Malawi’s backstreet abortions compromising safe motherhood

Aida, 31, is a mother of four and married. When she gave birth to her last child, the pregnancy was unplanned.

Aida, of Bwelero in Traditional Authority (TA) Mankhambira, Nkhata-Bay District, says her husband had agreed to terminate the pregnancy when it was two months old.

But when Aida went to Nkhata-Bay District Hospital, medical personnel refused to attend to her to enable her to abort the pregnancy.

“When I was refused safe abortion services at the hospital, I went back home and told my husband. We then agreed to visit an elderly woman for help,” she says.

COPUA Community Mobilizing Task-force Chairperson, Darlington Harawa: Legalise abortion. Pix by Aliko Munde.

Aida says the herbalist, who lives in a village next to theirs, gave her green leaves to chew. When she chewed the leaves, she went home.

“When I arrived home, I started feeling pain in my stomach. A few minutes later, blood started coming out as if I was menstruating.

“Blood continued coming out heavily and when my husband saw that I had lost a lot of blood, he hired a taxi and took me to the hospital. I was admitted and accessed post abortion care services,” Aida recounts.

Just like Aida, a 17-year-old girl form two student at a private school in Nkhata-Bay  who simply wants to be identified as Lucy, says she too went to the district hospital wanting to abort, but doctors refused to give her the services she wanted.

“I had no option but to seek help from a traditional doctor in the town to terminate the pregnancy but with severe consequences,” says Lucy. “I lost a lot of blood and was immediately admitted to hospital. I thank God that I am alive today.”

Aida and Lucy are some of the hundreds of women in Nkhata-Bay District who carry out illegal and unsafe abortions, compromising safe motherhood in the process.

A visit to both government and private clinics in the district discovered that medical personnel at the facilities are under intense pressure to clandestinely provide safe abortion services.

Medical personnel confided in Mana that most of such women claim that they want to terminate their pregnancies because they are at school.

Some women claim that their husbands are working in foreign countries like South Africa and that they are returning home, while others have unplanned pregnancies.

“Accidental pregnancy among couples practising child spacing is another reason couples come to ask for abortion services,” says Austin Mwafulirwa, Sexual Reproductive Health Focal Officer in the district.

Mwafulirwa says since January this year, for example, Nkhata-Bay District hospital alone has handled a total of 57 Post Abortion Care (PAC) cases.

Some medical personnel say they send such women back because abortion is illegal in the country. Sections 149, 150 and 151 of the penal code prohibit abortion, unless the life of the mother is in danger, but permits PAC.

Mwafulirwa says women who are denied safe abortion resort to aborting illegally, but often get back to hospital with complications emanating from unsafe abortion.

He points out that in 2009 Nkhata-Bay District Hospital alone treated a total of 103 PAC cases. In 2010, the figure rose to 117 and in 2011, the hospital treated 92 cases.

“we have so far registered 57 post care cases since January this year, and the figure is likely to increase,” says Mwafulirwa.

He observes that other health centres across the district are equally overwhelmed with complications resulting from backstreet abortions.

In a desperate attempt to counter maternal deaths and rapid population growth, the district health office has embarked on an ambitious programme aimed at making communities access family planning services right in their localities.

District Family Planning Coordinator, Diana Mwanyongo, says that the district has already recorded six maternal deaths due to early pregnancies this year alone.

Mwanyongo says with funding from United Nations Population Fund (UNFPA), the programme seeks to avert population explosion and unplanned pregnancies by making available to people various contraceptive services right where they live.

“This is why we have trained health surveillance assistance across Nkhata-Bay district on how to administer modern contraceptive methods,” she says.

Mwanyongo says rapid population increase and maternal and neonatal deaths currently facing Nkhata-Bay district have forced health authorities in the district to introduce a programme that seeks to enable even the remotest communities to access family planning services at their door steps.

She says last year, the district registered 11 maternal deaths, whereas only five months into 2012, six deaths have already been recorded due to pregnancy complications. She adds that concerted efforts are needed to tackle the problem.

Mwanyongo says cases of uterus rapture and serious vaginal bleeding as a result of early pregnancy have been the major cause of maternal deaths registered so far.

Unwanted pregnancies and forcing mothers to go for unsafe abortion since Malawi’s law bars abortion have also been blamed for such deaths.

The Coalition for Prevention of Unsafe Abortions in Malawi (COPUA), which wants abortion legalized, describes the law as outdated and that it needs to be repealed, as a way of minimising maternal deaths in the country.

Darlington Harawa, COPUA’s Community Mobilisation Task Force Chairperson, claims that 18 per cent of maternal deaths emanating from unsafe abortion in the country are as a result of the anti abortion law as it denies women access to safe reproductive health care.

According to the United Nation’s Millennium Development Goal (MDG) monitor, Malawi has been challenged to achieve the MDG goal of a 75 per cent reduction in maternal mortality by 2015.

Global recommendations offer three major steps to improve maternal and reproductive health for women: increasing access to family planning, increasing access to quality care of pregnancy and childbirth, and increasing access to safe abortion services within the current law, including the provision of PAC for complications of induced and spontaneous abortion (Women Deliver 2010).

Harawa says Malawi, despite having never been at war since independence, is said to be the worst country affected by maternal deaths in southern Africa, with 16 mothers estimated to be dying of pregnancy-related complications every day.

The statistics are equated to countries which are synonymous with wars such as Sudan, Sierra Leone and Afghanistan.

“Research has revealed that 18 per of such deaths in Malawi are due to unsafe abortions as the country’s laws bar abortion unless the life of the mother is in danger,” says Harawa.

It is against this background that COPUA is on a national-wide tour sensitising the communities to the need to repeal the anti abortion law.

Harawa says the anti abortion legislation infringes on women’s rights to access quality reproductive health care, adding: “The law has failed to achieve its intended purpose, hence the need to have it scrapped off.”

He questions the wisdom of denying a mother safe abortion services for unwanted pregnancy on point of law, only to treat her of complications later on when the same woman aborts on her own using crude methods.

“Government spends millions of Kwacha in post abortion care services, instead of legalizing the law to avoid losing lives of our dear women and girls and also avoid losing huge sums of money in PAC services,” Harawa says.

TA Mankhambira agrees with organisations that are advocating for the repeal of the anti abortion law, saying many women suffer after undergoing unsafe abortion.

“Many women and girls in our villages are practising unsafe aborting, which is compromising the safe motherhood initiative in the country,” the chief says.

TA Mankhambira says the best way is just to repeal the law and allow all women to access safe abortion services in health facilities.

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