Teen’s harrowing post-abortion care experience

In June this year, 15-year-old Sarah (not real name) from Traditional Authority Nyambi in Machinga District induced an unsafe abortion.

She felt the pregnancy would result in her dropping out of school. Unfortunately, she could not approach the nearest health centre, Nyambi, to procure a safe abortion since the current laws restrict termination of pregnancy, with some exceptions.

After she proceeded with the unsafe abortion, Sarah started bleeding profusely and she now had to go to Nyambi Health Centre to seek post-abortion care.

Prior to going to the health centre, she confessed to her mother about the situation when she noticed blood oozing out of her.

But Sarah’s visit to the health facility turned out to be a nightmare. She claims the nurse she met on arrival at the facility was rude to her.

“The nurse bluntly told me that she could not handle a person who has aborted. She said she would, instead, ask one of her colleagues to help me,”she says.

The rejection stung. But Sarah had no option but to wait for the other nurse to help her.

Luckily, the other nurse Sarah was referred to was kind. She treated her and gave her the support she needed, including giving her some words of comfort.

“She was compassionate,” says Sarah.

The treatment Sarah got from the second nurse made her feel “alive”, she claims.

But when she returned home, despite getting the treatment she needed, she was still haunted by the rejection she faced with the first nurse she met at the health centre.

Sarah says she felt judged, ashamed and unclean.

To make matters worse, Sarah’s 19-year-old boyfriend who had impregnated her ended the affair two weeks after the abortion.

“Had it not been that my mother has been supportive, I could have taken my life already,” she says.

The Standard Five learner hopes that with time, she will heal both physically and mentally.

Sarah’s story reflects the situation some girls face when accessing post-abortion care at some public health facilities in the country. Besides, it also shows the dilemma some nurses find themselves in as regards providing post-abortion care due to their beliefs, especially with the current restrictions on abortion.

Safe abortion in Malawi is restricted under Sections 149, 150 and 151 of the Penal Code. However, Section 243 of the Penal Code makes an exemption that abortion can only be procured when either the life and health of a woman or girl is in danger.

Section 243 reads: “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, if the performance of the operation is reasonable, having regard to the patient’s state at the time, and to all the circumstances of the case”.

Due to such restrictions, young girls and women are compelled to terminate pregnancies through unconventional methods.

This has often resulted in the young girls and women developing complications and in extreme situations some have died in the process.

Data compiled by Ipas Malawi in a November 2023 policy brief published on African Population and Health Research Centre’s website shows that in 2022 alone, 3 395 women and girls who induced unsafe abortions sought post-abortion at public health facilities.

“The increase in the number of those seeking post-abortion treatment was observed in both Blantyre and Lilongwe. While health facilities in Blantyre provided post-abortion care to 665 women in 2020, the number rose to 1 144 in 2021 and further to 3 395 in 2022.

“A similar trend is observed in Lilongwe, which recorded 1 098 cases in 2020, 4 711 cases in 2021 and 7 851 cases in 2022,” reads part of the Ipas data.

Centre for Human Rights and Rehabilitation executive director Michael Kaiyatsa says it is important that although abortion in Malawi is restricted and permitted to save the life of the woman, health facilities are still mandated to offer post-abortion care to manage complications.

“It is, therefore, wrong for health workers to ill-treat or discriminate against those seeking post-abortion services. Many girls experience emotional distress or trauma following abortion, especially if it was unsafe.

“It is, therefore, important that health workers should approach each girl seeking post-abortion care with empathy, respect and without judgement regarding her decision or circumstances that led to the abortion,” he says.

Nyale Institute executive director Dr. Godfrey Kangaude shares similar thoughts.

He says health professionals have ethical standards to follow and this includes respecting the dignity and autonomy of persons, doing no harm to the persons and acting in ways that are beneficial to the persons in their best interest.

“Over and above ethics, the health professional should respect the rights of the adolescent child under the Gender Equality Act including Section 20 which stipulates the duties of health providers to respect the sexual and reproductive health rights without discrimination, respect the dignity and integrity of every person accessing sexual and reproductive health services,” he says.

Kangaude says in the particular scenario, the health providers were, therefore, in breach of both their ethics and the law. He says the particular woman is free to complain to the Medical Council of Malawi or take the matter to court for breach of statutory duty.

He says Nyale Institute, as a champion of sexual and reproductive justice, will facilitate access to justice for those who believe their rights have been violated.

In 2021, the High Court of Malawi reiterated the statutory protections for legal abortion in the country in a ruling by High Court Judge Mzondi Mvula.

The ruling followed a case which was brought before the court by a 15-year-old girl who was sexually abused and, unfortunately, became pregnant. When she went to Queen Elizabeth Central Hospital in Blantyre to procure an abortion, she was turned away; hence, decided to take the matter to court.

But in his ruling, Judge Mvula stated that girls and women seeking abortion should present their case before a doctor and explain the conditions they are basing their decision on.

The Judge further stated that the doctor would then review the request prior to making a decision. This clarified and meant that girls and women seeking abortion in the country should demonstrate how pregnancy would endanger their health and life as per what the Penal Code stipulates.

Youth rights activist Kenneth Mtago says it is unfortunate that some healthcare workers are refusing to treat women who procure unsafe abortions despite the fact that they were trained to be professional.

He says: “The case at Nyambi Health Centre is not the only one in Malawi but many health centres have such healthcare workers who do not want to save the lives of women who go for post-abortion care”.

As part of dealing with such issues, Mtago says it will be imperative for the Termination of Pregnancy Bill to be tabled and subsequently passed.

Human rights and governance advocate Undule Mwakasungula says the plight of young girls facing ridicule and denial of care at health centres is a serious human rights issue and concern.

He says health workers need to be trained to provide compassionate, unbiased care and that legislative reforms are necessary to clarify abortion laws and protect the rights of women and girls.

He says: “We need to address these issues through a combination of legal, educational and healthcare improvements. Malawi must ensure that all women and girls receive the care and respect they deserve regardless of us not having clear laws on abortion”.

We reached out to Ministry of Health Principal Secretary Dr Samson Mndolo and spokesperson Adrian Chikumbe on July 9 2024 but we did not get any responses.

Malawi has a Termination to Pregnancy Bill which was blocked by legislators in 2021 amid strong opposition from numerous stakeholders, including the clergy.

If debated and passed into law, the Bill would, among others, allow women and girls to access abortion whenever they feel like not keeping the pregnancy.