By Arnold Namanja

Blantyre, September 19, Mana: Febronia Chitsamba, 23, (not her real name) is a student at one of the public universities in the country and is faced with the dilemma of whether to continue her tertiary education or keep the pregnancy.

She was raped after getting drunk for the first time in her life at the overnight finale get- together by one of her ‘hopefuls.’ Apparently, this once-off encounter led into a conception.

These backstreet activities, nevertheless, end up at public hospitals since the law allows for post-abortion care which is also very expensive, regardless of the other factors.  

Chitsamba’s situation mirrors the experience of many other girls and young women who have to procure an abortion, quite often in very clandestine and unsafe conditions at the mercy of untrained personnel and unsterile environment.

According to a study by the United States based Guttacher Institute and the Centre for Reproductive Health at the Kamuzu University of Health Sciences (KUHES), at least 141 000 abortions occurred in the country in 2020 at annual rate of 38 abortions per 1,000 women of reproductive age-all of which indicate that abortion is common in the country.

Malawi has one of the highest maternal mortality rates in the world. Statistics show that there is a one in 29 chance that a 15-year-old girl in the country will eventually die from a pregnancy-related condition.

Arguably, unsafe abortion is one of the major causes of maternal death in the country.

“Restrictive abortion laws don’t stop abortion from occurring, they just drive it underground, forcing women to resort to clandestine procedures which are unsafe,” Secretary General for the Coalition for the Prevention of Unsafe Abortion (Copua), Francis Makiya said.

Over 144 000 girls and women in the country procure abortion every year. It is estimated that of the 144 000 women who abort, 60 percent of such cases result in complications.

By implication, these complications exert unnecessary pressure on government which continues risking losing billions of kwachas due to the delay of enactment of Abortion Law.

Additionally, statistics indicate that in 2002, 36 225 women and girls suffered from serious complications of unsafe abortion and sought post-abortion care treatment in government health facilities with Lilongwe alone registering 7 851.

Conversely, women and girls sustained complications from unsafe abortion and sought post-abortion care in 2002.

Research conducted by IPAS Malawi in 2022 revealed complications of post-abortion cases showed that the northern region was the highest with 61 induced abortions per 1,000 women aged 15-49 years with Blantyre registering 3,395 while Rumphi registered 569 post abortion cases.

Abortion is widespread and universal. In Malawi it is illegal but despite this, women still go for abortion. When a woman decides that she doesn’t want a pregnancy, she will do everything to terminate it.

The criminal law against abortion does not work neither does it prevent abortion. Instead, it kills women and places their health in danger by driving them to quacks or untrained persons.

Currently, termination of a pregnancy may be performed by certified health service providers only when the pregnancy will endanger the life of a pregnant woman which legal expert want ‘life in danger’ to be debated.

With these alarming figures, government is digging deeper in its coffers in treating post-abortion cases which could have been avoided if the law was enacted.

According to Chairperson for Copua, Mateyu Msisha, married women abort because of two possible factors.

He suggests the failure of contraceptives, on one hand and preservation of marriage on the other, especially for women whose husbands migrated forcing them to engage in extra marital affairs in the end.

Msisha asserts that abortion is a human right issue where women should be allowed to make independent decisions regarding their well-being, noting: “It is also a social justice issue where those from the rural areas and marginalized lack access to properly equipped abortion facilities.”

According to Msisha, the cost of post-abortion care is US$1 million (approximately K1.7 billion) per year or US$16 per simple procedure.

Recently, Machinga District Hospital nurse and psychosocial counsellor, Davison Mvula decried increasing unsafe abortion cases in the district.

“Post-abortion cases among the youth in the first half of 2024 are 430, compared with 310 recorded during the corresponding period in 2023,” he stated during a sexual reproductive health training for the youth advocates by Malawi SRHR Alliance.    

Meanwhile, the report of the Law Commission on the review of the law on abortion published in March 2016, recommends the liberalization of the abortion law to ‘cater for certain justifiable instances where termination of a pregnancy should be allowed.’

Health workers say the survivors often present too late and in life-and-death conditions.

The complications of unsafe abortion account for up to 18 percent of pregnancy-related deaths in the country, according to the Ministry of Health.

A Reproductive Health Expert and Researcher, Chisale Mhango said women with abortion complications endure untold misery and stigma.

“Safe abortion prevents these complications; it affords women the dignity of safely managing their reproductive choices,” he added.    

A legal practitioner speaking during a media training in Blantyre, Yankho Mwandidya contended that large numbers of women who die from illegal induced abortion in the country each year would be converted to safe abortions upon legalization; hence, lowering the maternal mortality ratio as well as its related post-abortion care costs.

She advocated for modernization of the restrictive Abortion Law inherited from the Britain during independence in the 1960s, noting: “The law is harsh and severe. It condemns women to injury, health complications and death”.

Malawi Health Equity Network, Executive Director, George Jobe concured that unsafe abortion increases the risks of pregnancy-related deaths as well as the cost of post-abortion care in public health facilities.

“It is a fact that government is spending huge sums of money to provide care to women and girls who risk complications, most of which are life threatening due to unsafe abortion,” he stated.

On the other hand, Ipas, an international sexual and reproductive health think-tank, supports comprehensive abortion care through health systems strengthening, advocacy for policy reform and post-abortion care guidelines enforcement in all health facilities.

So, when all is said and done, until the current Abortion Law is reviewed, people like Chitsamba will still grapple with the dilemma of whether to take the path of abortion or not at the expense of post-abortion care costs being incurred by public health utilities.