalaa had just received her Uganda Certificate of Education results, which showed an aggregate of 24, when the mother was admitted, and she had begun preparing to enroll in a medical school to become a nurse.
Days beside her sick mother, just like she would first attend to her in the morning, Lalaa would leave in the afternoon to sell roasted maize within the city before she returned to her in the evening.
Consistently, for two months, she would balance her time to run the family with street vending and attend to the mother in her hospital bed.
“Then I got a restaurant which allowed me to work for six hours. I wasn’t paid money but was given three plates of food to take home. One for my mother, two for my siblings,” She vividly recalls.
At least there was food, but her mother’s condition kept deteriorating. This government hospital had referred her to a private clinic to conduct more tests, which required an additional 135,000 shillings.
Susan Kipwola takes a daily record of people seeking post abortion services, HIV care at Ayee Health Centre in Gulu,Photo By Simon Wokorach
Suddenly, two men visited her mother; one volunteered to pay the bills. Lalaa felt relieved, hoping to get the support, only to be raped before being handed the money, the painful reality she lives with.
“He told my mother I would come back with the money; we never reached his home but took me to a lodge and raped me! he rapped me”, Lalaa quietly speaks with a heavy load visible on her face.
She adds” Yes, you need this money. I will be helping you if you need more support. I had a boyfriend and never slept with him, but I lost my pride through rape. He was three times older than me.”
Detained until late evening by the man who eventually raped her, and when she returned, her mother had passed on and the nurses were preparing the body for transfer to the mortuary.
“When I started going, she called me back and said, if we do what the nurses are saying, they will give me the right drugs, and we shall go home this week. I never talked to her again.” She narrates.
Motherhood on the streets
As a result, Lalaa’s struggle to survive persisted; she began taking care of the family after giving up on her goal of becoming a nurse, and the boys also stopped attending elementary school.
Her life abruptly altered, and she eventually ended up on the streets of Gulu, where she joined hundreds of other young girls who are tricked into engaging in commercial sex in order to survive. Today, she is a breadwinner.
Although on the streets, Lalaa continues facing multiple challenges, and she has lost count of the many times men have raped her as she tries to make a living.
Pregnancy was the outcome of the current tragedy. “He offered me 6,000 shillings; we agreed to use condom, but he ended up tying my hands on the bed, put 15,000 shillings down, raped me and left.”
After being raped a second time, Lalaa became pregnant a few months later, but she was unable to notify the man who had caused her pregnancy. Raising a child alone made her feel more distressed once more, and she ultimately had an abortion.
Uganda’s abortion laws remain restrictive, permitting the procedure only under specific medical and legal conditions.
The legal frameworks include Article 22(2) of the 1995 Constitution and the Penal Code Act, which prohibit abortion except under limited circumstances.
These circumstances include rape, non-viable pregnancies, HIV-related risks, or when the mother’s life is in danger, but for survivors like Lalaa, securing abortion through court is a complex journey to explore.
As a result, some women turn to private clinics; others resort to traditional herbs, including a plant like wandering jew, to induce abortion that often results in severe complications.
Like many, Lalaa bought drugs from a nearby clinic, induced herself at home that ended her pregnancy, but later developed complications that nearly claimed her life.
Susan Kipwola holds Prep that she frequently gives to high risk populations: Photo By Simon Wokorach
On July 9, 2026, Thursday morning, she walks out of a private clinic to her grass-thatched house carrying some drugs as she slowly recovers from abortion complications.
At the private health facilities within Gulu City, Lydia’s post-pill is among the commonly available over-the-counter drugs being prescribed.
This, as an emergency contraceptive, is used to prevent pregnancy when taken within 72 hours,(3 days) of unprotected intercourse, but Lalaa used this drug to end her pregnancy.
“I just thought of a child I will raise alone. I don’t know the father; I will never know him; nobody even knows him. I risked and swallowed five tablets at once”. Lalaa painfully reflects.
But a few hours later, she was admitted to Gulu Regional Referral Hospital for post- abortion care, although her complications arising from losing much blood were managed.
While she survived, several of her peers are battling with abortion complications, including death and removal of their uterus, with multiple challenges they quietly face.
Within the neighbourhood, in March 2026, Lalaa lost her immediate friend aged 19 who died by suicide when she realised that she was living positively with Human Immune Virus (HIV) infection.
Like many of these young girls who are struggling to survive on the streets, Lalaa said, when her friend tested positive, she was enrolled on the antiretroviral treatment (ARV) from a nearby health facility.
But a day before her death, she had gone with a man who promised her money after sex; then, after the intercourse, the man locked the room and left her unconscious.
The next morning, people broke the door and rescued her; under her bed, HIV drugs were discovered. Her status was exposed; people started talking badly about her, and she isolated herself from the public.
“When I checked on her the next day, I found her lying on the floor half dead. We rushed to the hospital, but it was too late to save her life. She swallowed all the ARV pills at once,” Lalaa emotionally stated.
However, she noted that, of the over 20 girls closer to her who live on the streets, 5 of them are living with HIV, 11 had undergone abortion from February to July this year, while one died by suicide.
“My friend felt hopeless after because her status was known. The man mixed soda with some drug that made her sleep, slept with her and never gave her anything. She was really depressed,” Lalaa disclosed.
In the next grass-thatched house, a young girl in her 20s was also still struggling to manage the excessive bleeding from a private clinic after she ended her pregnancy with a traditional herb.
The records from Gulu Regional Referral Hospital indicate that 362 women sought post-abortion care over the past year.
However, many of the women did not receive follow-up psychosocial support due to a shortage of trained counselors which continues to affect their recovery.
Nationally, Uganda records approximately 2.2 million pregnancies annually, with 44% classified as unintended. These figures contribute significantly to unsafe abortion practices in the Country.
In the Acholi sub-region, complications arising from abortions accounted for 9.4 % of maternal deaths between 2021 and 2022, one of the highest proportions in the country.
Dr Francis Pebolo, a gynecologist at the hospital’s maternity ward and lecturer at Gulu University, revealed that daily admissions for post-abortion care have doubled from about five cases to at least ten.
He noted that the majority of patients are teenage mothers and women from economically disadvantaged backgrounds, many of whom resort to unsafe methods to terminate pregnancies.
“Most of these cases are preventable, but the restrictions and stigma push women to unsafe alternatives,” Dr Pebolo said recently while speaking to journalists at a health cafe in Gulu.
A lawyer and sexual and reproductive health rights advocate, Cinderella Alimuchan, warned that restrictive abortion laws continue to endanger women and girls.
She noted that Uganda is a signatory to several international frameworks, including provisions under Article 14(2) of the African Women’s Charter, which support access to reproductive health services.
She argues that taking post-abortion care services to lower-level health facilities will improve accessibility for women and reduce maternal deaths and other health-related complications.
Health care on the streets
The lower health facilities have brought health care services closer, focusing on the high-risk groups, while survivors and young moms like Lalaa continue to face numerous obstacles on the streets.
HIV testing and post-abortion care services are provided at covert locations as part of the program, which is being carried out by community connection facilitators, volunteer health workers, and counselors.
Susan Kipwala, a 28-year-old primary school teacher, left the classroom to pursue training as a paramedic after seeing the lack of healthcare facilities available to Gulu’s high-risk populations.
Aywee Health Centre, where only three of fourty volunter workers continue to work amidist health aid cut ,Photo By Simon Wokorach
Today, while serving on the streets each evening with HIV testing equipment, ARV drugs, and PrEP (pre-exposure prophylaxis), Kipwala continues to build a stronger network of expanding health care services.
The team move on the streets of the targeted areas each day. These three volunteer workers attached to Aywee Health Three in Laroo-Pece conduct a minimum of 50 HIV tests and counselling services.
“We were 40 volunteer workers in Pece Laroo Division, but when Trump cut off funding to Usaid, many left; but 3 of us are supporting these lower health facilities”. Kipwala noted.
As recently as June 30, 2026, of the 48 tests the team conducted on female sex workers, 4 new cases were recorded, while of their 15 male sexual partners, two positive cases were also documented.
That day, before stepping on the streets, in the morning, at her recording desk at the health facility, Kipwala received over 20 female sex workers, some as young as 14 and 16, who sought medical care.
At least 8 of them who tested HIV positive were enrolled on treatment, while 6 who came with complications related to induced abortion were put on post- abortion care.
At Gulu Regional Referral Hospital, the In charge Gynecology and Maternity Ward, Sister Margaret Auma, says most mothers who come to the facility present with retained products.
This means the abortion has either started at a clinic or been self-induced for such cases as she noted, reiterating that the unit receives between 5 and 10 mothers seeking post abortion care daily.
“Some come while bleeding, and we can tell that this is a natural abortion, (spontaneous) but others come with sepsis. For those, the abortion is self-induced or has started from a clinic,” Auma observed.
She, however, noted that managing induced abortion is complex, which requires more days with patients, noting that the unit sometimes runs out of equipment to handle such conditions.
The average age of the mother seeking post abortion care ranges between 20 and 29, with isolated cases of young girls below 18 years.
“Those who come with sepsis conditions, we put them on antibiotics for three days before removing the retained products. It requires more days with the patients and is very challenging,” Auma explained.
Meanwhile, as the city battles post abortion care, the HIV Focal Point Person for the City, Florence Amito, has expressed concern about the high prevalence of HIV within the City.
She noted that the higher numbers of mothers turning to post-abortion care clearly explain the vulnerability of most women who do not negotiate for safer and protected sex.
By June 2026, the city had a total of 22,437 people living with HIV, largely comprising 14,802 women against 7, 637 men, with the prevalence standing at 9%, above the national standing of 7%.
The higher risk factors of the infection include behaviors, social factors, barriers to accessing healthcare services, transgender people, and women who receive money, goods, or money in exchange for sex.
The production of this story was done with small grant support from the Health Journalism Network Uganda.
