Health activist Denis Kibera has seen women bleeding to death from illegal abortions. He has seen women dying after quack doctors used crude equipment to kill their fetuses.
The solution, he believes, is to decriminalize abortion and bring it into safe clinics and hospitals. Yet as a Christian in Uganda, he would never dare to say so publicly. "I'd be targeted by religious people," he said. "I'd be attacked."
The top bureaucrat in Uganda's health department, Asuman Lukwago, is also in favour of legalizing abortion. But he, too, would never say so in public in this heavily Christian country, where abortion is a taboo subject. "People would hate me."
Around the world, an estimated 67,000 women die from unsafe abortions every year, including about 1,500 in Uganda. Thousands more are maimed or permanently injured, mainly because the criminalization of abortion forces them into the hands of dangerous backroom practitioners.
Now, for the first time, a senior United Nations official is openly calling for the decriminalization of abortion. Supporters say it could trigger a long-overdue debate – even though it is unlikely to bring immediate reforms in religiously conservative countries in Africa and Latin America where abortion is illegal.
The new UN statement is unambiguous. "States must take measures to ensure that legal and safe abortion services are available, accessible, and of good quality," said Anand Grover, the UN special rapporteur on health, in a report that has galvanized support from women's groups and health activists.
"Absolute prohibition under criminal law deprives women of access to what, in some cases, is a life-saving procedure," he said. "Criminalization of abortion results in women seeking clandestine, and likely unsafe, abortions."
About 25 per cent of the world's population is living under legal regimes that prohibit all abortions, except those following rape or incest, or when necessary to save a woman's life, Mr. Grover noted. He described how women suffer "enormous anguish" – or even commit suicide – because of the pressures caused by criminalization.
Human rights and health groups say the UN report is a ground-breaking moment for the abortion issue in the developing world. "This report is the first of its kind in the way that it talks about abortion, because it isn't constrained by the usual political considerations that are in operation in UN spaces," said Meghan Doherty, a communications officer at Action Canada for Population and Development, an Ottawa-based advocacy group.
"Now that these arguments have been made publicly and unapologetically, and the report has the UN logo, it has already pushed the discussion forward."
But in countries such as Uganda, the debate on abortion has yet to begin – even though experts acknowledge the need for reform.
Dr. Lukwago, the permanent secretary in Uganda's health ministry, practised medicine for 12 years and says he saw hundreds of women dying from illegal abortions. He estimates that unsafe abortions are responsible for a quarter of the 6,000 annual pregnancy-related deaths in Uganda. An entire ward at Kampala's leading hospital is full of women injured by unsafe abortions, he said.
"I've seen girls swallowing aspirin to create toxicity so the baby won't come out," Dr. Lukwago said in an interview. "I know illegal abortion kills women."
He personally believes that decriminalization should be supported, but he doesn't expect it to happen for generations. "We're a religious country."
Religion is a powerful force in Ugandan politics, as it is in many African countries. Churches are key leaders in the controversial Ugandan campaign for an anti-homosexuality law, which would impose life imprisonment or even the death penalty for homosexual acts. Ugandan President Yoweri Museveni's wife, Janet, is a born-again Christian who praises God on almost every page of her autobiography, and she is reportedly a key supporter of the anti-gay bill. Church leaders often rail against abortion in their Sunday sermons.
About 300,000 abortions are performed annually in Uganda, mostly in dangerous conditions. "I feel so bad when I see a woman bleeding to death, and I know it could be stopped," said Mr. Kibera, who works for the Coalition for Health Promotion and Social Development.
He doesn't see any prospect of abortion being decriminalized – "Not in this generation."
Moses Mulumba, a Ugandan lawyer who heads a centre on human rights and health, is one of the few activists willing to launch a constitutional challenge against the anti-abortion laws. But he said he would be lucky to find any women willing to be involved in a test case.
"People don't want to speak about it," he said. "Many people can talk about it privately, but never on television. We need to open it up and normalize it."
In his UN report, Mr. Grover acknowledges the difficulty of decriminalizing abortion. He suggests, as an interim step, that governments consider a moratorium on the enforcement of anti-abortion laws.
"This recommendation shows that this is a serious issue that requires immediate attention in order to prevent needless suffering," said Sandeep Prasad, executive director of Action Canada. "Even if a state is having problems repealing its laws criminalizing abortion, it should not be prosecuting women for undergoing illegal abortions."