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To abort or not to abort: Debate rages on

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The abdominal pain was so unbearable but the Traditional Birth Attendant (TBA) had assured Chimwemwe that this would pass.

She thought she was dying particularly after she began bleeding heavily and feeling dizzy. And she was too weak to cry.

Chimwemwe’s predicament began the moment she fell to peer pressure to get a boyfriend.

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So, to prove to her friends she was feminine enough, she accepted a proposal by one of the boys who had been after her.

“He promised to give me money. The relationship was somehow an opportunity. I got carried away,” says Chimwemwe.

At that time, she was 15 years old and in Standard 3.

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A month into the relationship, the boyfriend coaxed her into sex promising her a million things.

“I wanted to prove that I was normal, so I accepted,” she says.

Few months later, she was pregnant. Her relations and mother suggested she should terminate the pregnancy because in their clan, it is a shame for a girl to fall pregnant out of the wedlock.

“I had no say on this decision. I was taken to a TBA to have it done,” Chimwemwe says.

The TBA gave her a mixture of native medication and instructed that she should take it for three days.

“She told me that on the third day I will experience ‘strange’ things. Little did I know that ‘strange’ meant lots of unbearable pain,” Chimwemwe says.

The TBA, whom they paid K2, 300 earlier, advised that after the pain, she would bleed, the foetus would get out and the pregnancy would be gone.

But things never happened that way.

“I bled the whole day whilst in pain but no foetus came out. Something I suspect as a foetus came out around midnight (the next day) but there was no relief from the pain. I continued to bleed for three more days. The bleeding stopped after the TBA gave me another mixture of native medicine but I remained unwell for three more months.”

Even though she was not well, she was afraid to go to the hospital because her mother said pregnancy termination is against the law and she would be arrested.

Her mother, who earlier had told her that she would would not die, also became worried and decided to take her to the hospital after noticing that her situation became critical.

“I was taken to Mangochi District Hospital where I was assisted. They put me on a drip and I had a blood transfusion,” she recalls, sounding regretful.

A study which Ministry of Health conducted in 2010 titled: ‘Abortion in Malawi: Results of a study of incidence and magnitude of complication due to unsafe abortion’ noted that estimated costs associated with first trimester abortion varied amongst urban and rural areas and type of provider.

It says depending on the cadre of provider, rural women are estimated to spend double or triple to obtain an abortion compared to urban women.

The cost of abortion services, according to the study, ranged from an average of about K3, 080 ($7) for an urban TBA to K29, 480 ($67) for a rural doctor.

Clinical Officer and Safe Motherhood Coordinator at Mangochi District Hospital, Clophat Baleti, says 20 per cent of total admitted cases at the hospital’s female ward have post unsafe abortion complications and they are mostly aged 16 to 25.

“It’s hard for us to know whether the abortions were spontaneous or induced until we look at their history. Most of them hide if they induced the abortion because they are afraid of being arrested,” said Ndalama during a media tour organised by Coalition for the Prevention of Unsafe Abortion (Copua).

Clinical Officer at Thyolo District Hospital, Knoxy Ndalama, says an average of four to five women aged 16 to 30 seeks post abortion care at the hospital on daily basis.

“The demand for this service is very high. Generally the women have the placenta remaining in their womb so we just evacuate it and they are discharged the next day,” he reveals.

The World Health Organisations says unsafe abortion is a major public health concern for many developing countries where an estimated 98 per cent of unsafe induced abortions like what Chimwemwe had are done.

It also says countries with less restrictive abortion laws have lower rates of induced unsafe abortion.

Acting spokesperson for the Ministry of Health, Adrian Chikumbe, says the ministry is spending more money in treating post abortion care than it would spend if the women procured a safe abortion.

He says the issue of unscrupulous abortion practitioners is a huge concern at the moment to the ministry.

“Women go there knowing fully that those people are not qualified practitioners. The fact that there are many cases of unsafe abortion complications treated at public hospitals is enough evidence of this,” he says.

Chikumbe adds: “This is a crime. These people are endangering women’s lives and people should be reporting them to authorities so that they should face the law.”

Chairperson for Copua Godfrey Kangaude thinks that such black market services are provided because the public health system will not allow it.

“Unfortunately while we wait for the law to change [to make abortion legal], there is little we can do to get the public health system to provide safe abortion services. These illegal services will therefore continue.”

But several other players say the fact that women and girls want to procure abortion and are obtaining it from the black market does not speak enough to justify arguments that the laws on abortion should be relaxed.

Executive Director for Health and Rights Education Programme, Maziko Matemba, says the current law on abortion in Malawi states that abortion is legal only if medically approved.

“Any given country is driven by laws so if the current law says abortion is illegal, it is illegal. This also applies to those doing the business [of providing abortion services],” he says.

“If women are allowed to abort the way they want, is our health system ready to support all cases of abortion?” he questions.

Spokesperson for Muslim Association of Malawi (Mam) Sheikh Dinala Chabulika says Islamic teachings are in line with the laws of Malawi that do not allow the termination of pregnancy unless a woman’s life is in danger.

“Abortion is killing and there is no point in legalising it simply because many people are said to be doing it. Theft is rampant in the country but are we going to legalise it because many people are doing it?” he questions.

On his part, Senior Chief Kawinga of Machinga says legalisation of abortion is an issue that needs thorough discussion involving all sectors.

“I might not have evidence of black market abortions in my area but in this world, people are capable of doing evil things. Government should discipline these people plying underground abortions. They are putting people’s lives at risk,” he says.

Kawinga adds: “When a man and woman have sex, its either they contract Sexually Transmitted Infections or the woman falls pregnant. This is a fact and the people engaged in it know it.

“Women shouldn’t be allowed to abort as they wish at any public facility. That would mean as a country we have accepted to kill. Let’s just enhance the use of contraceptives,” he says.

Reverend Osborn Joda Mbewe says the current abortion laws are in line with Bible teachings and changing them would go against God’s will.

“Unscrupulous abortion specialists started operating long time ago. The fact that women are still going to pay for an abortion is an indication that our society is rotten. The church can’t accept such society decay to become a law because people who have sex are well aware of its consequences,” he observes.

As the debate rages on, Chimwemwe is a statistic that could be used to guide the discussion.

But for her, to have gone for a backstreet abortion has left on her mind terrifying images.

She is married now but, she has been carrying the trauma to herself. For fear of consequences, she does not have the courage to tell the husband that she once aborted.

So the pain of an illegal abortion remains etched on her heart.

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