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‘Malawi needs a law to regulate safe abortion’

Although abortion is illegal in Malawi, recent statistics indicate that 70 000 Malawian women have abortion every year. Bright Mhango speaks to national coordinator for Coalition on the Prevention of Unsafe Abortion (Copua), Chrispine Sibande, who argues the country is better off legalising abortion as unsafe abortions are currently threatening women’s lives and costing government more in treatment.

What is unsafe abortion?

According to World Health Organisation (WHO), unsafe abortion is a procedure for terminating an unwanted pregnancy either by person lacking the necessary skills or in an environment lacking the minimal medical standards, or both.

How widespread is unsafe abortion in Malawi?

According to a Ministry of Health study on Abortion in Malawi in 2010, 70 000 Malawian women have abortions every year, or there are 24 abortions for every 1 000 women aged 15-44. The study also showed that 31 000 Malawian women are treated for complications of unsafe abortion annually. Approximately 17 percent of maternal deaths in Malawi are attributable to unsafe abortion, making it one of the primary causes of maternal mortality. In addition, 30 percent of all admissions in country’s gynaecological wards are due to unsafe abortion.

What is the social status of these women?

Research findings show that in Malawi, almost half of the women treated for post-abortion complications are younger than 25 years old.  Four out of five are married and almost two-thirds live in rural areas. Women with limited access to family planning methods are at particular risk for unwanted pregnancy. 

How much does it cost to treat a woman with abortion complications?

In terms of cost basic post-abortion care, it is estimated to be $23 (about K8 500) per case. More severe cases requiring a blood transfusion, treatment of sepsis or surgical repair of the reproductive tract can increase cost by between 67 and 89 percent.

Why do you think abortion cases are increasing?

The main reason is the unwanted pregnancy. Unwanted pregnancies result from a number of factors such as lack of use of contraceptives. According to research and experts, Malawi’s consumption of contraceptives is at 42 percent. Therefore, 58 percent of Malawians do not use contraceptives which means they are likely to have unplanned pregnancies.

The other reasons can be contraceptive failure; culture, traditional practices and religious beliefs that force women not to practice any family methods; pressure from partner or spouse; pressure to continue with education or access to scholarship opportunity; high poverty levels; work and employment restrictions and pregnancy resulting from rape or incest.

Is Malawi doing enough to deal with challenges of unsafe abortion?

Malawi as a country has not provided a legal environment where safe abortion can be accessed easily. Abortion is legal in Malawi under Section 243 of the Penal Code, but the law demands that it should be carried out by any person with reasonable care and skill to carry out an operation to preserve mother’s life.

So, we have one condition in Malawi where termination of pregnancy will be acceptable within our framework of the law, that is, where it is meant to preserve woman’s or mother’s life. There are always questions as to who makes this decision? Atwhat level? What are the guiding principles?

The situation now is that we have free for all abortions being carried out by many unskilled people. These unsafe abortions are injuring women; result in permanent injuries, infertility, disability, disorders and deaths. Further, we have situations in which all complications related to unsafe abortion are ending up in hospitals. So hospitals are spending a lot of time and resources providing post abortion care from unsafe abortions.

Apart from fighting for the legalisation of abortion, are there no other alternative ways of dealing with this challenge?

We need to scale up provision of information and education on family planning methods and use of contraceptives at all levels of the society so that people get pregnant only through choice and not by accident.  The same information and education should be extended to the youth and active sexual groups because they are adversely affected. 

We need to come up with a law to regulate safe abortions and stop the free for all and chaotic situation in the country right now. If you go to the hospitals, especially in gynaecological wards, they will tell you that 30 percent of the space is being occupied by unsafe abortion patients.

Then you realise that Malawi can save K350 million [about $972 222] every year that can be used to address equally important health problems.  Treating complications arising out of unsafe abortion costs the Malawian taxpayer more than the cost of providing a safe abortion. 

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