Unsafe abortions in spite of a liberal law

Original story by Violet MengoJune 2015MM from a village in Nchelenge district was the only girl in a large family. She wanted to become a lawyer and was always a top student. However, one fateful day on her way from school, she was attacked and raped by a stranger. With little or no knowledge of where to go, she decided not to tell anyone about what had happened. By the time she decided to go to the health centre, she was two months pregnant. This news was shocking and disappointing. She saw her dream of becoming a lawyer shattered.Later, she went back to the health centre to get advice on how to get an abortion, but she was instead rebuked by the health personnel for being promiscuous. So, with the help of a friend, she used some cassava stems to terminate the pregnancy. No sooner had she inserted the cassava stems in her cervix than she started bleeding profusely. MM was later referred to the General Hospital where her uterus had to be removed.According to WHO guidelines, if a termination is to be done, it should be done by somebody who is trained and in an environment that is considered to be medically-acceptable. In Zambia, that means in a medical facility that has been certified by the Health Professions Council.In Zambia, safe, legal abortion is inaccessible for many women, in spite of the 1972 Abortion Act, which is considered by many to be among the most liberal in the world. University of Zambia Teaching Hospital (UTH) head of obstetrics and gynaecology Bellington Vwalika explains that the law to a great extent allows provision of safe abortion in a hospital if the medical personnel certify in good faith that the pregnancy should be terminated on grounds of risk to the health of the woman, risk of social, mental or physical injury to the woman, including on socio-economic grounds, risk of mental or physical injury to her children, or risk of fetus abnormality incompatible with life. Moreover, when the Government noticed that there was an increase in the number of rape, defilement and incest cases, the Act was amended via the Penal Code in 2005 to allow abortions on these grounds.Dr Vwalika describes the second clause as very broad in intent. “For example, if a woman has many children or has contraceptive failure, she has a pregnancy that she did not plan for, so this can lead to a mental injury of the woman. However, it is believed that very few women who need an abortion meet the requirements.Unfortunately, the law also requires three doctors in good faith to determine that the pregnancy should be terminated, one of whom should be a specialist in obstetrics and gynaecology. Yet the country has fewer than 60 ob-gynae specialists, most of whom are located along the line of rail that links the main cities.If a woman or adolescent like MM in a rural area needs an abortion, where would she find a specialist to certify that she meets the requirements? This is a major impediment.In 2009, Government issued standard guidelines which have further spelled out how to harmonise the provision of the service on abortion. Yet women do not necessarily access services for several reasons. First, according to Dr Vwalika, neither health workers nor the community are aware of the law and that safe abortion can be provided..Secondly, clandestine provision by health workers is taking place, in which they ask for a fee before they carry out an abortion, which is an impediment for the many women who are poor cannot and afford the fee, and who therefore go to someone in their community who charges little or no fee.The Ministry of Health estimates that up to 30% of maternal deaths are a result of complications of unsafe abortions, mainly in young girls like MM and vulnerable or poor women who cannot afford safe services. Some studies suggest that if Government invested in the provision of safe abortion services, the treasury would save about US$13 per unsafe abortion treated.SOURCE: Zambia Daily Mail