Abortion law lost in tongues

Some Malawians fear that the ongoing law review will overwhelm health workers with women and girls demanding to terminate pregnancies.

However, a counterview is emerging that this perspective does not just insult the Malawian woman, for not every pregnancy compels one to abort.

However, the proponents say it typifies falsehoods blocking the push to modernise the country’s colonial abortion law.

“This is wrong,” says gender activist Emma Kaliya. “The proposed Termination of Pregnancy Bill does not subscribe to abortion on demand. Rather, it is just extending the grounds for safe abortion.”

The Penal Code only permits abortion when a woman’s life is in danger.

However, the Bill proposed by the Law Commission seeks to give a woman the liberty to terminate a pregnancy where it results from rape, defilement or incest; threatens her physical and mental health or where  the foetus is severely malformed.

“This doesn’t legalise abortion at will as some groups would want to mislead Malawians. It’s just propaganda,” Kaliya says.

Misinformation typifies the debate over rising demands to relax restrictions to safe abortion.

Campaigners say adding exceptions to the restrictive law will save lives, but protesters, backed by some faith and traditional leaders, liken abortion to murder.

“Currently, abortion in Malawi can only be performed when the life of a woman is deemed to be in extreme danger,” says lawyer Yankho Mwandidya. “Under the draft Bill, abortion will not be performed on demand. The proposed law calls for solid evidence for the suggested grounds.”

Section 243 of the Penal Code requires health workers to perform a surgical operation in good faith to preserve life.

 “How the law is enforced forces women to seek unsafe abortion, which leads to high maternal mortality and cost of post-abortion care,” says the lawyer.

In 2015, the Law Commission announced that Malawians had rejected suggestions to legalise abortion on demand as is the case in the neighbouring Mozambique, Zambia and South Africa.

Instead, the commissioners recommended liberalisation of termination of pregnancy, proposing three more exceptions to the existing law.

The proposed grounds are prescribed by the Maputo Protocol ratified by African leaders.

Malawi is one of the 44 countries that have signed up to the African Union’s protocol on the rights of women, including access to comprehensive sexual and reproductive health services, including safe abortion.

Kaliya says the proposed amendments, once blocked from being debated in Parliament, will benefit women who cannot afford safe abortion in private clinics concentrated in cities and towns.

She asks: “Why should laws favour only the rich whose resistance disadvantages the poor majority that risk their lives in backstreet abortions?

“Even with the restrictive law, the rich still access safe abortion in private hospitals. Others even fly women and girls abroad for abortions.

Dr Chisale Mhango, a reproductive health researcher at the Kamuzu University for Health Sciences (Kuhes) in Blantyre, says studies show that the termination of about two million pregnancies when the US population had a population of 200 million resulted in three abortion-related deaths.

However, a 2015 study by Mhango and his team from Kuhes and the US-based Guttmacher Institute showed that unsafe abortion killed 500 women from at least 141 000 abortions that occurred in Malawi that year.

“Put differently, abortion causes 80 deaths in every 100 000 live births. To achieve the Sustainable Development Goal of reducing maternal deaths to 70 per 100 000 live births, we have to tackle unsafe abortion,” says the former director of the Reproductive Health Unit in the Ministry of Health.

Unsafe abortion refers to the termination of pregnancy by untrained persons outside healthcare facilities, especially in countries with restrictive laws.

To tackle the burden, the ministry prompted the Law Commission to review abortion laws to prevent women from dying from complications of pregnancy.

However, the proposed law, which suggests new grounds for the safe termination of pregnancy, has been gathering dust on Cabinet shelves since 2015.

Ministry of Health spokesperson Adrian Chikumbe concurs that unsafe abortion increases the risks of pregnancy-related deaths.

Ipas, an international sexual and reproductive health think-tank, supports comprehensive abortion care through health systems strengthening, advocacy for policy reform and post-abortion care guidelines enforcement in all health facilities.

It reports that Malawi recorded 929 abortion cases in 2020, but the annual count rose to 35 933 in 2021 and 37 242 in 2022.

“The country recorded 13 deaths in 2020, 21 in 2021 and 16 in 2022,” says Christopher Kandionamaso, health systems adviser Ipas in Southern Africa. “Lilongwe, Blantyre, Dowa, Machinga, Mangochi, Mzimba, Salima and Thyolo recorded the highest figures of unsafe abortion.”

National Police spokesperson Peter Kalaya says most abortion cases are neither detected nor reported unless complications kick in.

“Even the few are mostly reported by parents or guardians. This is so because such acts are done secretly,” he says.

And this is the more reason that campaigners are going against cultural and religious currents in the lobby for safe abortion.

“Why should the poor face preventable deaths outside hospitals because the current law favours the rich?” Kaliya asks.nS

exually active young Malawians find it tricky to talk about sex and reproductive health issues, with some shunning life-saving services for fear of being spotted by their guardians, neighbours and relatives.

To beat the barrier, service providers are putting sexual and reproductive health (SRH)supplies and information in youthful hands that privately distribute them to peers.

The peer-to-peer approach is credited with increasing SRH awareness while reducing the risk of unintended pregnancies, early marriages, school dropout and sexually transmitted infections, including HIV.

Eliza Chisamba, 23, has become a go-to person for the youth in Traditional Authority Malili on the outskirts of Lilongwe City.

A beacon of hope and determination, the peer educator is breaking the mound by sharing SRH information and condoms with sexually active boys and girls in her community.

Chisamba sounds undeterred by insults and skepticism in the rural community where many grow up hearing that contraceptives are meant for adults and married couples.

“I am on a mission to safeguard my peers from preventable perils such as unwanted pregnancies and STIs, which negatively affect their health, productivity and chances in life,” she states.

Chisamba is a peer educator under the Her Future Her Choice Project by Oxfam in Malawi in partnership with Point of Progress and the Family Planning Association of Malawi (Fpam) with funding from Global Affairs Canada through Oxfam Canada.

The five-year initiative, which phases out this year, targets 20 000 young men and women aged 10 to 24 years in Lilongwe and Balaka.

With zeal, Chisamba reaches out to over 100 peers in five villages.

“I distribute more than 500 condoms each month, saving the youth from unwanted pregnancies, HIV and other dangers likely to push them to quit school and marry too young,” she says.

In her line of duty, she endures insults to serve the population with a huge unmet demand for SRH services.

The young woman on the move dispels myths and misconceptions about contraceptives.

She narrates: “Some call me a prostitute and accuse me of recruiting my peers, but they forget that the boys and girls I go to are already sexually active.

“Others sneer at me, saying the contraceptives will make girls barren. But this is unsubstantiated.”

Apart from distributing condoms and contraceptive pills from the nearest public facilities, the peer educators establish youth clubs, counsel their peers and encourage them to seek medical treatment when they contract STIs.

Malili Youth Network chairperson Ellen Chimtengo says the demand for SRH services and rights has led to reductions in teen pregnancies and child marriages, meaning more girls are likely to complete their education.

“The project’s impact extends beyond the clubs as individual members have become foot soldiers in the fight against gender-based violence, including early pregnancy and marriages, in their communities,” she explains.

Chimtengo’s network is an umbrella of 24 youth clubs that reach more than 2 000 members across T/A Malili .

“We want to reach out to more, but there are mobility challenges,” she says. “We travel long distances and the bicycles provided by the project cannot take us to some places that require a motorcycle,” she says.

The non-governmental organisations are implementing the project together with the Ministry of Health and other relevant government institutions.

Mary Chirambo, who coordinates family planning interventions at Lilongwe District Health Office, says the project has helped the target community accept contraceptives as vital tools to keep girls in school.

“Working with peer educators and community-based distributors has proven to be a success in offering communities SRH supplies, the right information and demystifying myths and misconceptions,” she says.

Group village head Mbilizi said before the project, most men could not allow girls and women to take contraceptives.

“A woman could not access contraceptives without a man’s consent though many men had the misconception that family planning affects their performance in bed,” says the traditional leader.

Periodically, community health worker Lucy Kalipeni joins the peer educators in raising awareness and administering modern family planning methods such as injections and implants.

“Everywhere we go, the demand is growing,” she says.

Point of Progress project manager Sekanawo Mwatibu says the project has improved the uptake of contraceptives, economic empowerment of youth and community attitudes to SRH services and rights.

“Apart from a marked improvement in community attitudes and knowledge, there is rising widespread support for women’s rights and SRH rights from men, boys, community influencers and chiefs,” said Mwatibu.

Despite the successes, challenges persist.

These include commodity stockouts in public facilities and ingrained negative social norms.

These contribute to undesirable outcomes such as rampant teen pregnancy and child marriages.

Although the Constitution outlaws sex and marriage with persons aged below 18, the Malawi Demographic and Health Survey shows that 46 percent of women marry before their 18th birthday and 29 percent become mothers before reaching 19.

These fuel school dropouts, maternal deaths, STIs, HIV infections and poverty.

The inroads by  Chisamba and her colleagues personify the transformative power of peer-to-peer outreach in communities where discussing sex and SRH rights was taboo.