Southern Africa: Better education will help fight unsafe abortions

Having been brought up Catholic, I spent most of my adolescent years at a Zimbabwean mission school. I grew up thinking that contraceptive use before marriage and abortion were two topics those “properly brought up” girls like me would never discuss in public, let alone advocate for. At the innocent age of 13 my world was so idyllic that I never quite understood why a woman would opt for what is in most cases unsafe abortion when she could as easily keep the baby.

According to the World Health Organization (WHO) unsafe abortion is a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.

A decade later I find myself questioning my beliefs because every time I engage with a report or article on maternal mortality, the same ugly creature called unsafe abortion creeps up as one of the major causes of death for many African women.

It is estimated that at least 5.5 million unsafe abortions occur in Africa every year and about 40% of the women die as a result of complications due to these procedures. Abortion, unless it is done for medical purposes, remains illegal in most of the region. It is legal in South Africa.

Many argue about the morality of seeking abortion when one has an option to keep the baby and avoid health risks associated with unsafe abortions. But before we start judging these women, it is important to look at the root cause of this public health problem and the possible ways in which it can be addressed.

Abortions can be avoided should all governments meet their obligations to the various international, regional and national policies they have signed to ensure that women’s sexual and reproductive rights are upheld.

Of particular note is the Africa Union Maputo Plan of Action of 2006 which, among other things, calls for the guarantee of safe motherhood, making family planning services more accessible, preventing abortion and management of complications resulting from unsafe abortion and the enhancing of sexual reproductive health services for adolescents and the youth. Regionally, 13 of the 15 SADC countries are signatories to the SADC Protocol on Gender and Development, which calls for the development and implementation of policies and programmes that address the physical, mental, sexual and reproductive health needs of women.

At national level, the majority of SADC member states have domesticated the Campaign for Accelerated Reduction of Maternal Mortality in Africa. Despite all these commitments, women in the region continue to die as a result of unsafe abortions.

According to the 2010 Millennium Development Goals (MDG) report, the unmet need for family planning remains moderate to high in most regions, particularly in sub-Saharan Africa, where one in four women aged 15 to 49 who are married or in a union and have expressed the desire to use contraceptives do not have access to them.

When such women fall pregnant, the only way out is abortion. It is not surprising that most women who find themselves in this situation are poor with little education and cannot afford to access abortion facilities. This forces most of them into using ghastly methods such as inserting sharp objects into their vagina, swallowing toxic herbal concoctions, overdosing on malaria medication or drinking bleach, just in order to get rid of an unwanted pregnancy.

These are horrific risks which no woman should be forced to take in the 21st century, especially at a time when Africa is basking in the glory of other progress and achievements, including improved education enrolments and reduced HIV prevalence rates.

In many countries, young women and men are engaging in sexual behaviour at a very young age. This exposes young women to unwanted pregnancies and sexually transmitted infections, including HIV. Keeping this issue of contraceptive usage and abortion in the shadows does not help anyone.

The evidence has shown that criminalising abortion and discouraging contraceptive use has adversely contributed to high maternal mortality in the region.

Realistically, the most appropriate way of dealing with abortion is for governments to revise their legal stance and scale-up programmes designed to meet the need for family planning.

According to a 2008 WHO study on unsafe abortion, unintended pregnancy and induced abortion can be prevented by expanding and improving family planning services and choices and reaching out to communities and underserved population groups. This could be sexually active teenagers and unmarried women, migrants or poor urban slum dwellers.

The sooner we all open our eyes and realise that unsafe abortions and the unmet need for family planning services are huge impediments to the realisation of the MDG’s, the better for us all.

Lucia Makamure is the Gender Links Alliance Programme Officer. This article is part of the Gender Links Opinion and Commentary Service special series for Women’s Month.