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Rebecca J acobson 22 October 2010
Gender Links (Johannesburg)
Malawi's Abortion Debate
Blantyre, Malawi The young woman slumps in a white plastic
chair. She is still woozy
from anaesthesia and her eyelids sag.
She has just emerged from the operating theatre, where a
clinical officer scraped
clean her womb to remedy the results of an incomplete
abortion.
J oyce Phiri* is only one of many women admitted daily to Queen
Elizabeth CentralHospital (QECH), in Malawi's commercial capital
Blantyre, for complications of unsafe
abortions. Winasi Boma, a supervising nurse at QECH, says the
gynaecology ward
admits about 20 women each day. Roughly half of these, he says,
are there for post-
abortion care.
Like most of its neighbours in the region, abortion is illegal
in Malawi (except to save the
life of the mother). Phiri, a 21-year-old mother of two, sought
to terminate her
pregnancy only after a contraceptive implant failed.
Clinicians at the health centre, operated by a major Malawian
non-governmental
organisation, apologised for the failure and offered, J oyce
says, to "clean out" her
uterus. She underwent "some sort of suction" (likely manual
vacuum aspiration,
according to Boma) and returned home. Two days later, severe
pains wracked her
lower abdomen. A visit to QECH revealed that products of
conception still remained in
her uterus.
Bonus Makanani, head of the Department of Obstetrics and
Gynaecology at University of
Malawi's College of Medicine, says QECH commonly sees women who
have soughtabortions from health care workers - clinical officers,
nurses, medical assistants,
occasionally medical doctors. "A lot of them think they've got
the theory, but I am not
certain that they have the practical experience to undertake
such procedures," Makanani
says. Such workers may begin the process and then send the woman
to QECH once
complications arise. Other women seek to induce an abortion by
ingesting detergent
powder, consuming drugs or herbal concoctions, or inserting
sharp objects vaginally.
Such methods can rupture the uterus or bowel and lead to
infection, bleeding and insome cases infertility or death.
The World Health Organization estimates that 19 million unsafe
abortions occur
worldwide each year, killing 70,000 women. Most of these deaths
occur in poor
countries with restrictive abortion laws, such as Malawi. This
country's maternal mortality
rate - which is estimated to be as high as 1,140 deaths per
100,000 live births - already
ranks as one of the world's worst. A recent study by the
Ministry of Health, titled the
Strategic Assessment, Magnitude and Consequences of Unsafe
Abortion, found that
abortion accounts for nearly a quarter of these deaths.
Another study, by Malawi's Family Planning Research Centre,
found that half of the
women who suffer abortion-related complications are under the
age of 25. At QECH,
54% of abortion-related deaths between 2001 and 2008 occurred
among this age group.
"The ones who are having unsafe abortions are young women," says
Seodi White,
National Coordinator of Women and Law in Southern
Africa-Malawi.
Moreover, White says, "unsafe abortion is related to poverty.
Unsafe abortion has
become a problem of the poor and the young."
Indeed, neither Phiri nor her husband is formally employed. He
sells cell phone airtime
units and brings home a few dollars a day. She came to QECH
because its services are
free to patients.
"There's no doubt that it's the younger single women where we
mostly see these
problems," Makanani says. "It's certainly those that are less
educated, less economically
empowered, who are at a disadvantage. I'm sure they are the ones
that would seek
unsafe abortion because they don't have the knowledge, and
obviously they would alsogo to facilities that are less than ideal
for undertaking such procedures."
Makanani contrasted the women at QECH to those he sees in
private practice.
The latter, he says, are wealthier and more informed about
sexual and reproductive
OME
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7/27/2019 Malawi's Abortion Debate
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ca.com: Malawi's Abortion Debate
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8:48:07 AM]
health issues. Despite the law, Makanani says safe abortion
services "are available
within Malawi" - with adequate economic resources and the right
personal connections.
Those accessing safe abortion services are also those with
political power, notes
Godfrey Kangaude, a lawyer specialising in sexual and
reproductive rights. This, he
says, helps account for political inertia on the issue. The
Ministry of Health refused to
comment for this story.
"On the public face, policy makers and politicians want to look
good, want to look
moral," Kangaude says. "But privately they're the very same who
actually seek
abortions. That's why things don't change. It's because those
who have the power and
can talk publicly can access safe abortion."
By providing post-abortion care at public hospitals, government
implicitly acknowledges
that illegal abortions take place in Malawi. Yet the topic
remains deeply taboo. Evenwhen women arrive at QECH with sticks in
their uterus, they deny having induced an
abortion. Beyond legal penalty (women are liable to seven years
in prison and
abortionists to 14), women fear social discrimination. Boma says
they may face verbal
abuse from hospital staff.
Advocates of legal reform must tread carefully. In a country
where using contraceptioncan brand women as promiscuous, mentioning
abortion invites charges of moral
degeneracy. Kangaude says some have accused him of imposing
alien culture. He
reminds them that Malawi's penal code is a relic of British
colonialism. Kangaude thinks
abortion law will eventually change, but argues Malawi can also
reduce the number of
unsafe abortions by preventing unwanted pregnancies in the first
place. The United
Nations Children's Fund (UNICEF) puts Malawi's contraceptive
prevalence at 41%.
Kangaude would like to see this figure much higher.
But White says addressing family planning is not enough.
Contraceptive use already
occupies a huge part of the national discussion on sexual and
reproductive health.Abortion must have a place in the debate as
well. But without legal reform, White
maintains, women will continue to suffer.
Advocates point to South Africa, where legalisation of abortion
cut abortion-related
mortality by 91%. Though such liberal legislation - South Africa
allows abortion on-
demand - would likely face swift rejection in a nation as
conservative and religious as
Malawi, the country could begin by allowing abortion in a
broader variety of cases: ininstances of rape or incest, for
example, or if the life of the foetus is in danger.
Stigma, White acknowledges, would persist, but this is no reason
to shirk legal reform.
"The most important thing is, let's put mechanisms in place to
help those who are
suffering, stigma or no stigma," she says. "The stigma can
continue, but let's not use
the stigma to stop women from accessing proper and effective
health services."
*Not her real name
Rebecca J acobson is an American writer based in Malawi. This
article is part of theGender Links Opinion and Commentary
Service.
Copyright 2010 Gender Links. All rights reserved. Distributed by
AllAfrica Global Media
(allAfrica.com).
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