Just four months after delivering her third child, Margaret Kawala, 42, discovered she was three months pregnant.
She felt dejected. She discussed the issue with her husband and opted for safe abortion at a nearby hospital. However, they were denied the service based on law. In Malawi, abortion is illegal.
Kawala had no option, but to seek unsafe abortion from a herbalist. She was given a concoction. The same day, on January 3 2016, she had an abortion that appeared to be successful.
But this is what cost Kawala her womb and later her marriage. Her husband of 17 years abandoned her for another woman because she could no longer have children.
“It was an agreed decision with my husband,” explains Kawala who comes from Kamwana Village in Traditional Authority Dzoole, Dowa.
“I felt like a grinder was in my womb, trying to cut every piece. I started bleeding heavily, and later, I collapsed and was taken to a private hospital where doctors said I had lost a lot of blood and my womb was damaged.”
Her womb was eventually removed.
“It was hard to believe that I would never give birth again,” she recalls.
She says after the incident, the husband, Ziutse Mthebe, started changing colours, saying she wanted to marry another woman to give him children.
In an interview Mthebe said: “We didn’t really agree to the abortion decision,” he claims. “The complications after the abortion are what made me to remarry. It was just a misunderstanding.”
Kawala says she resigned to fate and allowed the husband to marry another wife, but this was the beginning of trouble. He told her to leave his home, but she insisted on staying. Later, Mthebe left the place.
Since then, Kawala looks after the three children alone. She tried to engage marriage counselors and chiefs, but it did not work. Her elder daughter is now married with two children.
In a phone interview from Zambia, Mthebe only said: “I am ready to meet her and see my children. She is still my wife.”
Magnitude of Problem
College of Medicine researcher Dr Chisale Mhango says a recent study done at Queen Elizabeth Central Hospital, covering two years, reveals that abortion complications contribute to about 23.5 percent of maternal deaths.
“A study conducted in 2009 reveals that 67 300 induced abortions occurred in that year, which costed the government about $314 000 (about K230 million) to manage resultant complications in that year,” he says.
A repeat study, according to Mhango, revealed that 141 444 induced abortions occurred in 2015. If the costing remains the same as at 2009 calculations, Mhango says, government is spending more than $658 000 (K500 million) each year to manage abortion complications.
However, Mhango, who is also President of the Association of Obstetricians and Gynaecologists of Malawi, says this does not include the cost of losing women in their productive ages.
At district level, between July 2015 and November 2016, Karonga District Hospital treated 577 women with maternal complications due to induced abortion. Out of the 577 clients sampled, 16 were girls under the age of 15. Further data indicates the district treated 1 093 abortion-related cases in 2015 and 2016. One woman lost life due to delays in seeking post-abortion care. In 2014 and 2015, the hospital recorded an average of 960 cases each year.
Between July and October 2016, Mzimba North District Hospital treated 207 women with abortion-related complications and most of them were married women. During the same period, the hospital had 553 cases and admitted 144 women requiring abortion-related surgeries. This accounts for 26 percent of the admissions at the hospital. As of October 2016, the ward had 174 admissions, of which, 63 were due to unsafe abortions.
Research shows that women and girls seek abortion due to the desire to remain in school, shame from extra-marital pregnancy, pregnancy that is too close to the previous pregnancy, poverty and pregnancies resulting from defilement, rape and, or incest.
Law Reform Process
Under the laws of Malawi, specifically the Penal Code of 1930 (Sections 149-151), the performance of abortions is generally illegal.
A person, who unlawfully uses any means with intent to procure an abortion, is subjected to 14 years imprisonment while an expectant woman who unlawfully uses any means or permits the use of such means with intent to procure her own abortion is subject to seven years imprisonment.
On the other hand, a person who unlawfully supplies or procures anything, knowing that it is intended to be unlawfully used to procure an abortion, is subject to three years imprisonment.
But Section 243 of the Penal Code provides that a person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon any person for his benefit, or upon an unborn child for the preservation of the mother’s life.
Malawi Law Commission commissioner Mike Chinoko says they want termination of pregnancy to remain an offence, but with exceptions expanded to provide for more grounds that would warrant pregnancy termination. He says they have proposed that abortion should be carried out when saving the life of the mother and preserving the physical or mental health of the pregnant woman.
It should also be carried out in cases of severe foetal malformation, which will affect its viability or compatibility with life as well as in cases of rape, incest or defilement provided that this will be done within 16 weeks of gestation.
If only the new law was in place, women like Kawala would not have been in their current state. The hospital she visited could have helped her access safe abortion.
Human rights activist Emma Kaliya says Malawi should allow women access safe abortion. She calls on religious leaders to try and resolve the dilemma and let government protect the health of women. The campaign for safe abortion has been facing stiff resistance from religious leaders because they regard abortion as a sin.