New Bill seeks to stop fertility treatment for unmarried

A proposed Bill on assisted reproductive technology (ART) has stoked immediate controversy, with critics slamming key proposals in the instrument as a setback pulling the country back to the Stone Age. 

Those in support, including former Minister of State for Health in-charge of General Duties Sarah Opendi, who is also the sponsor of the Bill, argue that if enacted, the instrument will offer protection to both providers and persons seeking the ART services. 

READ: What happens during IVF?

There have been calls for the enactment of a law on surrogacy and ART, but some of the provisions proposed by Ms Opendi are likely to cause a pushback given the Bill favours married couples and excludes unmarried men or women who may want to take advantage of the process to have children.   

In November 2021, Ms Opendi was granted leave by Parliament to introduce the legislation. 
Bukuya County MP Micheal Bukenya seconded the motion.

“The object of the Bill is to regulate the use of ART by married couples; to provide for registered practitioners; to designate the Medical and Dental Practitioners Council as the body responsible for the administration of this Act; to provide for designation and approval of fertility centres; to provide for the approval of ART banks; to provide for surrogacy; to provide for access to information on (ART) services; and for related matters,” the Bill reads in part.

Contentious 
Section 7(1) of the Bill requires a fertility centre to demand proof of marriage from a couple seeking ART services before providing the services.

The fertility centre, under Section 7(2), shall be deemed to have discharged the duty if the couple produces a marriage certificate issued in accordance with the laws of Uganda, or in the absence of a marriage certificate, a statutory declaration. 

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The Bill also imposes limits on the freedom of married couples to pursue reproductive technology services and surrogacy. 

The Bill requires a fertility centre to carry out a medical examination on the married couple to ascertain that the couple suffers from infertility or other health challenges before providing ART services. 

Prior to recommending surrogacy for a married couple, a fertility centre shall be required to carry out a medical examination on the married couple to ascertain that surrogacy is the only alternative for the married couple to have a child. 

The Bill also bars a married couple from using any gamete other than their own for the purpose of ART services. The only exception is when, “upon medical examination, it is discovered that there is a problem with their gamete, or the married couple has a genetic disorder that could pass on to the child”.

A similar provision has also been made for surrogacy. A married couple may use surrogacy if, after medical examination, it is discovered that surrogacy is the only alternative for the couple to have a child.

Although the age of consent in many instances is 18 years, the Bill makes it an offence to procure surrogacy services from a woman below 25 years. The Bill imposes a fine of Shs8m or 10-year imprisonment term or both. 

The Bill is, however, silent on instances a man has issues that would require a couple to pursue ART and, or surrogacy.

Further, the Bill also makes it unlawful for anyone to utilise any sperm other than the sperm of the wife’s husband, donated sperm, a woman’s oocyte after processing or storage, or an oocyte from any other woman without the consent of the husband and wife who are seeking the assisted reproductive services.
Committing the offence attracts a fine of Shs200m or 10 years in prison or both. 

IVF: Hope of conception for childless couples

The Bill also prohibits the use of genetic material not of human origin and attracts a fine of Shs200m or 10 years in prison, or both. 

In her 2021 paper on “Assisted reproductive technologies in Uganda”, Dr Zahara Nampewo, the deputy principal of Makerere Law School, observes that the practice and propriety have generated widespread controversy along religious, cultural, and moral lines. She adds that the practice of ART is confronted by prohibitive high costs of treatment and inadequately trained physicians.

“Despite the devastating social, psychological, and economic consequences of childlessness, the absence of a public health scheme hinders access to equitable healthcare, including assisted reproductive technologies. Therefore, childless couples can only access this service through private means,” she says.

The proposed law, however, does not address the provision of a public health scheme that would make the service more affordable and accessible to those who require it. 

In the paper, Dr Nampewo makes a case for regulation. Because people are desperate to have children, she says, they are often tempted to do anything to bring this about, they are also very vulnerable and can very easily be manipulated and exploited. 

“It is important for Uganda to aspire to improve both the medical standards in ART but also to address the existing institutional and infrastructural deficiencies through purpose-driven legislation for the administration and regulation of ART treatment. This should be aligned with community educational and sensitisation programmes on the role of ART as an alternative to natural reproduction,” she writes. 

Opendi’s latest move
The Tororo District Woman legislator is no stranger to controversy. The Alcohol Regulation Bill, which aims to restrict drinking hours and bar opening hours, was introduced by Ms Opendi on November 8, 2022, after receiving permission from Parliament to consult on it. If passed, the measure will also attempt to punish anyone who purchases, sells, or consumes alcohol before noon.

ALSO READ: The life that risks your fertility

Earlier, in July, the House gave Ms Opendi permission to reintroduce “The Marriage Bill,” a Private Member’s Bill. Without any agreement, the Bill has been debated in Parliament for decades.

Ms Opendi made a motion to abolish the renowned Nyege Nyege festival at its height in September of last year. Ms Opendi pressured the Ministry of Education to outlaw secular music performances in schools before the Nyege Nyege event.

Ms Opendi also had difficulties with the manner in which certain Makerere University graduates dressed.
She says the dress rule demonstrated that moral deterioration in society started with children’s upbringing.
When asked about the Bill in a telephone conversation with Monitor yesterday, Ms Opendi said: “Have you seen the Bill? We are consulting and will finalise after listening to all stakeholders. Stop speculating please. Wait for my Bill.”

In November 2021, while making a pitch to the House for the Bill, she said: “Biological advancements of surrogacy and fertility treatment have made it possible that any woman who desires to enjoy her God-given heritage of child bearing can do so notwithstanding malformation of the womb, recurrent pregnancy loss or repeated In Vitro Fertilisation (IVF) implantation failures”. 

She added: “We need a law in place that not only regulates the donors but also the doctors and physicians involved in this. This will protect the donors, as well as the children born out of these processes.”
We asked her whether she was disowning the existing version of the Bill but she did not respond to this. 

Assisted Reproductive Technology 

Assisted Reproductive Technology (ART) refers to medical procedures that assist individuals or couples in achieving pregnancy when natural conception is not possible, or is unlikely to be successful. 
In Uganda, ART services are available in a number of clinics and hospitals, and are regulated by the Ministry of Health.

The most commonly used ART procedures in Uganda include in vitro fertilisation (IVF), intrauterine insemination (IUI), and intracytoplasmic sperm injection (ICSI). IVF involves fertilising eggs outside of the body in a laboratory, and then transferring the resulting embryos into the uterus. 

IUI involves placing sperm directly into the uterus during ovulation, while ICSI involves injecting a single sperm into an egg to achieve fertilisation.

ART services in Uganda are generally available to both Ugandan citizens and foreigners, although the costs can be high and may not be covered by health insurance. In Uganda, the service can set one back by more than Shs14m per cycle. Some ART clinics in Uganda also offer services such as surrogacy and egg donation.
It’s important to note that while ART procedures can be highly effective, they are not without risks and may not always result in a successful pregnancy. 

Anyone considering ART should consult with a qualified healthcare provider to discuss their options and potential risks and benefits.

The Bill: Key proposals

Objective: The objective of the Bill is to regulate the use of assisted reproductive technology by married couples; to provide for registered practitioners; to designate the Medical and Dental Practitioners Council as the body responsible for the administration of this Act.

Approval: The Bill seeks to provide for designation and approval of fertility centres; to provide for the approval of assisted reproductive technology banks; to provide for surrogacy; to provide for access to information on assisted reproductive technology services; and for related matters.

Assisted reproductive technology: There is no law on assisted reproductive technology in Uganda yet over the years, there has been an increase in the number of both primary and secondary infertility cases, among married couples seeking to have children.

Mandate: Part II of the Bill comprises clauses 4, 5 and 6. Clause 4 and 5 provides for designation of the Medical and Dental Practitioners Council as the body responsible for the administration of this Act as well as additional functions of the Council. 

Administration: The Medical and Dental Practitioners Council established under the Medical and Dental Practitioners Act is responsible for the administration of this Act. The Council is responsible for the regulation, organisation and supervision of all activities involving assisted reproductive technology.

Proof of marriage 

Only married couples: 
(1) A fertility centre shall require proof of marriage by a married couple seeking assisted reproductive technology services before providing the services. 
(2) In the absence of a marriage certificate, the facility will require a statutory declaration.

Reason: (1) A fertility centre shall, before providing this service to a married couple, carry out a medical examination on the married couple to ascertain that the married couple suffers from infertility or other health challenges.  

Other alternatives: 
(2) A fertility centre shall, before recommending surrogacy for a married couple, carry out a medical examination on the married couple to ascertain that surrogacy is the only alternative for the married couple to have a child. 

Application: (1) A health unit that seeks to be designated as a fertility centre under Section 11 shall apply to the Council in a manner prescribed by regulations.
(2) The Council shall, by notice in the Gazette, or a newspaper of nationwide circulation, publish a list of fertility centres every year.  

Certification: The designation certificate issued to the fertility centre under Section 12(3) shall be valid for the calendar year in which it is issued. 
The Council may revoke the designation of a fertility centre where the centre ceases to meet the requirements under this Act.