By Arnold Namanja:
Febronia Chitsamba, 23, a student at a public university, is faced with a difficult choice: to continue her education or proceed with her pregnancy.
After a night of drinking at an overnight gathering hosted by her “hopeful”, she was raped. This encounter led to an unwanted pregnancy.
Many women like Chitsamba often find themselves seeking post-abortion care in public hospitals. Although the law allows for such care, it comes with significant costs.
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Chitsamba’s experience reflects the reality for countless girls and young women who undergo abortions in clandestine and unsafe conditions, often at the hands of untrained personnel in unsterile environments.
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A study by the Guttmacher Institute and the Centre for Reproductive Health at Kamuzu University of Health Sciences (Kuhes) revealed that at least 141,000 abortions were procured in the country in 2020, with a rate of 38 abortions per 1,000 women of reproductive age.
This highlights the prevalence of abortion in Malawi.
Malawi has one of the highest maternal mortality rates globally. Statistics indicate that a 15-year-old girl in the country faces a one in 29 chance of dying from a pregnancy-related condition.
Unsafe abortions are arguably a leading cause of maternal death.
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“Restrictive abortion laws don’t stop abortions; they merely push them underground, forcing women to resort to unsafe procedures,” Secretary General of the Coalition for the Prevention of Unsafe Abortion (Copua), Francis Makiya, says.
Each year, over 144,000 women and girls in Malawi procure abortions. Of these, approximately 60 percent experience complications, placing a huge strain on the healthcare system and resulting in significant financial losses due to the delay in enacting comprehensive abortion legislation.
In 2002 alone, 36,225 women and girls sought post-abortion care in government facilities due to serious complications from unsafe abortions, with Lilongwe alone recording 7,851 cases.
Research conducted by Ipas Malawi in 2022 found that the Northern Region had the highest rate of induced abortions, with 61 per 1,000 women aged 15-49.
The prevalence of unsafe abortion is clear, despite its illegality. When a woman decides to terminate a pregnancy, she will often do whatever it takes to do so.
The existing criminal law on abortion does not prevent the practice; instead, it jeopardises women’s lives by pushing them towards unqualified practitioners.
Currently, a pregnancy can only be terminated by certified health providers if it poses a risk to the woman’s life. Legal experts advocate for a debate on what constitutes “life in danger.”
With these statistics, the government faces mounting healthcare costs for treating avoidable post-abortion cases, estimated at around $1 million (approximately K1.7 billion) annually.
Copua chairperson, Mateyu Sisya, notes that married women often seek abortions due to contraceptive failures or the need to preserve their marriages, especially when husbands are away and they engage in extramarital relationships.
Sisya stresses that abortion is a human rights issue, asserting that women should have the autonomy to make decisions regarding their own health.
“It is also a social justice issue, as women in rural and marginalised communities lack access to safe abortion facilities,” he says.
Davison Mvula, a nurse and psychosocial counsellor at Machinga District Hospital, highlighted what he called the troubling rise in unsafe abortion cases, reporting 430 post- abortion cases among the youth in the first half of 2024, up from 310 in the same period in 2023.
The Law Commission’s report on abortion law reform, published in March 2016, recommended liberalising the law to allow for justifiable circumstances for pregnancy termination.
Health professionals indicate that many survivors of unsafe abortions arrive at medical facilities too late and in critical condition.
Reproductive health expert Chisale Mhango states that women facing abortion complications suffer immense stigma and hardship.
“Safe abortion prevents these complications and allows women to manage their reproductive choices with dignity,” Mhango says.
On her part, legal practitioner Yankho Mwandidya, speaking at a media training in Blantyre, argued that legalising safe abortions could significantly reduce the number of maternal deaths from illegal procedures and lower post-abortion care costs.
She called for the reform of outdated abortion laws inherited from Britain at independence in the 1960s.
“The law is harsh and severe, condemning women to injury and death,” Mwandidya said.
Executive Director of the Malawi Health Equity Network, George Jobe, agrees that unsafe abortions elevate the risk of pregnancy-related deaths and escalate post-abortion care costs.
“The government is spending huge sums to care for women who face life-threatening complications from unsafe abortions,” Jobe says.
Ipas, an international think tank on sexual and reproductive health, advocates for comprehensive abortion care through health systems strengthening, policy reform and enforcement of post-abortion care guidelines.
Until the current abortion law is reviewed, women like Chitsamba will continue to face the difficult choice of whether to terminate a pregnancy, often at a significant cost to public health services.—Mana
