Post-abortion care saves lives

Mary Edward of Kasinje Village in Ntcheu has miscarried eight pregnancies since she got married in 2015.

“It all begins with abdominal pains, then vaginal bleeding for two to three days,” says the distraught woman in an interview at Kasinje Health Centre.

Health workers once referred her to Queen Elizabeth Central Hospital in Blantyre, where she had her cervix reinforced.

“Even after that procedure, I lost another pregnancy in 2019 in my fifth month and my eighth one in October 2022,” recounts the 26-year-old.

Her agemate Anesi Dinwell of Nkotamo Village in Dowa is equally troubled.

Having lost two babies hours after giving birth, in 2015 and in 2018, she miscarried a two-month pregnancy.

“When I woke up that night, I noticed some vaginal discharges and bleeding. I felt pain in my lower abdomen,” she narrates.

When Anesi arrived at Nambuma Community Hospital around midnight, she was shattered when a clinician broke the news of her miscarriage and put her on post-abortion care.

“I wonder what my problem is and how it can be fixed. It pains me,” she explained while waiting to be discharged.

Timely post-abortion care services reduce the risk of deadly pregnancy-related infections and complications.

The national post-abortion care programme envisions no woman suffering or dying from complications of incomplete childbirths.

Family Planning Association of Malawi (Fpam) is supporting post-abortion care in Lilongwe and Ntcheu.

The project is funded through the International Planned Parenthood Federation’s Africa regional office to improve access to quality post-abortion care and modern contraception in an enabling environment.

The services that saved Mary and Anesi from spontaneous abortions are equally handy for women and girls who clandestinely terminate pregnancies for various reasons, including education and lack of support from their partners.

Studies by the Ministry of Health show that induced abortions, often conducted by unskilled hands beyond health facilities, claim up to 18 lives in every 100 pregnancy-related deaths.

These unsafe abortions are often propelled by the fear of being detained or ostracised as Malawi’s colonial Penal Code outlaws health workers from terminating a pregnancy except to save the woman’s life. The crime carries a maximum penalty of 14 years in jail time.

“The restrictive law pushes women and girls to procure unsafe abortion,” says Father Martin Kalimbe, who heads the Coalition for the Prevention of Unsafe Abortion (Copua) religious leaders committee.

The Anglican priest called for relaxation of the laws to untie health workers’ hands to provide comprehensive sexual and reproductive health services, including safe abortion, modern family planning and public awareness campaigns.

Ipas reports that 35 048 women procured unsafe abortions in 2021. Lilongwe topped the list with 4 432, followed by Blantyre with 2 500.

In Lilongwe, Kabudula Rural Hospital provides post-abortion care to about 35 patients a month, says the facility’s clinician-in-charge Chance Msongole.

He explains: “Most girls come with complications of unsafe termination of pregnancies. Once, we found a cassava stick in a girl’s uterus, which she used to jab the foetus.

“And most schoolgirls report to the hospital late when they are in danger of death.”

Msongole underscored the need to sensitise the youth to family planning methods to curb unplanned pregnancies.

Concurring, Given Chilimira, Fpam district manager in Ntcheu, said women and girls should be encouraged to seek medical assistance before pregnancy-related complications get out of hand.

“It’s said that some women and girls experience deadly complications and end up being hospitalised or losing uteruses and a lot of money because they seek health care too late. Government also spends a lot treating abortion complications,” he says.

Ntcheu district’s safe motherhood coordinator Mwai Sabola-Banda attributed the delays to seek medical assistance to stigma and fear of arrests.

“The clients, who suffer in silence, risk losing life or suffering lifelong complications,” he states.

Banda said the demand for post-abortion care in Ntcheu keeps rising as those who clandestinely procure abortions shun public hospitals for fear of being detained.

“In the end, they come to us when the condition gets worse. Just last year, we lost two patients due to severe bacterial infection and bleeding resulting from abortion complications,” she explains.

Banda is grateful that the Post-Abortion Care project by Fpam has trained more service providers and supplied necessary equipment in constrained health facilities.

“There is a huge impact in rural hospitals that previously referred all post-abortion care clients to the district hospital due to lack of equipment and expertise. Now they perform the procedures and clients are saving resources,” she said.

Fpam has also trained community-based distribution agents. The volunteers go door-to-door in hard-to-reach areas, discreetly distributing condoms, pills and other modern family planning methods to avert unwanted pregnancies.

Ellen Yona, from Katsekera, feared an increase in unplanned pregnancies in her area following the shortage of family planning methods.

She states: “The demand for family planning methods is high and the shortage is affecting many people.

‘Three of my clients are currently pregnant following the shortage of contraception pills. One of them had a secret abortion.”

The volunteers also link pregnant women with providers of post-abortion care.

If a pregnant woman suddenly starts menstruating, Yona advises them to rush to the hospital since their pregnancy might be at risk.

“I send them off with a letter to present at the health facility for rapid assistance,” she says.