Top Malawi doctor speaks out in favour of abortion

Over 70,000 women abort every year and because it is almost illegal to abort in Malawi, many of them resort to unsafe abortions as a result 17% of maternal deaths in Malawi are attributable to unsafe abortion, making it one of the primary causes of maternal mortality. 30% of all admissions in country’s gynaecological wards are due to unsafe abortion.

Malawi’s top doctor’s including gynaecologist Dr. Grace Chiudzu and Dr Edgar Kuchingale have all said its time Malawi started providing safe abortion options to prevent women from using unsafe means and dying in the process.

In continuing with the calls, Dr. Chisale Mhango, Associate Professor of Clinical Obstetrics and Gynaecology at College of Medicine,adds his voice on the issue and warns of the dangers of mistaking abortion law reform with morality and religion issues in this abridged article.

Malawi is one of the many countries in Africa discussing Abortion Law reform as proposed by the Africa Union.

Why this proposed reform has become such a controversial issue is of great concern to many especially in the legal and medical professions. The abortion law reform is not about the rights and wrongs of termination of pregnancy. It is not about whether or not abortion is morally right or wrong.

Questions such as when life begins and whether or not foetus has rights are irrelevant at this point. Malawi, like all other countries in Africa, and also the world, has abortion laws. Unfortunately many people speaking on the matter don’t appear to understand what the discussion is about.

Let women have safe abortions: Dr Mhango

Let women have safe abortions: Dr Mhango

Many people for example think that Malawi is trying to legalise abortion. The fact is that abortion is legal in all African countries; there are only three countries in the world where abortion is illegal, namely El Salvador, Chile, Malta; and unless one considers Holy See as a country.

I have been privileged to attend Africa’s meetings of Ministers of Health and those of Heads of States, and those of the regional Health Ministers’ Conferences as well as other national meetings on this subject and I am baffled by the mistaken view that many people including Heads of States, Ministers of Health and Permanent Secretaries of Health hold about the objectives of abortion laws in their countries and on the continent in general.

Imagine a Secretary of Health who did not know the objective of the law, what guidance would s/heprovide to the medical profession on the implementation of the law. A lot of people also are opposed to abortion law reforms because they hold the mistaken view that the objectives of the abortion laws are to preserve morality and Biblical standards. Nothing can be far from the truth.

I am using the term “mistaken view” because many will take offence to use of the correct word “ignorant” and it is not my wish to offend anyone. If I had chosen to use the word ignorant I would have quickly added that that ignorance is understandable.

The abortion laws we have in Africa, including Malawi, were transplanted from the countries of our colonial masters, and we were not there to listen to the arguments that were presented before those laws were introduced in those countries a long time ago. There is no excuse however for us not to examine the arguments that have been put forward in these countries as they all reformed their abortion laws in the relatively recent past. These argument infer on the intended objectives of the laws they were reforming.

The extent to which abortion services should be made available to women as indicated in the four categories above is hotly contested as it touches on deeply held convictions regarding human sexuality and reproduction, shaped by religious ideologies, ethics, culture and human rights. The abortion law in Malawi is classified as being restrictive in that most women who want to terminate their pregnancies do not qualify under the existing law or at least they think they do not qualify. Unfortunately there is no religion, and no restrict law which has stopped women from procuring abortion when they so wished.

Hospitals all over the world have required people to provide information about their religious affiliations at the time of admission, just in case it became necessary to call the appropriate clergy to give the last rites at short notice. A study of this information reveals that all religious faiths without exception are represented among women who are admitted with complications of unsafe abortions.

Despite the fact that all women know that abortion when not done by skilled health care providers kills and despite the fact that it is against the teachings of their faiths, women still seek unsafe abortion rather than keep unwanted pregnancies. Current studies estimate that 5.6 million women procure abortions each year in Africa alone, and that 95% of these abortions are unsafe.

Some people have even peppered their argument against abortion reform with falsehoods such as saying that a blastocyst on day 5 has the features of a person. A blastocyst as the word point is a cyst not a fetus. It forms on the 5th day after fertilisation of the egg by the sperm when it then implants or gets attached to the womb. Five days later it is still in the implantation phase. In medicine the embryo is referred to as a fetus in the eighth week of pregnancy. Abortion is by definition the expulsion from the womb a foetus that would not survive under the skills and technologies that currently exist.

This begs the question “is there then such a thing as safe abortion then?” A classic example to answer this question is the case study of Romania. Abortion by skilled medical personnel was made legally available in Romania in 1957. In 1966 the government of President Nicolai Ceausescu, worried about a negative population growth reversed the abortion law through Decree 770.

The government also banned the importation of contraceptives. The result was a sudden and sharp escalation of maternal deaths, mostly due to unsafe abortions.When a popular revolt had President Nicolai Ceausescu shot and safe abortion made legal again, maternal deaths plummeted. Many will argue that it was the family planning restriction in Romania that was responsible for the maternal deaths.

True; family planning does reduce the number of unplanned pregnancies but only to a point. When I worked at the Center for Disease Control in Atlanta, USA, in the early 80s, we counted 2 million terminations of pregnancy each year in the American population of about 200 million people. Today with a population of about 312 million people there are only half a million abortions reported each year.

In England and Wales, another place where contraceptives are universally available with a population of 56.1 million people, there were 184,415 abortions performed in 2004 which climbed to 189,100 in 2009. This means that when contraceptives become available to all in Africa and women as a result became as health as those in USA and Europe, African willexperience less induced abortions but they will continue to die from complications of those fewer abortions.

The data from the USA reveal that 54% of the women who underwent abortion procedures had used contraceptives in the months they became pregnant. The reason why women who abort in America and in Europe do not die when they procure abortions is because they have access to safe abortion services while the women in Africa do not.

So why is abortion reform so important for Malawi and the rest of Africa? The response is that Africa and Malawi in particular has appalling maternal mortality ratios and are not making significant progress towards the achievement of Millennium Development Goal number 5 that calls for the reduction of maternal mortality ratios by three-fourth of the 1990 level by 2015.

I have come to accept that before a country develops, the minds of its people must first develop. The countries of our colonial masters that we commonly refer to as developed countries did not have difficult in reforming their abortion laws. As soon as evidence was produced to show that women who terminated their pregnancies though skilled health professionals under ideal medical conditions did not die they immediately reformed their laws; after all that was what the restrictive abortion laws were intended to do; minimize women’s deaths from complications of abortion; the moment a new environment offered better alleviation of the problem, it would be a violation of women’s right not to go for it.

That is what the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa commonly referred to as the Maputo Protocol is all about. This charter was produced by Africans for the good of its people, especially women. Malawi ratified this protocol in 2005 and it is time to domesticate it.

The African Commission on Human and Peoples’ Rights recommends that AU member states that have not yet done so should urgently ratify the Maputo Protocol. Member states that have already ratified this protocol such as Malawi are urged to immediately undertake measures for domestication, including the amendments of internal laws to conform to the provisions of the Protocol.

In this case article 14:2c) which reads: “protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the unborn child”.

The fact that women continue to die from complications of unsafe abortion in Malawi to the extent that this is the fourth commonest cause of maternal deaths in the country means that there exist a factor, social or otherwise in each one of these women that “endangers the life of the mother” but are not being provided for in the existing abortion laws in this country.

The clergy are hired and paid to save souls; the stand of some of them on abortion is therefore understandable. The message I get from them however is that if they had lived at the time of Jesus the Christ, they would have told Him to stand aside while they stoned to death the woman taken into adultery in Galilee.

They would have rebuked Jesus on that Damascus road for giving Saul a second chance instead of just let his soul perish, for by his own admission Saul was the chief of sinners. That they would rather let women die after procuring abortion is because they fear that if these women lived that gracious Christ might give them a second chance like He did to Paul. The bible has a word that describes people who are in conflict with the teachings of Jesus – anti-Christ.

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