Nationwide, health workers struggle to save thousands of sexually active Malawians haunted by complications of unsafe termination of pregnancy.
The Ministry of Health estimates that its overwhelmed workforce treats 70 000 women and girls hit hard by the silent crisis, two or three of them die every day.
“It’s devastating!” Dr Maranatha Banda told legislators during their visit to Queen Elizabeth Central Hospital (QECH), “every life counts. Maternal death is one too many.”
At QECH, where she has been working since 2013, birth complications have killed 39 since January and seven succumbed to bleeding, infections and other tragic aftermaths of unsafe abortion.
But the doctor remembers a girl who died aged 16.
She recounts: “The girl suffered an advanced infection called sepsis after she admittedly terminated her pregnancy using sticks or other unsterilised sharp objects. Her chances of survival were very slim. For slightly over a week, the staff at QECH tried to save her. Later, the shortage of space in our intensive care unit [ICU] compelled us to transfer her to Mwaiwathu Private Hospital where she died.”
Dr Gladys Gadama terms unsafe abortions a big drain on the country’s constrained healthcare budget because they often involve “costly operations and lengthy admissions” in the ICU with inadequate space, skilled hands, equipment and drugs.
A 2009 study by the Ministry of Health shows that government spends almost K300 million treating these complications of unsafe abortions every year. This is enough to run QECH for almost four months. The hospital receives K70 million monthly, but got just K54 million last month.
With the economy on life-support, sexual and reproductive health activists argue that universal access to contraceptives and safe termination of pregnancy could drastically cut the cost.
Backers of the Termination of Pregnancy Bill point to Ethiopia and South Africa where women’s liberty to safely abort unwanted pregnancies has almost halved maternal deaths.
Similarly, figures from the Directorate of Reproductive Health stunningly back a petition of Paramount Chief Kyungu and other traditional leaders for government to increase uptake of contraceptives by 60 percent to reduce unwanted pregnancies.
Director Mary Mulombe-Phiri, whose directorate received K75 million for the Family Planning 2020 agenda adopted in London in 2012, says increasing use of contraceptives has averted about 158 300 unsafe abortions, almost eight times higher the cases treated in 2009.
“This is a milestone,” she said at this year’s population conference in Lilongwe. “About 1 860 625 women are using modern methods of family planning. Approximately, we have prevented 531 895 unintended pregnancies, 158 292 unsafe abortions and 2 480 maternal deaths.”
By these computer-aided calculations pioneered by Marie Stopes International, government would have to hire about 1 979 eighty-seater buses to ferry women and girls saved from life-or-death abortions to a venue six times bigger than the 25 000-seater Kamuzu Stadium for a celebration of this feat.
But it is no party time yet. Not because an official at Axa Bus Service, with the largest running fleet, says: “No company can supply the buses even if we subcontracted our competitors.”
Rather, maternal deaths are still high though last year’s Malawi Demographic and Health Survey shows that almost 58 percent married women use modern contraceptives, a jump from just 46 percent in 2010.
Besides, about 19 out of 100 willing to delay pregnancies have no access.
The unmet need is high among the youth, with 29 percent of adolescent girls reportedly getting pregnant—up from just 25 percent six years ago.
“Most of those suffering hardships of unsafe abortions are schoolgirls trying to escape a backlash from their teachers, guardians and peers,” says Dr Arnold Kapachika, district medical officer at Mwanza Hospital.
The health workers recommend safer spaces where the worst hit group can access information and contraceptives without watching their back.
QECH senior nurse-cum-midwife Mary Mwale concurs: “Like all hospitals, we have youth-friendly services, but boys and girls shun them. When they pop in, everyone knows they want condoms. They are afraid of bumping into people who know them.
At Coalition for the Prevention of Unsafe Abortion (Copua), campaigners back calls for easy access to contraceptives, but say even 100 percent access will not stop unsafe abortions because some women are pushed by complex causes, including rape and rejection. The globally acclaimed model does not capture possible causes of averted abortions and deaths. n