Unsafe Abortion: Zambia at crossroads
By DOREEN NAWA
NINETEEN-YEAR OLD Amanda Kayula of Lusaka’s Chainda township died of complications from illegal abortion on May 1 last year at the University Teaching Hospital (UTH).
Sadly, Amanda’s fate is all too common. Illegal abortions kill dozens of Zambian women every year.
According to a Gynaecologist Swebby Macha, 50 percent of acute gynaecological admissions are as a result of abortion complications, a big proportion being from unsafe abortion.
Although there is limited formal data on the subject, the number of deaths caused by unsafe abortion is likely far higher than recorded since the UTH only took into account cases that were attended to by medical professionals at the institution.
“Alongside death, illegal abortions result in serious illness. Immediate complications from unsafe abortions include severe bleeding, uterine perforation, tearing of the cervix, severe damage to the genitals and abdomen, internal infection of the abdomen and blood poisoning,” Dr Macha says.
According to Dr Macha, medium-term complications range from reproductive tract infections and pelvic inflammatory disease to chronic pain, and long term complications include increased risk of infertility and ectopic pregnancy, miscarriage or premature delivery in subsequent pregnancies.
However, the media has reported on how easily accessible illegal and unsafe abortion is in Zambia. Cases of baby dumping are stories that make interesting reading in newspapers all point to how easily accessible unsafe and illegal abortion is and the victims are condemned by society without scrutinising the reason behind their action.
Recently, a 19-year-old girl of Lusaka’s Chunga Township dumped her newly-born into a pit latrine and the baby died after several hours of trying to rescue it. Such stories are the order of the day in Lusaka and many other cities in the country. Such are cases that go unnoticed and just the collection of data is another challenge.
Unfortunately, the very nature of illegal abortion provision makes it difficult to collect figures on providers’ activities or confirm trends, though increased advertising seems to support that the number of unsafe providers is increasing.
According to Dr Macha, very limited data is collected on the number of women who die or experience serious illness due to illegal abortions outside of health facilities, apart from sporadic cases, like those that receive media coverage.
What is clear is that the number of women who seek an abortion in a formal health facility is nearly equal to those who seek them elsewhere.
Statistics at the UTH shows that 30 percent of abortions undergone by young people between the ages of 13 and 19 took place outside a hospital or clinic and were therefore likely to be unsafe.
Dr Macha says cases of illegal abortion are expected to be on the rise should Article 28 in the Draft constitution pass. The proposed law: Article 28 states that; every person has, subject to clauses (2) and (3), right to life which begins at conception.
Article 28 further states that a person shall not be deprived of life intentionally, expect to the extent authorised by this Constitution or any other law.
But Article 12 states that; No person shall deprive an unborn child of life by termination of pregnancy expect in accordance with the conditions laid down by an Act of Parliament for that purpose.
According to Dr Macha, if enacted, Article 28 could be used as a basis to restrict reproductive health services.
Dr Macha says, the clause ‘Life begins at conception’ does not belong in the Zambian Constitution adding that women should be allowed to decide whether to keep the pregnancy or not.
“Should Article 28 in the Draft Constitution go as it is now, it will be an infringement on women’s rights. Women in Zambia seek abortions outside hospitals and clinics for various reasons. There are reasons for going to illegal providers include not knowing where to access safe abortions, stigma from their communities, judgemental staff and concerns over confidentiality and cost,” Dr Macha says.
Giving reference to the Draft Constitution’s Article 28, Dr Macha says if enacted could limit the treatment of infertility and also the treatment for ectopic pregnancies.
And Ipas Zambia says illegal abortion providers prey on women’s lack of knowledge for their financial gain. There is a vital need for a two-pronged approach to end illegal abortion.
“First, the public need to be fully informed on who is a legitimate safe abortion provider. Second, implementation of the Choice on Termination of Pregnancy Act needs to be assessed on a national level. Steps must be taken to end the needless mortality and morbidity that result from unsafe abortions. Unsafe abortions are on the rise across the world,” says Ipas Zambia country director Felicia Sakala.
Ipas is an international organisation dedicated to preventing maternal deaths.
Mrs Sakala notes that while some countries have decreased their restrictions on abortion, others have increased barriers to safe abortions through more restrictive laws, unwillingness to train providers, increasing the cost of obtaining safe services and validating abortion stigmatisation through perpetuation of cultural and societal norms.
Mrs Sakala says unsafe abortion is a serious problem in Zambia, “National figures do not exist, reflecting the low status of the issue, but our research suggests thousands die every year attempting to terminate their pregnancies. These deaths account for 30 percent of an excessively high maternal mortality rate of 591 deaths per 100,000 live births. Girls and young women under 19 years old account for a staggering 80 percent of these deaths.
According to Mrs Sakala, without tackling unsafe abortion, it will be impossible to reduce maternal mortality.
“Abortion is actually legal under the Termination of Pregnancy Act of 1972 but very few people know about it. It is not just the general public either; health providers and even lawyers do not have all the information and should Article 28 be enacted, the problem will be massive,” Mrs Sakala says.
“We really need to change people’s mind-set, if we are to win this battle. When a woman has decided she wants to get rid of a pregnancy then she has really made up her mind, whatever you say she will procure it, so you may as well make it safe,” the country director says.
Mrs Sakala was a midwife for 30 years and has worked on highly contentious issues such as gender-based violence and HIV, which currently affects 14.3 percent of Zambians.
She believes abortion should be approached in a similar way, by bringing it out of the shadows. “Everyone knows someone who has had an unsafe abortion; three of my daughters’ friends have died from it. So, whether we are mothers, grandmothers or sisters, we need to start talking about it, to challenge the stigma. We have been silent for too long and the longer we stay silent, the more women will die.”
According to a Gynaecologist Swebby Macha, 50 percent of acute gynaecological admissions are as a result of abortion complications, a big proportion being from unsafe abortion.
Although there is limited formal data on the subject, the number of deaths caused by unsafe abortion is likely far higher than recorded since the UTH only took into account cases that were attended to by medical professionals at the institution.
“Alongside death, illegal abortions result in serious illness. Immediate complications from unsafe abortions include severe bleeding, uterine perforation, tearing of the cervix, severe damage to the genitals and abdomen, internal infection of the abdomen and blood poisoning,” Dr Macha says.
According to Dr Macha, medium-term complications range from reproductive tract infections and pelvic inflammatory disease to chronic pain, and long term complications include increased risk of infertility and ectopic pregnancy, miscarriage or premature delivery in subsequent pregnancies.
However, the media has reported on how easily accessible illegal and unsafe abortion is in Zambia. Cases of baby dumping are stories that make interesting reading in newspapers all point to how easily accessible unsafe and illegal abortion is and the victims are condemned by society without scrutinising the reason behind their action.
Recently, a 19-year-old girl of Lusaka’s Chunga Township dumped her newly-born into a pit latrine and the baby died after several hours of trying to rescue it. Such stories are the order of the day in Lusaka and many other cities in the country. Such are cases that go unnoticed and just the collection of data is another challenge.
Unfortunately, the very nature of illegal abortion provision makes it difficult to collect figures on providers’ activities or confirm trends, though increased advertising seems to support that the number of unsafe providers is increasing.
According to Dr Macha, very limited data is collected on the number of women who die or experience serious illness due to illegal abortions outside of health facilities, apart from sporadic cases, like those that receive media coverage.
What is clear is that the number of women who seek an abortion in a formal health facility is nearly equal to those who seek them elsewhere.
Statistics at the UTH shows that 30 percent of abortions undergone by young people between the ages of 13 and 19 took place outside a hospital or clinic and were therefore likely to be unsafe.
Dr Macha says cases of illegal abortion are expected to be on the rise should Article 28 in the Draft constitution pass. The proposed law: Article 28 states that; every person has, subject to clauses (2) and (3), right to life which begins at conception.
Article 28 further states that a person shall not be deprived of life intentionally, expect to the extent authorised by this Constitution or any other law.
But Article 12 states that; No person shall deprive an unborn child of life by termination of pregnancy expect in accordance with the conditions laid down by an Act of Parliament for that purpose.
According to Dr Macha, if enacted, Article 28 could be used as a basis to restrict reproductive health services.
Dr Macha says, the clause ‘Life begins at conception’ does not belong in the Zambian Constitution adding that women should be allowed to decide whether to keep the pregnancy or not.
“Should Article 28 in the Draft Constitution go as it is now, it will be an infringement on women’s rights. Women in Zambia seek abortions outside hospitals and clinics for various reasons. There are reasons for going to illegal providers include not knowing where to access safe abortions, stigma from their communities, judgemental staff and concerns over confidentiality and cost,” Dr Macha says.
Giving reference to the Draft Constitution’s Article 28, Dr Macha says if enacted could limit the treatment of infertility and also the treatment for ectopic pregnancies.
And Ipas Zambia says illegal abortion providers prey on women’s lack of knowledge for their financial gain. There is a vital need for a two-pronged approach to end illegal abortion.
“First, the public need to be fully informed on who is a legitimate safe abortion provider. Second, implementation of the Choice on Termination of Pregnancy Act needs to be assessed on a national level. Steps must be taken to end the needless mortality and morbidity that result from unsafe abortions. Unsafe abortions are on the rise across the world,” says Ipas Zambia country director Felicia Sakala.
Ipas is an international organisation dedicated to preventing maternal deaths.
Mrs Sakala notes that while some countries have decreased their restrictions on abortion, others have increased barriers to safe abortions through more restrictive laws, unwillingness to train providers, increasing the cost of obtaining safe services and validating abortion stigmatisation through perpetuation of cultural and societal norms.
Mrs Sakala says unsafe abortion is a serious problem in Zambia, “National figures do not exist, reflecting the low status of the issue, but our research suggests thousands die every year attempting to terminate their pregnancies. These deaths account for 30 percent of an excessively high maternal mortality rate of 591 deaths per 100,000 live births. Girls and young women under 19 years old account for a staggering 80 percent of these deaths.
According to Mrs Sakala, without tackling unsafe abortion, it will be impossible to reduce maternal mortality.
“Abortion is actually legal under the Termination of Pregnancy Act of 1972 but very few people know about it. It is not just the general public either; health providers and even lawyers do not have all the information and should Article 28 be enacted, the problem will be massive,” Mrs Sakala says.
“We really need to change people’s mind-set, if we are to win this battle. When a woman has decided she wants to get rid of a pregnancy then she has really made up her mind, whatever you say she will procure it, so you may as well make it safe,” the country director says.
Mrs Sakala was a midwife for 30 years and has worked on highly contentious issues such as gender-based violence and HIV, which currently affects 14.3 percent of Zambians.
She believes abortion should be approached in a similar way, by bringing it out of the shadows. “Everyone knows someone who has had an unsafe abortion; three of my daughters’ friends have died from it. So, whether we are mothers, grandmothers or sisters, we need to start talking about it, to challenge the stigma. We have been silent for too long and the longer we stay silent, the more women will die.”
No comments:
Post a Comment