CONTEXT: Although Uganda’s law permits induced abortion only to save a woman’s life, many women obtain abortions, often under unhygienic conditions. Small-scale studies suggest that unsafe abortion is an important health problem in Uganda, but no national quantitative studies of abortion exist. METHODS: A nationally representative survey of 313 health facilities that treat women who have postabortion complications and a survey of 53 professionals who are knowledgeable about the conditions of abortion provision in Uganda were conducted in 2003. Indirect estimation techniques were applied to the data to calculate the number of induced abortions performed annually. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and its four major regions. Data on contraceptive use and unmet need were obtained from Demographic and Health Surveys. RESULTS: Each year, an estimated 297,000 induced abortions are performed in Uganda, and nearly 85,000 women are treated for complications. Abortions occur at a rate of 54 per 1,000 women aged 15–49 and account for one in five pregnancies. The abortion rate is higher than average in the Central region (62 per 1,000 women), the country’s most urban and economically developed region. It is also very high in the Northern region (70 per 1,000). Nationally, about half of pregnancies are unintended; 51% of married women aged 15–49 and 12% of their unmarried counterparts have an unmet need for effective contraceptives. CONCLUSIONS: Unsafe abortion exacts a heavy toll on women in Uganda. To reduce unplanned pregnancy and unsafe abortion, and to improve women’s health, increased access to contraceptive services is needed for all women