Post-abortion care saves women’s lives

In November 2023, Shukran Ali, 25, of Pemba Village, Traditional Authority Kuluunda in Salima District, was left in agony after having miscarried a five-month pregnancy.

Her relatives took her to Salima District Hospital for post-abortion care.

The medical procedure involves clearing life-threatening residues of an incomplete birth process from the womb.

It can be life-saving even for women and girls who clandestinely induce abortion, usually at the risk of losing their lives or sustaining crippling complications.

“I am still alive because I received post-abortion care support,” says Ali. “I had severe bleeding and abdominal pain which forced me to seek medical assistance at the hospital, over 25 kilometres from my village.”

The hospital has provided post-abortion care to 340 patients in the first half of 2024. Some 32 of them were teen girls.

According to records at the hospital, this is more than half of the 811 cases recorded last year and 85 of them were teens.

Stigma, low support for clandestine abortions, costly hospital trips and stays and delays in providing safe abortion services affect access to the life-saving procedure. It involves the removal of deadly residues of a terminated pregnancy.

The hospital’s post abortion care coordinator Peter Pinakuwa says the new figures represent a decline from the 846 cases registered in 2022 when 60 of those cases were teens.

He says most women seek medical assistance ”rather late” due to a climate of fear created by the country’s restrictive abortion laws.

The laws inherited from Britain during independence in 1964 only allow medical abortion to save a woman’s life. One can be jailed for 14 years if convicted of terminating a pregnancy.

In rural areas, women and girls seek backstreet abortions to escape the glare of the colonial law and only seek medical care when deadly complications kick in.

Others, especially the well-off urban dwellers, seek safe abortion in private clinics.

However, those with complications receive post-abortion care from public hospitals that decline to provide safe termination of pregnancy.

Pinakuwa says: “Most patients come late, which results in unnecessary deaths. However, we properly carry out our obligations to save lives.

 “Lack of information on post-abortion care is another setback. Many people don’t know they can get post-abortion care in a public hospital in case of miscarriage or abortion.”

Salima District Hospital has introduced teen clubs where young people discuss their shared experience, knowledge and values to curb teen pregnancies, unsafe abortions and sexually transmitted infections (STIs), including HIV.

During the meetings, health workers give them sexual and reproductive health talks, including on the importance of modern family planning and how to avoid early pregnancies and marriage as well as STIs.

Adolescent boys and girls also get family planning through youth-friendly outreach clinics in hard-to-reach areas.

The country recorded 6 338 unsafe abortion complications and 464 deaths in 2020, reports the Ministry of Health.

Bridge to Community Liberty and Development (BCLD) executive director Faida Amurani Phiri says poverty and peer pressure push girls into a trap where they sleep with fishermen along the shoreline of Lake Malawi.

Her youth-led organisation advocates against barriers that prevent girls and young women from accessing essential services, including sexual and reproductive health.

BCLD promotes enhanced access and uptake of SRH rights services in rural settings under T/A Kuluunda and Senior Chief Maganga to reduce teen pregnancies, unsafe abortions and STIs.

“These areas have increased cases. For instance, 177 women went through post-abortion care and 18 were teens from January to June,” she says.

According to Ipas Malawi, the country records about 886 161 pregnancies a year and half of them are unintended.

The sexual and reproductive health (SRH) think-tank reports that 30 percent of these unintended pregnancies result in unsafe abortion, which accounts for up to 18 percent of pregnancy-related deaths.

In 2009, Malawi adopted the National SRH and Rights Policy, which expired in 2022 to empower and enable women and adolescent girls to prevent unplanned and unwanted pregnancies.

The policy requires the government and its partners to develop and implement family planning services and ensure all women with abortion complications access to quality post-abortion care services.