Zambia:Taboo surrounding abortion leads to death

By: Dorothy Chisi

YVONNE Mwanza (25) now, discovered she was pregnant at 16 in her first month in her final grade.
Both Yvonne and her boyfriend were not ready as they were still pursuing their education in the same grade. Yvonne explained that knowing he family she was coming from, she would be told to keep the pregnancy and she and her boyfriend with the help of friends were directed to some place in the nearby township from where she stayed that would help them with termination of pregnancy.
She explained that things went well as she was administered with some pills and some which were inserted in her private parts.

Yvonne explained that , during it was some few minutes past midnight that she started feeling some discomfort in her tummy which became worse as time went by and the only thing she remembered was finding herself ta the hospital.

“I was taken to the hospital in a unconscious state and I was shocked to find myself in a place that I never wanted to be found and I felt embarrassed with the people that surrounded me at my bedside after the cleaning of my stomach, “she said In both India and Zambia, abortion was legalized in the early 1970’s, but due to a lack of adequate services and continued procedural barriers, safe abortions remain limited. The taboo surrounding abortion in Zambia leads to thousands of women
dying every year as they try to terminate pregnancies.

Zambia is one of the countries which has an act on safe termination of pregnancy, although many cases of deaths due to unsafe abortions have continued being recorded among the child-bearing age group. Many, especially teens, find themselves in a predicament when they discover they are pregnant without being ready. On the other hand, those who want safe abortion can do it in safe health facilities. Induced abortion has been legal in Zambia since 1972, but many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead.

The Termination of Pregnancy (TOP) Act of 1972 permits an abortion to be performed if three registered medical practitioners are of the opinion formed in good faith and that continuation of the pregnancy would involve risk to the life or injury to the physical mental health of the pregnant woman. Unsafe abortion is a significant, preventable, cause of maternal mortality and morbidity and is both a cause and a consequence of poverty.

Post-abortion care (PAC) is a strategy to address the problem of the outcomes of unsafe abortion. Investment in safe abortion services impacts on the socio-economic conditions of women and their households, and the implications for policy-making and service provision in Zambia. Unsafe abortion is a serious problem in Zambia although national figures do not exist, reflecting the low status of the issue, but research suggests thousands die every year attempting to terminate their pregnancies.

Due to the required consent from three registered medical practitioners and a lack of available safe abortion services, many women continue to rely on unsafe, clandestine abortions, which contribute to the maternal mortality ratio. Bertha Chulu is a second year Bachelor of Science with Education
student at Zambia’s higher learning institution  University of Zambia and says most girls prefer illegal abortion due to lack of knowledge on the existence of the act providing for legal abortion.
“Many girls do not know there is a law that allows them to abort legally. Plus there is little confidentiality among health care providers so instead of being stigmatised at a health centre, a young girl would rather do it illegal,” she said.

Bertha who confirmed the high number of illegal abortion cases at the campus said there was need for sensitisation and awareness on the act. She said most female student fall prey to illegal abortion because of not knowing how to administer the contraceptives. Bertha said the morning after pill which was commonly used by female students who are engaged in sexual activities was not properly used making some falling pregnant and leading to abortions.

An estimated 15-25% of women in need of medical treatment for abortion-related complications do not seek care. In many cases women who do try to access the health care system for post-abortion care are met with stigma and given sub-par medical treatment, further compounding the risk of morbidity and mortality. Young Women Christian Association (YWCA) says young people need to be given platforms where they need to be provided with information which could prevent them from indulging into activities that would cost their lives. YWCA President Lucy Lungu said much as the act the TOP was in place, many teenagers were not in the situation which they could be provided
with the services because of the stigma and discrimination attached to abortion. Ms Lungu said currently safe abortion was not accessible by anyone because of the requirement attached to the provision of the service to the few who may need the service. She said the low numbers, and urban concentration, of health professionals also acted as a barrier to the provision of safe abortion services especially to those in rural set up.

Ms Lungu said for some private medical practitioners who are registered and regulated by the Health Professions Council of Zambia to provide safe abortion services are usually unknown. According to World Health Organisation, unsafe abortion is defined as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both. Out of the estimated 205 million pregnancies occurring each year worldwide, approximately 42 million abortions are performed, 20 million of which are classified as unsafe.

Globally it is estimated that unsafe abortion causes 13 per cent maternal mortality while the 2018 Zambia Demographic Health Survey (ZDHS) indicates that in Zambia, maternal mortality ratio stands at 252 deaths per 100,000 live births. In developed regions, it is estimated that 30 women die for every 100 000 unsafe abortions. That number rises to 220 deaths per 100 000 unsafe abortions in
developing regions and 520 deaths per 100 000 unsafe abortions in sub-Saharan Africa.
University Teaching Hospital Gynaecologist Dr Swebby Macha disclosed that there was a lot that needed to be done in terms of sensitisation on the Termination of Pregnancy Act because most people do not know its legality. Dr Macha said for teens under the age of sixteen, were protected by
the law because there pregnancy cases are treated as defilement and have access to the service although in most cases people are not aware.

“ For those who are eighteen to nineteen years old, cannot be offered the service at a mere walk-in at any health facility not until their cases are weighed, the situation is sad especially that even some
health workers are ignorant about the legality of abortion in certain circumstances ‘ said Dr Macha.
He said the hospital which is the highest referral in the country, most times receive cases incomplete abortion as well as tempering to abort which are treated with the urgency they deserve. Dr Macha said these unsafe abortions result in complications such as injuries to the birth canal and uterus, profuse bleeding, infections leading to sepsis, and may require surgical corrections. Dr Macha said unsafe abortion is amongst the top five causes of maternal mortality in Zambia. He said because of the incorrect information on the access to safe abortion many Zambian women resort to crude and unsafe methods.

Dr Macha said unlike in the past where cases which came to the hospital involved incomplete abortion using unskilled providers through the use of cassava sticks, detergent paste and other unprofessional methods, nowadays many use pills which are wrongly prescribed. He said before the creation of first level hospitals, the highest referral hospital used to attend to 10-15 cases of incomplete abortion in a day which has now reduced to 2-4 cases in a day. Dr Macha explained that abortion which was the major cause of maternal mortality rate had reduced from 30% in 2012 to 16% in this time around.

“Currently, we are doing countrywide sensitisations on the TOP and other sexuality education awareness so that people know what they are supposed to do and the availability of this service, “he said. Clearly, with these figures, abortions are a threat to efforts aimed at promoting safe motherhood, through reduction of maternal mortality, and improving maternal health service provision. More and more sensitisations on how and who is eligible to receive abortion services should be made known to the public so that premature deaths for teenagers and others is avoided.

  This article is written by Dorothy Chisi  journalist at Times of Zambia. It is part of Gender Links Sexual and Reproductive Health and Rights (SRHR) Media. This article was first published in the Times of Zambia.