Women's experiences of emergency post-abortion care at Kawempe National Referral Hospital, Uganda

Abstract

Post-abortion care (PAC) encompasses emergency treatment, counselling, contraceptive services, and referral linkages. The emergency component of PAC, which is Emergency post-abortion care (EPAC), is a life-saving service for women presenting with acute abortion-related complications such as haemorrhage, sepsis, retained products of conception, and severe pain. In Uganda, where abortion is legally restricted and socially stigmatised, women’s experiences of care are shaped not only by clinical urgency but also by fear, moral vulnerability, provider interactions, and structural health system constraints. While EPAC is essential for survival, there is limited evidence on how women interpret and evaluate their care experiences in referral hospital settings in Uganda. To explore women's experiences of emergency post-abortion care at Kawempe National Referral Hospital, Uganda. A qualitative phenomenological design was employed. Eligible participants varied in age, parity, education, and socio-economic background. Sixteen in-depth interview transcripts from women who had received EPAC at KNRH in March and April 2026 were analysed thematically. The transcripts were analysed thematically using an inductive approach. The Socio-Ecological Model guided interpretation across individual, interpersonal, and facility levels. Rigour was ensured through iterative coding, constant comparison, and close engagement with participants’ narratives. Women’s experiences of EPAC were complex and often contradictory. Six themes were identified: (1) survival and physical relief as the immediate measure of good care; (2) pain, fear, and emotional distress during treatment; (3) reassurance and support as buffers against vulnerability; (4) dignity under pressure: communication and privacy in EPAC; (5) structural barriers across the pathway of care; and (6) experiences beyond discharge: incomplete recovery and uncertainty. Care was frequently evaluated through the lens of survival and physical relief, with many participants describing rapid stabilisation, supportive providers, and timely intervention. Although many participants described survival and physical stabilisation positively, these accounts frequently coexisted with intense procedural pain, fear of death, dismissive communication, compromised privacy, delays, financial burden, and inadequate follow-up after discharge. Experiences extended beyond discharge, with ongoing physical symptoms, uncertainty about recovery and fertility, and variable follow-up support. EPAC at KNRH was experienced not only as a clinical intervention but as a complex encounter shaped by bodily vulnerability, interpersonal dynamics, and system-level constraints. While lifesaving care was often delivered successfully, women’s experiences of care were evaluated through a broader lens that included dignity, communication, pain management, timeliness, and continuity of care. Strengthening EPAC, therefore, requires a shift toward more consistent, patient-centred approaches that integrate clinical effectiveness with respectful care, improved triage, enhanced counselling, and clearer post-discharge support systems/mechanisms.