Malawi: Unsafe Abortions - What is the Position In Country? | News

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Unsafe abortion has the highest impact in developing countries whose citizens lack widespread access to high-quality medical care. The risk of death from unsafe abortion is higher in Africa than any other region: nearly half of global maternal deaths related to abortion occur here - Marie Stopes International

Recent reports have indicated that the situation in Malawi has become a concern. Approximately 900 to 1,000 maternal deaths occur for every 100,000 live births, a significant increase from the year 1992. A high percentage of the deaths are related to unsafe abortions.

According to (IPAS) Alliance for Africa, "incomplete abortions caused largely as a result of unsafe abortions are the most common reasons for admission to gynecological wards in Malawi".

In his speech at the International Conference on Population and Development (ICPD) in 1994 the former Vic President of Malawi, Honorable Justine Malewezi said despite the criminalization of abortion in Malawi, nearly 35% of all maternal deaths are due to induced abortions, translating into an increasing rate of clandestine and back-door abortions. He added that unsafe abortions account for 60% of all acute gynecological admissions and is responsible for 30% of maternal deaths.

To address the rate of maternal mortality and other issues that marginalize women, a special Law Commission was appointed under the section 133 of the Constitution to review gender-related laws in Malawi.

The commission has since produced a 3rd report in draft form on the development of legislation on gender equality which was extensively discussed with civil society and other interested parties at a national consultative meeting in September this year.

According to the findings of the commission, recent statistics show that; "the central hospitals in Malawi are attending to high numbers of women seeking post abortion care".

The commission report also states that between the year 1999 and early 2006 Kamuzu Central Hospital (KCH) in Lilongwe registered 2,384 women seeking post abortion care. Queen Elisabeth Central Hospital (QECH) in Blantyre registered 3,178 cases and Zomba Central Hospital registered 1,239 cases.

One of the largest referral hospitals in Malawi, QECH receives an estimated 15 -20 gynecology cases on a daily basis; 50% of the cases relate to abortion complications.

Despite abortion being a crime that carries a stiff prison sentence for both provider and women seeking abortion, some statistics report that nearly 35% of all maternal deaths are due to induced terminations by clandestine back street providers. These abortions are often carried out in unhygienic conditions, using un-sterlised equipment and dangerous objects.

The commission report states that it (the commission) observed that the provisions of the Penal Code 120 in respect of abortion brought into force in 1930 are overly restrictive and inconsistent with the spirit of the Reproductive Health Policy of the country, as well as several international conventions to which Malawi is signatory.

"Malawi has ratified the Protocol to the African Charter on Human and Peoples' Rights on the rights of women in Africa which has progressive provisions on women's reproductive health rights. Further, women are entitled to reproductive health that includes entitlement to medical abortion.

The Protocol to the African Charter also provides the removal of the liability for women who seek, and providers who perform abortions; and for the clarification of the requirements for health facilities offering pregnancy termination. In addition, the Protocol to the African Charter obliges State Parties to protect reproductive rights of women by authorizing medical abortion in the cases of sexual assault, rape, incest and where the mental and physical health of the mother or foetus is endangered," the report states.

Malawi is also signatory to the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) which obliges the country to take all appropriate measures to eliminate discrimination in the field of healthcare including those related to family planning.

Under the Maputo Plan of Action agreed by African Ministers for health as well as high level representatives of the African Union, for the implementation of the Continental Policy Framework for Sexual and Reproductive Rights 2007-2010 to which Malawi has signed, government is bound to reduce the incidents of unsafe abortion.

Part of the strategy in the plan of action for fulfilling this obligation includes enacting policies and legal frameworks to reduce the incidence of unsafe abortions.

Malawi, through Dr. Chisale Mhango , Director for the Reproductive Health Unit in the ministry of health was significantly involved in the development of the Plan of Action.

Taking into account the action programme recommendations at the ICPD conference, the commission also recommended that: "in all cases women should have access to quality services for management of complications arising from abortion. Post abortion counseling, education and family planning services should be offered which will also help to avoid repeat abortion".

In the light of its findings, recommendations were made by the commission to consider unsafe abortion the reasons and consequences to individuals, society and the country as part of the review process in the development of a Gender Equality Act.

However, the recommendation on abortion has met with some strong opposition by religious leaders who considered abortion as just another form of killing. Both Christian and Muslim clergy agreed that abortion was unacceptable and that medical means should be sought immediately to avoid conception taking place rather than having an abortion after a woman falls pregnant. Fears were also expressed that easy access to abortion could result in women seeking abortion as a means to family planning rather than using other family planning methods available.

Asked what they thought about a review of the current law in Malawi to make abortions more accessible, medical practitioners said it would be a welcome move although the law would have to make it very clear in what instances an abortion could be carried out.

A leading obstetrics gynecologist from one of the central hospitals said, before any move was made to lawfully broaden the reasons for access to abortion, there needs to be proper consultations and preparations. "I welcome the suggestion. But there needs to be proper consultation and preparations with those who will be involved in order for any provider, especially government hospitals to be able to provide the service in the best way." He added; "With the situation in hospitals now where there is still not enough staff to care for patients the health system could be further burdened by an increase in women seeking abortion".

The suggestion that Malawi should revisit the laws that deal with abortion will have to be dealt with in a manner that takes into consideration all issues that have been discussed at the national consultative meeting on the development of the Gender Equality Act.

In an effort to reduce maternal mortality due to unsafe abortion, some countries in Africa have changed their laws considerably in order to allow for access to safe abortion. These include South Africa that has the Choice on Termination of Pregnancy Act as well as Zambia, which has the Termination of Pregnancy Act. Ghana also allows that an abortion is carried out as a result of a number of reasons that are less restrictive.

Many insist that the rate of maternal deaths in Malawi is totally unacceptable and needs to be addressed. The question of abortion has for many years been a taboo subject. The fact that a national consultative meeting was held and abortion discussed is a clear indication that the nation is ready to do something about high maternal mortality rate due to unsafe abortions.

The special law commission will continue to work until there is complete agreement by all stakeholders and interested parties on what the law should say about access to safe abortion for women in Malawi.