DOREEN NAWA, Lusaka
IN THE emergency ward at the University Teaching Hospital (UTH), a child-like young woman aged 16 is struggling to breath and dangerously close to death not because she is a Road Traffic Accident (RTA) victim. She is haemorrhaging.
The people around her, the mother and sister, apparently complicit in her nightmare, are sobbing next to her.
To ascertain what illness it is, a doctor on duty tries to coax the terrified girl to narrate what happened. But the girl insists she has no idea, and so do the mother and sister.
But after the desperate chaos that often surrounds emergency healthcare, a large part of cassava stick is found in the girl’s bloody and damaged cervix and removed.
She procured an unsafe abortion.
Quickly, the victim is transferred to the already congested female ward, CO3, and there, her condition is not new because over 50 percent of bed occupants have cases similar to that of this 16-year-old girl.
A procedure called Manual Vacuum Aspiration (MVA) is done on her to manage the incomplete abortion. MVA is found to be equally safe, effective, simple and fast set of instruments which can be employed in the management of incomplete abortions.
Fortunately, after a few days of admission, the girl survives and returns home.
A renowned healthcare practitioner, specialised in Gynaecology and Obstetrics, Swebby Macha says an average of 15 uterine evacuations on a daily basis come for incomplete abortions and they are mostly female juveniles and tertiary students.
“We are seeing many girls haemorrhage, sometimes they cannot reach the hospital fast enough and though we try to resuscitate them, they are already gone. Unsafe abortions are a big problem. Actually abortion is among the top five causes of maternal deaths in Zambia,” Dr Macha said.
There is also a lack of space at UTH. Originally the hospital was built for a Lusaka of 1.5 million; its population has since spiralled to 4 million according to the Central Statistical Office (CSO) data of 2015. Besides, UTH does not service Lusaka only, but the whole country.
“There’s only one operating room,” Dr Macha says, “so if we have various girls needing vacuum aspiration at the same time, I have to play God by picking who goes first,” he adds.
This does not mean women have stopped using crude methods.
“Just recently I had a girl come in with a stick protruding from her vagina, it went through the uterus and hooked into her bowels. We removed the uterus and she survived. Alongside injuries, we have to think about cost. It would be much cheaper to prevent such cases with family planning than to operate. But only 45 percent of Zambians who need contraception can get it,” Dr Macha said.
According to the World Report on Women’s Health 2015, Zambia has one of the highest maternal mortality rates in the world, attributed to complications of pregnancy and childbirth, unintended pregnancy, unsafe abortions and high HIV prevalence.
The disparity between urban and rural areas and high rates of teenage pregnancy are two important, contributing reproductive health challenges.
On average, Zambian women have between five and six children with an average of 3.7 percent children in urban areas and 6.6 percent in rural areas. Modern contraceptive use is 45 percent in Zambia overall and drops to 39 percent in rural areas. An estimated 29 percent of adolescent women aged 15-19 are already mothers or pregnant with their first child.
These statistics can only cover those who make it to hospital. In a rural country with a population of over 17 million (CSO 2017 estimates), the real figure is probably much higher. Zambia has one of the highest rates of maternal mortality in the world, and close to half of these are estimated to be from unsafe abortions.
The big question is after 45 years of a relatively liberal law on the Termination of Pregnancy (TOP), why does the country still have so many unsafe abortion cases and deaths.
In 1972, Parliament passed an act allowing women to access safe abortion, under which safe abortion was defined. The republican constitution allows for the termination of pregnancies, provided such is done within the laid down conditions of the law.
According to the TOP Act of 1972, an abortion in Zambia can be conducted where the pregnancy constitutes a risk to the life of the pregnant woman.
And the Ministry of Health’s standards and guidelines for reducing unsafe abortion, morbidity and mortality in Zambia stipulate that termination of pregnancies is legal, provided it is conducted by trained and skilled medical providers within the confines of the law.
Yet the abortion issue seems far from settled.
“It’s just as contentious today as it has ever been in Zambia and many other developing countries. This is so because of the connotation attached to abortion. Just at the mention of abortion, the views of those around quickly attach abortion to crime when in fact it is permissible by law to procure a safe abortion,” Ipas Zambia executive director Grace Tambatamba Chiyaba says.
Mrs Chiyaba says the terrible irony of all of this is that Zambia is one of the most liberal sub-saharan African states on the issue.
“It has an extensive law which permits abortions under certain conditions, for socio-economic, physical or mental health reasons. The Ministry of Health also launched new standards and guidelines in June 2009 to help confront the problem. Yet we still have this problem that is why as Ipas Zambia has brought on board the Members of Parliament to help sensitize in their constituencies as well as the country population through the debates in parliament that abortion in Zambia is legal. So people that wish to have such a service should go to a health facility and not self-procure abortion,” Mrs Chiyaba says.
But Zambia is also a staunchly Christian nation many of whom do not believe in procuring abortion and because of the sociological and cultural pressures, most women in Zambia consider abortion illegal. And whilst there are pockets of legal terminations being carried out, a larger number of women get treated for the consequences of unsafe abortions.
Chairperson for the Parliamentary committee on health Dr Jonas Chanda says an end to unsafe abortion cases is possible, all what is needed is a vigorous sensitization on preventive measures and the current legislations available on the access of abortion services.
“Without the comprehensive approach, unsafe abortion will still continue. The future of Zambia lies in its young population, anything done to prevent unwanted pregnancy and unsafe abortion is ideal. We want data driven statistics on unsafe abortions and this will make it easy for us to advocate and convince our colleagues in parliament. We will be speaking the loudest in parliament regards issues of sexual reproductive health,” Dr Chanda who is also Bwanamkubwa member of Parliament says.
And another law maker, Listed Tembo, member of Parliament for Kaumbwe constituency in Petauke likens safe motherhood to the seasonality of farming, “Farmers know you cannot harvest a crop before it is ready and you cannot plant the same crop year after year. Under these conditions, the plants and trees can no longer bear good fruit.
Similarly, girls and women who give birth at a young age or at a very late age or have multiple births without appropriate spacing put both themselves and their children at risk. I feel there is urgent need to finding solution to the increased cases of unsafe abortion.”
The country is trying to address the issue. Time and again, the President has said that “We still need to ensure that not a single woman dies from a pregnancy-related condition” adding that it was worrying that so many of these cases involved teenage girls. Many of these pregnancies end up being aborted under unsafe conditions.
It is adopting a holistic approach – not only providing safe post-abortion care to pick up the pieces when things go wrong, but also adopting a comprehensive care programme, integrating contraceptive, sexual health care with the reduction of the risk of unwanted pregnancies and a big kill of stigmatisation and wrong notions.
Then the fight against unsafe abortions will be won. PUBLISHED IN THE ZAMBIA DAILY MAIL ON APRIL 9, 2017. HERE IS THE LINK: https://www.daily-mail.co.zm/?p=97928
IN THE emergency ward at the University Teaching Hospital (UTH), a child-like young woman aged 16 is struggling to breath and dangerously close to death not because she is a Road Traffic Accident (RTA) victim. She is haemorrhaging.
The people around her, the mother and sister, apparently complicit in her nightmare, are sobbing next to her.
To ascertain what illness it is, a doctor on duty tries to coax the terrified girl to narrate what happened. But the girl insists she has no idea, and so do the mother and sister.
But after the desperate chaos that often surrounds emergency healthcare, a large part of cassava stick is found in the girl’s bloody and damaged cervix and removed.
She procured an unsafe abortion.
Quickly, the victim is transferred to the already congested female ward, CO3, and there, her condition is not new because over 50 percent of bed occupants have cases similar to that of this 16-year-old girl.
A procedure called Manual Vacuum Aspiration (MVA) is done on her to manage the incomplete abortion. MVA is found to be equally safe, effective, simple and fast set of instruments which can be employed in the management of incomplete abortions.
Fortunately, after a few days of admission, the girl survives and returns home.
A renowned healthcare practitioner, specialised in Gynaecology and Obstetrics, Swebby Macha says an average of 15 uterine evacuations on a daily basis come for incomplete abortions and they are mostly female juveniles and tertiary students.
“We are seeing many girls haemorrhage, sometimes they cannot reach the hospital fast enough and though we try to resuscitate them, they are already gone. Unsafe abortions are a big problem. Actually abortion is among the top five causes of maternal deaths in Zambia,” Dr Macha said.
There is also a lack of space at UTH. Originally the hospital was built for a Lusaka of 1.5 million; its population has since spiralled to 4 million according to the Central Statistical Office (CSO) data of 2015. Besides, UTH does not service Lusaka only, but the whole country.
“There’s only one operating room,” Dr Macha says, “so if we have various girls needing vacuum aspiration at the same time, I have to play God by picking who goes first,” he adds.
This does not mean women have stopped using crude methods.
“Just recently I had a girl come in with a stick protruding from her vagina, it went through the uterus and hooked into her bowels. We removed the uterus and she survived. Alongside injuries, we have to think about cost. It would be much cheaper to prevent such cases with family planning than to operate. But only 45 percent of Zambians who need contraception can get it,” Dr Macha said.
According to the World Report on Women’s Health 2015, Zambia has one of the highest maternal mortality rates in the world, attributed to complications of pregnancy and childbirth, unintended pregnancy, unsafe abortions and high HIV prevalence.
The disparity between urban and rural areas and high rates of teenage pregnancy are two important, contributing reproductive health challenges.
On average, Zambian women have between five and six children with an average of 3.7 percent children in urban areas and 6.6 percent in rural areas. Modern contraceptive use is 45 percent in Zambia overall and drops to 39 percent in rural areas. An estimated 29 percent of adolescent women aged 15-19 are already mothers or pregnant with their first child.
These statistics can only cover those who make it to hospital. In a rural country with a population of over 17 million (CSO 2017 estimates), the real figure is probably much higher. Zambia has one of the highest rates of maternal mortality in the world, and close to half of these are estimated to be from unsafe abortions.
The big question is after 45 years of a relatively liberal law on the Termination of Pregnancy (TOP), why does the country still have so many unsafe abortion cases and deaths.
In 1972, Parliament passed an act allowing women to access safe abortion, under which safe abortion was defined. The republican constitution allows for the termination of pregnancies, provided such is done within the laid down conditions of the law.
According to the TOP Act of 1972, an abortion in Zambia can be conducted where the pregnancy constitutes a risk to the life of the pregnant woman.
And the Ministry of Health’s standards and guidelines for reducing unsafe abortion, morbidity and mortality in Zambia stipulate that termination of pregnancies is legal, provided it is conducted by trained and skilled medical providers within the confines of the law.
Yet the abortion issue seems far from settled.
“It’s just as contentious today as it has ever been in Zambia and many other developing countries. This is so because of the connotation attached to abortion. Just at the mention of abortion, the views of those around quickly attach abortion to crime when in fact it is permissible by law to procure a safe abortion,” Ipas Zambia executive director Grace Tambatamba Chiyaba says.
Mrs Chiyaba says the terrible irony of all of this is that Zambia is one of the most liberal sub-saharan African states on the issue.
“It has an extensive law which permits abortions under certain conditions, for socio-economic, physical or mental health reasons. The Ministry of Health also launched new standards and guidelines in June 2009 to help confront the problem. Yet we still have this problem that is why as Ipas Zambia has brought on board the Members of Parliament to help sensitize in their constituencies as well as the country population through the debates in parliament that abortion in Zambia is legal. So people that wish to have such a service should go to a health facility and not self-procure abortion,” Mrs Chiyaba says.
But Zambia is also a staunchly Christian nation many of whom do not believe in procuring abortion and because of the sociological and cultural pressures, most women in Zambia consider abortion illegal. And whilst there are pockets of legal terminations being carried out, a larger number of women get treated for the consequences of unsafe abortions.
Chairperson for the Parliamentary committee on health Dr Jonas Chanda says an end to unsafe abortion cases is possible, all what is needed is a vigorous sensitization on preventive measures and the current legislations available on the access of abortion services.
“Without the comprehensive approach, unsafe abortion will still continue. The future of Zambia lies in its young population, anything done to prevent unwanted pregnancy and unsafe abortion is ideal. We want data driven statistics on unsafe abortions and this will make it easy for us to advocate and convince our colleagues in parliament. We will be speaking the loudest in parliament regards issues of sexual reproductive health,” Dr Chanda who is also Bwanamkubwa member of Parliament says.
And another law maker, Listed Tembo, member of Parliament for Kaumbwe constituency in Petauke likens safe motherhood to the seasonality of farming, “Farmers know you cannot harvest a crop before it is ready and you cannot plant the same crop year after year. Under these conditions, the plants and trees can no longer bear good fruit.
Similarly, girls and women who give birth at a young age or at a very late age or have multiple births without appropriate spacing put both themselves and their children at risk. I feel there is urgent need to finding solution to the increased cases of unsafe abortion.”
The country is trying to address the issue. Time and again, the President has said that “We still need to ensure that not a single woman dies from a pregnancy-related condition” adding that it was worrying that so many of these cases involved teenage girls. Many of these pregnancies end up being aborted under unsafe conditions.
It is adopting a holistic approach – not only providing safe post-abortion care to pick up the pieces when things go wrong, but also adopting a comprehensive care programme, integrating contraceptive, sexual health care with the reduction of the risk of unwanted pregnancies and a big kill of stigmatisation and wrong notions.
Then the fight against unsafe abortions will be won. PUBLISHED IN THE ZAMBIA DAILY MAIL ON APRIL 9, 2017. HERE IS THE LINK: https://www.daily-mail.co.zm/?p=97928
