Chikondi, age 29, was three months pregnant with a baby she could not afford. She lives in a small village east of Lusaka, amid an expanse of maize fields and mud homes with grass-thatched roofs. Her boyfriend of three years was unemployed and not ready to be a father. She had long supported her girls with an assortment of farming jobs, such as preparing fields and planting crops, but the coronavirus pandemic had made even those scarce.
In Zambia, abortion is legal but difficult to obtain, not least because it requires the approval of three ob-gyns in a country with a scarcity of doctors in the cities let alone the rural areas. So Chikondi’s friend had mixed her a herbal concoction commonly used for terminating a pregnancy at home. Chikondi didn’t ask what the brew consisted of — more important was that her friend had used it to end her own pregnancy with no major problems. However, even 6-8 years ago, nearly one-third of pregnancy-related deaths were tied to unsafe abortions in Zambia.
At University Teaching Hospital in Lusaka, the country’s largest hospital, the head of clinical care in the obstetrics and gynaecology department, says emergency gynaecological admissions have spiked during the pandemic, and more than half were linked to mostly unsafe abortions. “I am imagining how many women are out there that have failed to access post-abortion care, those that are silently dying,” he says.
What is the Zambian government doing about this? They have tried to make contraceptives more accessible. But in rural Zambia, where the majority of people live, they aren’t easy to acquire either. In a survey of rural women who were married or living with a partner, only 43% said they used modern contraceptives, such as birth control pills, according to a study in the BMJ Open.
For Chikondi, the nearest hospital is about 70 km away. Before the pandemic, she would take a day off work and spend hours on a bus to get an injectable contraceptive that would last three months. Like all contraceptives provided by public hospitals, the injection was free, but the bus ride cost about 100 Zambian kwacha ($5.40) — roughly one-tenth of her earnings during a good month. Sometimes Chikondi couldn’t afford the trip, and had to wait for the health care workers who visited her community only every six months. Other times she asked friends going to the city to buy oral contraceptives for her. Only in recent months have health care workers started distributing birth control in rural Zambia again.
Over the course of a day, Chikondi slowly drained the white container of the herbal concoction. Her friend had expelled her fetus within 24 hours. “I started having stomach cramps and water coming out of my private part,” Chikondi says. Then, blood. One day went by. Two. Three. Chikondi was still pregnant. She couldn’t think straight. Couldn’t walk. She’d used most of her clothes to sop up blood, but didn’t have the strength to wash them. A foul odour choked her bedroom. Her boyfriend panicked: was she going to die? He ran outside, flagged down a car and asked the driver to rush her to University Teaching Hospital. He had no money, but promised to pay 200 kwacha ($11) later. The driver obliged. Chikondi was hospitalised for a week. Doctors removed the fetus and cleaned the blood out of her uterus. She also had a blood transfusion. She survived. Many others don’t.
SOURCE: Global Press Journal, by Prudence Phiri, 27 February 2022 + VISUAL by Matt Haney/GPJ