A nationwide ban on traditional birth attendants (TBAs) has not stopped pregnancy-related deaths.
Women and girls keep dying as the unskilled hands declared unsafe to help women give birth clandestinely conduct abortions that claim six to 18 lives of women in very 100 pregnacy-related deaths, according to the Ministry of Health.
This makes abortion the fourth largest cause of maternal deaths in Malawi.
In a village near Mzimba Boma, a 72-year-old grandmother of 17 disguised as NyaChirwa points at six TBAs who conduct backstreet abortion a decade after she called it quits.
“This is a calling I accepted in 1985 when I was first possessed by vimbuza. The spirits of my ancestors showed me some trees for the benefit of women and girls,” she explains.
NyaChirwa remembers terminating over 250 pregnancies within 25 years even though abortion is illegal in Malawi except to save a woman.
“I used to attend to the birth of about two children every month and more than 10 abortions a year. Most of my clients were not teenage girls desperate to stay in school or afraid of their parents, but married women with numerous reasons,” she explains.
NyaChirwa remembers assisting a wife of a catechist who constantly preached against abortion, likening it to murder.
“They had a child with disability whom she used to carry on her back. When she fell pregnant, the couple agreed to abort because the child needed undivided attention. They secretly approached me,” she narrates.
For the retired TBA, this confirmed that neither religious sermons nor restrictive laws can stop a woman when she decides not to keep a pregnancy.
She told The Nation that she stopped conducting abortions in 2010 when the government banned TBAs to reduce maternal deaths, but it had nothing to do with ensuring that every woman should give birth with the help of a skilled caregiver.
Rather, she says, the granny spent eight months in prison following the death of a woman she was suspected to have helped terminate a pregnancy in her home.
“I denied the charge because the woman was severely bleeding from an incomplete abortion when she approached me to clean her womb,” she explains.
Malawi’s colonial penal laws prescribe seven to 14 years imprisonment for abortion-related crimes.
A concern is rising that the law inherited from Britain puts women and girls at risk of dying from unsafe abortion.
“The law hasn’t stopped abortion in Malawi. Although I stopped providing abortion services, women and girls still ask for my assistance. Some come with bulging bellies. I refuse, but there are more TBAs ready to help,” says NyaChirwa.
In 2009, the Ministry of Health tracked about 70 000 unsafe abortions—and 98 percent of those who aborted belonged to some religion.
A similar study by reproductive health researchers from the University of Malawi’s College of Medicine and US-based Guttmacher Institute shows that 141 000 women induced abortions in 2015. About 60 percent of them sought medical treatment for complications, the findings show.
Health workers say most patients arrive late for treatment due to the restrictive laws.
“Every abortion in Malawi is a top secret until it goes wrong. Sometimes, we find sticks, leaf stalks, herbs, soap, wires and toxic substances in their wombs. Some die and others have their pierced uteruses and ovaries removed, meaning they won’t give birth again,” says Dr Priscilla Phiri.
The medical doctor says the underfunded hospitals pay a huge price for unsafe abortion.
She explains: “It costs up to K10 million to treat a single patient who spends over 10 days in hospital after piercing the uterus, ovaries and even intestines if she overdid it. However, safe abortion costs less than K50 000,” she states.
NyaChirwa says that relaxing abortion laws will reduce these costs, deaths, injuries and disabilities.
“Health workers know their work,” says the elderly woman. “TBAs only come in because health workers hands are tied. If we refuse to help a woman to abort, she will come back to seek treatment for complications.”
Health workers are only permitted to conduct abortion when the woman is in grave danger of dying, yet they spend hours treating the aftermaths of unsafe abortions.
Matthews Ngwale, chairperson of the Parliamentary Committee on Health, wants the lawmakers to debate the colonial law and pass new grounds to expand access to safe abortion.
His private member’s motion proposes three exceptions to “liberate women from dying because the current laws restrict a simple procedure safely provided by health workers in clinical settings”.
If it passes, the Malawian woman will be free to abort safely if she suffers sexual violence or incest, the foetus is too malformed to survive after birth and their physical or mental health is affected.
“The law has outlived its importance and it has been overtaken by technology. It’s time lawmakers took sides with women who die needlessly due to unsafe abortion,” says the Chiradzulu West legislator.
But Episcopal Conference of Malawi spokesperson Fr Henry Saindi says the grounds smacks of a foreign agenda to legalise deliberate abortions, affirming the catholic teaching that life begins at birth.
NyaChirwa says sermons from the pulpit have not stopped TBAs from prividing “abortions that only come to light when things go wrong”.
“Those who cannot afford safe abortion in private clinics go to any of these. Those with no one to assist them will use sticks and pierce their intestine. This is suicide.”
Senior Chief Mabulabo of Mzimba says rural women and girls bear the brunt of unsafe abortion.
He says: “We are debating whether abortion is right or wrong, but chiefs across the country are burying women and girls dying from unsafe abortions while their urban colleagues safely terminate pregnancies in private clinics. This needs to change,” he explains.