470 000 unintended pregnancies, 141 000 abortions

Ensuring that every baby is wanted has become a global buzzword, but slightly over half of the babies in the country could not have been born if parents had a choice.

A new study by the Reproductive Health Department at the University of Malawi’s College of Medicine (CoM) and the US-based Guttimacher Institute shows 53 percent of pregnancies in 2015 were unintended.

Out of  886 220 registered in the year, almost 470 000 were conceived by mistake.

But an astonishing 141 000 pregnancies—close to a third of the total—resulted in induced abortions although colonial penal laws prohibit termination of any pregnancy except to save a woman’s life.

This is a red flag for the country to urgently increase access and consistent use of modern family planning methods as well as to relax laws adopted in 1925, the researchers say.

The six researchers collected information from 294 health facilities and 125 health workers across the country between October and December 2015.

The same year, the Special Law Commission empanelled in 2014 released recommendation for lawmakers to add more grounds for women to access safe abortion.

The new evidence coincides with a heated debate over proposals to add more exceptions to the restrictive abortion laws.

Last December, Catholics and evangelicals held nationwide protests against the tabling of the proposed amendments in Parliament.

The marchers and their groups may have renounced the calls to liberalise the controversial laws as sinful and murderous, but the finding shows women are still terminating pregnancies clandestinely and unsafely regardless of the restrictions, religious ideologies and the touchy debate.

 “Addressing unsafe abortion is an urgent public health priority,” says CoM senior lecturer Dr Chisale Mhango. “Restrictive laws do not stop abortion from occurring. They just drive it underground, forcing women to resort to clandestine procedures, which are often unsafe and fatal.”

The number of abortions is twice those enumerated by the Ministry of Health in 2009, but the researchers say they are not comparable since the current one is based on a bigger sample and slightly different methodology.

Then, the ministry estimated that unsafe abortions kill up to 17 in every 100 women dying of pregnancy-related deaths in the country.

The latest research from CoM and the US sexual and reproductive health think-tank uncovers more risks as almost 60 in 100 women who had an abortion experienced complication that required treatment in a health facility.

But one in three women suffering the complications did not receive the post-abortion care they needed, the findings show.

“Helping women avoid unintended pregnancy is critical to reducing the incidence of abortion and the complications and deaths that often follow unsafe, clandestine procedures,” says Guttmacher senior research scientist Dr Chelsea Polis, the lead author of the study.

The number of abortions translates to a rate of 38 terminated pregnancies out of every 1 000 sexually active women, aged 15 –49.

According to Polis, the rate is high, but consistent with trends in the region—including Tanzania where the rate is estimated at 36 per 1000 women and Uganda where it is 39 per 1000.

“There is need to critically look at the results and come up with the best way forward on how we can save the women,” reckoned Laston Chikoti, a reproductive health officer in the Ministry of Health.

His Directorate of Reproductive Health is tasked to increase access to contraceptives at a time nearly 20 in 100 married women who need to have children by choice have no access to contraceptives. The unmet need is higher—about 40 percent—among adolescent girls. Nearly 30 in 100 of school-age girls get pregnant, according to the recent Malawi Health and Democratic Survey.

Gender activist Emma Kaliya says: “We need to prevent unintended pregnancies from happening in the first place, but the hypocrisy and rhetoric that underpin abortion laws and the ongoing debate is punishing women and girls.”