Sluggish law review makes the International Safe Abortion Day a remembrance of preventable pain and deaths of women, our Features Editor JAMES CHAVULA writes.
What is sticky about unsafe abortions among health workers in rural areas where many Malawians live?
“Nothing is more painful than seeing a patient weeping in agony when you cannot do much about it,” says midwife Chifundo Mwehiwa.
At Mlomba Health Centre in Machinga, women reeling from unsafe abortion personify what Mvehiwa considers her worst heartbreak.
Every month, the overwhelmed staff, which sees almost 100 outpatients a day, watch helplessly as women suffer untold misery due to complications of clandestine abortions.
“It can be depressing,” she says. “Just in June, we had two. Both of them arrived before daybreak. They were bleeding severely, weeping in pain and their uteruses had started rotting. They needed urgent help, but all we could give them were painkillers while waiting for an ambulance from Machinga District Hospital.”
Thousands of women risk their lives due to backstreet abortions because penal laws only allow certified doctors to prescribe surgical termination of pregnancy to save a woman’s life.
Gender activist Emma Kaliya backed the push by sexual and reproductive health rights campaigners to increase grounds for women to terminate unintended pregnancies safely and legally.
The rising call for liberalisation of abortion laws, which some find restrictive and ambiguous, stirred a backlash from some religious groups. Last year, Catholic bishops and evangelicals marched to petition Parliament and President Peter Mutharika to snub a draft Bill proposed by the Special Law Commission on abortion law.
The clergy warned against “a culture of death”, saying life begins at conception.
But the heated debate rarely includes voices and dilemmas of rural Malawians.
“Abortion remains a sticky issue, but it is happening even in rural areas. Our hands are tied by laws, culture and religion. When women come with complications of clandestine abortions, we are obliged to save their lives. But the facility, which is far from Machinga District Hospital, has no skilled staff and necessary equipment to treat post-abortion complications. We give them painkillers,” she says.
Most survivors of backstreet abortions delay to seek medical assistance and are almost dying when they see skilled attendants.
Machinga registers five to 10 cases a day.
“Many visit our health centres. The problem is big and we need to talk about the silent crisis because the country still registers high maternal mortality rates,” said district health officer Innocent Mhango last year.
About 574 women nationwide die in every 100 000 live births.
But a 2009 study by the Ministry of Health shows risky abortions kill up to 18 of every 100 women dying of pregnancy-related conditions.
In April, researchers at the College of Medicine’s Centre for Reproductive Health in Blantyre and Guttimacher Institute in the US released findings which indicate that 53 percent of about 886 000 traceable pregnancies in 2015 -about 470 000 of them-were unintended.
“Out of the estimated 141 000 abortions performed in Malawi in 2015, approximately 60 percent resulted in complications that required medical treatment in a health facility,” reads the findings.
The new evidence comes amid the slow strides to review the laws-with the Ministry of Justice and Constitutional Affairs taking almost two years to publish the Law Commission’s report.
The commissioners rejected calls to decriminalise abortion, proposing new exceptions for safe and legal abortion.
To Blantyre district health officer Dr Charles Matchaya, the studies-and women receiving medical treatment-confirm the downside of the restrictive abortion laws.
Reacting to the study on incidence of unsafe abortions, he said: “No country can regulate reproductive health issues using tough laws. China tried it, but families resorted to terminating female foetuses in preference for boys instead of having one child as required by law.
“We need to be open-minded and use these research findings to make policies to reduce preventable deaths of women and ensure health workers do their job without fear.”
Senior chiefs Mabulabo and Lukwa asked government to fast-track law reviews, saying existing laws promote inequalities that disproportionately affect the rural poor.
They find it unfair that rural women and girls are desperately killing themselves with sticks, wires and toxic herbs while well-off urban dwellers easily access safe abortion in private clinics. n