Through community dialogues in Kampala’s Bwaise neighbourhood, the Alliance for Women Advocating for Change is amplifying the voices of marginalised women while pushing for affordable, accessible and non-discriminatory reproductive healthcare.
In Jambula Zone, Bwaise, the challenges surrounding safe motherhood are not simply a matter of accessing a health facility. For Female Sex Workers (FSWs), they begin with the threat of sexual violence, continue with the cost of contraceptives and are compounded by concerns about how they will be treated when they seek medical assistance.
These concerns emerged during a community baraza held on Friday, where FSWs shared their experiences with the Alliance for Women Advocating for Change (AWAC), an organisation working to advance the rights and welfare of marginalised women in Uganda.
The discussion brought together community members, health professionals and law enforcement representatives to address family planning, unintended pregnancies, post-abortion care and sexual violence. It also provided a platform for women to speak about the obstacles that can prevent them from protecting their health and making informed decisions about their reproductive lives.
For AWAC, taking these conversations directly into communities is part of a broader advocacy effort to ensure that reproductive healthcare is accessible to everyone, regardless of occupation or social circumstances.
The organisation is seeking not only to improve awareness of available services but also to challenge stigma, strengthen accountability and encourage healthcare systems to respond to the needs of women, especially female sex workers who are frequently overlooked.
Sexual violence and the cost of contraception
For X, a sex worker in Bwaise, the risks associated with her work extend beyond concerns about unintended pregnancies.
She said some clients disregard sex workers’ dignity and bodily autonomy, exposing them to sexual violence and pressure to engage in unprotected sex.
“Men sometimes rape us because they do not see us as human beings deserving of respect. Others refuse to use protection. Condoms have also become expensive, making it difficult for some of us to afford them,” X said.
Her account highlights how unequal power relationships can undermine female sex work’s ability to negotiate safer sex, even when she understands the risks involved.
When sexual violence or unprotected sex results in an unintended pregnancy, the consequences can be particularly difficult for female sex workers who have limited financial resources or do not know the men responsible.
X said the cost of family planning services presents another obstacle, calling on the government to expand affordable reproductive healthcare in informal settlements and other underserved communities.
She also urged authorities to ensure that trained health workers are available to explain contraceptive options and help women make informed decisions about their reproductive health.
Her colleague, Y, said access to family planning should involve more than the distribution of contraceptives. Women also need appropriate medical assessments, counselling and follow-up support to identify methods that suit their individual circumstances.
“Some health facilities do not assess us properly to determine which family planning method is suitable for our bodies. You may end up experiencing uncomfortable side effects, and this has forced many of us to stop using these methods,” she said.
Y added that the cost of condoms can make consistent protection difficult for some sex workers.
She credited AWAC with helping community members access information and understand their reproductive health options.
“That is why I thank the Alliance for Women Advocating for Change (AWAC). They have become like parents to us and have been very helpful in empowering us with knowledge,” she said.
Her testimony illustrates why reproductive health advocacy must address both the availability of services and the conditions that determine whether women can use them consistently.
For FSWs facing financial constraints, violence or discrimination, information alone may not be enough. They also need services they can afford, healthcare providers who listen to their concerns and support that enables them to seek assistance without fear of humiliation.
AWAC brings safe motherhood advocacy to Bwaise
AWAC has spent the past decade engaging marginalised communities through safe motherhood campaigns and advocacy against unsafe abortion.
Its community barazas bring together affected communities, health professionals, law enforcement officers and other stakeholders to discuss reproductive health concerns and identify possible responses.
The meetings provide an opportunity sex workers to ask questions, share experiences and raise issues that might otherwise remain outside formal discussions about maternal health.
Speaking at the Bwaise gathering, Michael Ssemakula, AWAC’s director of programmes, said safe motherhood requires access to a range of essential services, including family planning, antenatal care, emergency obstetric care and post-abortion care.
“Pregnancy should be a matter of choice, not an accident. People should be able to access family planning and contraceptives, mental health services and emergency obstetric care when they need them,” Ssemakula said.
He said marginalised communities can face heightened exposure to sexual and gender-based violence, which may lead to unintended pregnancies and other reproductive health complications.
He cited the experiences of sex workers and gender-expansive people, including lesbian, bisexual and queer (LBQ) women, who may face sexual violence, abuse and barriers to accessing appropriate healthcare.
According to Ssemakula, these circumstances can limit people’s ability to make informed reproductive decisions, particularly when they lack reliable information or fear discrimination from service providers.
“When someone experiences an unintended pregnancy, they need to know what options are available, where to seek help and how to access appropriate care. Without that information, some may resort to unsafe methods of ending a pregnancy, putting their lives at risk,” he said.
He called for greater public awareness of Uganda’s relevant self-care and post-abortion care guidance, emphasising the importance of knowing where to obtain appropriate medical assistance when reproductive health complications arise.
Ssemakula said Bwaise was chosen to bring the discussion closer to the people affected by these challenges rather than relying solely on general public awareness campaigns.
“This is where people are affected, and this is where we need to go and create awareness. We also use these engagements as a platform for advocacy,” he said.
Through the community dialogues, AWAC seeks to connect FSWs with information, encourage engagement with health professionals and bring their concerns to the attention of institutions responsible for protecting their health and safety.
Its approach also recognises that improving reproductive health outcomes requires more than individual behaviour change. It calls for services that are accessible, responsive and respectful of the circumstances in which people live.
Health workers call for timely medical attention
Dr Dan Kaye, a gynaecologist at Kawempe Hospital, said unintended pregnancies and sexually transmitted infections are among the reproductive health risks people may face when they cannot consistently access contraception and protection.
He encouraged sex workers to seek family planning services and advised those experiencing reproductive health complications to visit health facilities for professional assessment and treatment.
Kaye said public health facilities provide reproductive health services, including counselling and treatment, and urged FSWs seek medical assistance rather than attempt potentially dangerous procedures without appropriate support.
Addressing unintended pregnancies, he acknowledged that majority of sex workers consider ending a pregnancy but stressed the importance of obtaining medical advice and care.
“We are not encouraging people to terminate pregnancies. However, when an unintended pregnancy occurs and someone experiences complications, they should go to a health facility. They can receive support, counselling and treatment to help them through the situation,” he said.
Kaye emphasised that sex workers experiencing complications following an abortion should be treated with dignity and provided with the medical assistance they need.
“Any sex worker who have experienced an unintended pregnancy and complications after an abortion should be welcomed, counselled and supported. Our obligation is to help them through the adverse situation and provide the care they need,” he said.
He added that the Ministry of Health’s 2022 guidelines were undergoing a review process intended to address harm reduction.
In reproductive healthcare, harm reduction focuses on reducing the risks of injury, complications and death through appropriate information, medical support and treatment.
For AWAC, ensuring that Female Sex Workers can access care when complications arise is a central part of its safe motherhood advocacy. The organisation’s position is that a female sex worker circumstances should not become a reason to withhold the medical attention necessary to protect her life.
Police urge survivors to report sexual violence
Assistant Superintendent of Police Muteera Asiimwe of Kawempe Police Station urged sex workers to embrace family planning and seek assistance when they experience sexual violence.
He explained that family planning enables individuals and families to make decisions about whether and when to have children, while preparing for the responsibilities associated with raising them.
Asiimwe also encouraged all female sex workers that were present to report sexual violence to the police and seek medical attention at health facilities.
“I urge everyone here to come forward and report any sexual violence they experience. Go to a health facility for medical assistance, and we shall help you seek justice,” she said.
His message highlighted the role of law enforcement in responding to sexual violence and supporting survivors who seek justice.
However, encouraging sex workers to report abuse is only one part of the response. Survivors must also be able to access medical care, receive appropriate support and have confidence that their complaints will be handled seriously.
For sex workers who experience stigma because of their occupation or social circumstances, building that confidence is particularly important.
AWAC’s engagement with police officers and health professionals seeks to bring these different responsibilities into the same conversation, encouraging cooperation between institutions and the communities they serve.
AWAC calls for stronger post-abortion care and legal reform
Guttabingi Doreen, AWAC’s legal compliance and advocacy officer, said the organisation’s work on abortion-related issues focuses on access to post-abortion care and the need to ensure that sex workers experiencing complications receive appropriate medical attention.
She noted that although abortion is generally restricted under Uganda’s legal framework, post-abortion care remains an important component of reproductive healthcare.
“Our advocacy comes from the perspective of post-abortion care. We want to remind people especially the marginalized communities that accessing the necessary healthcare is their right and that post-abortion care is part of maternal healthcare,” Doreen said.
She also called on the government and lawmakers to review the legal framework governing abortion, including consideration of decriminalisation.
Post-abortion care is intended to address complications that can arise after a pregnancy ends, including those associated with an unsafe abortion. Timely medical attention can be critical in preventing further complications and protecting a woman’s life.
Doreen argued that healthcare providers should be able to deliver appropriate treatment to any Ugandan who present with such complications, regardless of the circumstances surrounding their pregnancies or their status.
“Despite the restrictions surrounding abortion, post-abortion care is recognised within the healthcare framework. When someone presents at a medical facility with complications, the priority should be to provide the necessary care and save their life no matter her occupation or status,” she said.
She pointed to Uganda’s post-abortion care guidelines and national framework as important references for guiding the provision of services.
Doreen said greater public awareness of the available healthcare provisions, alongside improved access to medical services, would help Female Sex Workers understand where to seek assistance when complications arise.
Her call for legal reform also places AWAC’s community engagement within a broader policy debate about reproductive rights, maternal health and the legal conditions under which the marginalized communities especially female sex workers can access reproductive healthcare.
Beyond awareness: The need for dignified healthcare
The experiences shared in Bwaise point to a set of interconnected challenges: sexual violence, the cost of contraception, concerns about side effects, limited access to reliable information and the fear of being judged when seeking medical assistance.
These barriers can reinforce one another. A sex worker may understand the importance of contraception but struggle to afford it. Another may seek family planning but discontinue a method because of side effects or inadequate counselling. A survivor of sexual violence may need medical attention but hesitate to seek help because of stigma or uncertainty about how she will be treated.
Addressing these challenges requires more than encouraging sex worker to make informed choices. It also demands affordable services, reliable reproductive health information, appropriate medical counselling, respectful treatment and effective responses to sexual violence.
This is where AWAC’s advocacy becomes significant. By taking safe motherhood discussions directly into communities, the organisation is creating space for marginalised women to describe their experiences and bring their concerns to health workers, police officers and other stakeholders.
The next challenge is to ensure that these conversations translate into practical improvements in access to care, the handling of sexual violence cases and the treatment of women who experience reproductive health complications.
For the female sex workers who gathered in Jambula Zone, safe motherhood is not simply an abstract public health goal. It is closely connected to their ability to protect themselves from violence, access contraception, receive medical care and make informed decisions about their lives.
AWAC’s message is that these needs should not depend on a woman’s occupation, income or social standing. Accessible and dignified reproductive healthcare, the organisation argues, must extend to the sex workers and other marginalized communities whose voices are too often excluded from the wider conversation about maternal health.
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