With Dr Chisale Mhango:
An estimated 886,161 pregnancies occur in Malawi every year, of which more than half are unintended. At least 30 percent of unintended pregnancies end in abortion in Malawi, most of which are performed under clandestine, unsafe conditions. As a result, 18 percent of maternal deaths in Malawi are caused by unsafe abortions and this costs the health system approximately K326 million per year in post- abortion care services.
Over 17.2 percent of women aged 15-45 years have an unmet need for family planning, leaving them vulnerable to unintended pregnancy and unsafe abortion. Young women are greatly affected. Over half of the population are under 20, and nearly half of these young women and girls are married. Unsafe abortion is the biggest killer of young women and girls in Malawi. There is one in twenty –nine chance of dying from pregnancy related causes.
Lack of choice and access to sexual and reproductive services contribute to the high rate of unintended pregnancies in Malawi. This in turn limits the women’s ability to pursue education and income generating activities thereby restricting economic growth and development of Malawi.
Current Legal Environment
In Malawi, abortion is permitted under one indication, to preserve a woman’s life under Section 243 of the Penal Code. Abortion is criminalised through Sections 149, 150 and 151 of the penal code, with the penalty for procuring an
illegal abortion for any other reason except the one cited under Section 243 being 7- 14 years imprisonment with hard labour.
Research by College of Medicine and Guttmacher Institute indicates that restricting abortion does not reduce the incidence, but it does increase cases of unsafe abortions. Even though most if not all women know that abortion when performed by unskilled health care providers can kill or injure, and that it is against the teachings if their faiths, women experiencing un intended pregnancy still risk life and health to procure unsafe abortion.
Reasons for abortions
There are several reasons why women terminate pregnancies including poverty and inability to care for a child, desire of young girls to remain in school, pregnancy resulting from defilement, rape and or incest, pregnancy that is too close to the previous one, fear of parents and guardians, fear of community stigma, fear of expulsion from church and extra- marital pregnancies.
Who procures unsafe abortions?
Women from all religions and socio economic class are at risk of being provided an unsafe abortion. However, poor rural women are disproportionately affected by the impacts of unsafe abortion. Research done by the College of Medicine found that 60 percent of women who had unsafe abortion experienced complications and required post-abortion care, and one in three women were unable to access the care they needed. Barriers to access include inability to pay, stigma and lack of knowledge. Young women are particularly vulnerable; one in twenty –nine young women in Malawi are at risk from dying from pregnancy related causes. When abortion laws are restrictive, abortions are likely to be procured under clandestine conditions which are very unsafe and will lead to different complications including death.
What’s the solution?
- Increase access to modern contraception by increasing budgetary allocation to family planning budget line, create youth friendly services and bust myths and misconceptions about modern contraception.
Review Life Skills curriculum for primary and secondary schools to introduce comprehensive sexuality education and equip educators with skills to effectively engage young people
Improve post abortion care services by improving training of providers and ensuring that many facilities have medicines and supplies to provide this care.
Support abortion law reforms
Because the legal environment is restrictive and only allows women whose lives are in danger to terminate pregnancies, women who have unintended pregnancies will resort to procuring abortions from unsafe providers. They will do so whether the law allows them or not
- To prevent unsafe abortions, support law reforms to increase grounds on which safe legal abortion can be accessed. Additional grounds should include pregnancy resulting from rape, defilement and incest, fetal malformation and to preserve mental health of a woman.
Termination of Pregnancy Bill
The termination of pregnancy bill proposes more grounds under which abortion can be procured by women to save women’s lives and complications resulting from unsafe abortions. The additional grounds are
- Pregnancy resulting from rape, incest and defilement
- Fetal malformation
- Preserving mental health of a woman.