Reaching Young Doctors from Around the World Through Student Activism
Paul Mulyamboga is a 4th year medical student and MSFC chapter leader at St Augustine International University in Kampala, Uganda. The chapter recently advocated for abortion education to be included in the curriculum, changes that were unprecedented at any medical schools in Uganda. After months of advocacy, culminating in a two-week student-run pilot program in April, university officials voted to include medication abortion education in all years of study. The changes will be implemented this summer.
The Medical Students for Choice chapter of St. Augustine International University (SAIU) was started in November 2017, with an aim of increasing medical students’ access to safe medical abortion education and skills through trainings, awareness talks and community outreach campaigns. We have seen great success through a number of projects, including curriculum reform.
Unsafe abortion is a major health concern in Uganda. However, abortion is illegal in Uganda and thus is not accessible to the general population except when the pregnant person’s life is threatened. In 2010, the Ministry of Health estimated that 8% of maternal deaths were due to unsafe abortion. And in 2013, 93,300 women were treated for complications (Guttmacher).
Despite the burden unsafe abortion places on both society and pregnant women, medical students in Uganda are not being taught the necessary skills to manage patients who have had unsafe abortions, nor are we taught safe medical abortion. As we are an international university with over half of students hailing from other countries including Australia, Tanzania, India, Nigeria, and more, we need to pass on information to them regardless of Ugandan law. Additionally, the foreign students would benefit from taking this knowledge back to their countries, where they will be practicing in different settings and abortion may be legal. I wanted to see to it that all medical students in our university finish their 5th year with practical skills to manage and provide safe abortion. This desire drove me to write a proposal for curriculum change and request the university to allow us to present it to the university senate.
Being a very sensitive issue in terms of cultural and religious values both in the university and the community, and the fact that abortion is illegal in Uganda, it would not be an easy task to accomplish; we faced enormous opposition from pro-life groups and from some conservative administrators. Because SAIU has Catholic roots (the owners are Catholic although the school is not officially Catholic and includes students and instructors from diverse religions), it was difficult to convince the different authorities to accept the cause of the above reforms that we had presented. Being a multi-linguistic university with all religions accommodated, we argued that the SAIU is not a strictly Catholic school.
In addition, SAIU lawyers argued that since abortion is illegal in Uganda, it’s not right for the university to teach abortion skills. In reply, we argued that in the Ugandan Constitution, we have the right to speech and to information. And as long as we are not committing a crime in doing it, access to information and teaching abortion is completely not a crime. The administration was ultimately open to this idea.
We faced opposition from the student body as well. Some students were completely against abortion education and through their pro-life groups staged rallies against us on different occasions. But we met their resistance with peaceful gathering, showing the support we had from many students for this education. Many of us students supporting the reforms were isolated socially and always criticized by those who were against the idea of reforms involving medical abortion. We overcame this isolation and criticism and supported each other by meeting frequently.
In order to demonstrate to the administrators how the curriculum reform would be implemented in the following academic year, we created a 2 week pilot training in the form of training in each year of study. It was a student-led initiative to help show the administrators how our reforms would be done and how the university should plan for them. With funding from MSFC, we held ten lectures over two weeks, taught by supportive instructors. This included lectures on contraception, medication abortion, and legal and policy considerations. In order to demonstrate the effectiveness of the pilot program, we designed a survey for participants. 70% of those who took the course thought that the proposed reforms would be very useful, and 55% said they would plan to incorporate abortion services into their future practice.
In the future, I hope to see implementation of the reforms regardless of change of administration. We hope the university will embrace all the changes especially those involving the practical skills. We also pray that all universities in the country can embrace the changes and start including safe abortion education in all their curricula.