Girls suffer as lawmakers await abortion Bill

It is Tuesday around 10 am, a scorching morning in Karonga District on the Northern shoreline of Lake Malawi.

Pacing in the lengthy corridors of Karonga District Hospital, a nurse is seen pushing a wheelchair carrying a 15-year-old girl visibly in agony.

The teenager disguised as Ndamyo is supposed to be in class with her agemates, but here she is.

The Standard Seven learner is on the way to a tiny room where health workers treat women and girls at risk of dying from severe complications of terminating pregnancies outside clinical settings. The assistance mostly involves removing thick remains of incomplete abortions from the patients’ wombs.

“She is our second client this morning,” says clinician Donovan Mlangali, the district’s coordinator of post-abortion care.  “We see up to five a day, but some come with worse conditions that require surgery.”

To get there, Ndamyo terminated a two-month-old pregnancy using local remedies, but concealed it until severe bleeding and abdominal pains kicked in six days later.

 This is common in Malawi, where colonial laws inherited from Britain outlaw abortion unless the pregnancy threatens a woman’s life.

Ndamyo was writhing in pain when her mother and sister escorted her to Kaporo Health Centre, from where a clinician referred her to the district hospital. She got blood transfusion a day before being wheeled to the post-abortion care section.

To save her life, the health workers inserted a massive syringe to clean her birth canal.

In an interview in the presence of her mother, the girl said she “put her life in the hands of God” for fear of being kicked out of school and her home in a remote village along Lake Malawi.

“I didn’t intend to get pregnant at my age. I thought I was playing, not knowing I would get pregnant. So my friends told me it would go if I took excessive energy drinks, some pills and bitter herbs,” she explains.

Ndamyo took the unproven mixture with no one in sight.

“I was afraid of my parents, teachers, prayermates and neighbours. A day after taking the bitter leaves, I swallowed an overdose of pills for stomach pains and washed them down with five bottles of energy drinks.

Three days afterwards, she started bleeding heavily, feeling dizzy and stomach aches.

“My stomach was turning in pain. I spent two day in my hut, afraid of what onlookers would say if they realised  that I had terminated a pregnancy,” she explains.

Ndamyo was writhing in pain when she arrived at the nearest health centre.

“I was constantly under pressure to abort. The man who impregnated me told me to get rid of it because he is also a pupil and jobless. He didn’t want the responsibility of raising a baby.

But she had some fears.

“I was afraid because I have heard that hospitals don’t provide abortion and some girls die from secret abortions. Given the pains I have suffered, I would have gone to hospital earlier if the law allowed health workers to provide safe abortion,” she explains.

Thousands of Malawian girls and women brave deadly complications of backstreet abortions even though sections 149 to 151 of the Penal Code ban abortion except to save a woman’s life.

Health workers and their clients risk being jailed for seven to 14 years for providing or procuring the illicit procedure.

However, a study conducted by the Ministry of Health in the country’s hospitals shows about 67 300 induced abortions occurred in 2009, equivalent to 23 abortions per 1 000 Malawian women aged 15 to 44.

The findings show abortions performed under unsafe conditions is a third-largest cause of Malawi’s high maternal mortality ratio, killing up to 18 in every 100 women dying from pregnancy-related causes.

A similar research based on reports from health facilities and interviews with health workers countrywide estimated that about 141 000 women performed abortion in 2015. This translates to a rate of 38 abortions per 1 000 women aged 15 to 49.

Explains lead researcher Dr Chisale Mhango: “Despite the restrictive laws, almost one in every six pregnancies end in abortion.

“Out of the estimated 141 000 abortions performed in Malawi in 2015, approximately 60 percent resulted in complications that required medical treatment in a health facility.

About one-third of the women who experienced complications from an abortion did not receive the medical treatment they needed.”

However, the government’s push to relax the colonial abortion laws long abandoned by Britain stalled in 2015 when a special law commission recommended three more exceptions to the laws.

Activists described the law reform as sluggish, saying the restrictive laws are hurting women to death.

Mlangali, coordinator of post-abortion care in Karonga, says the relic of British legacy in Africa ties health workers’ hands and the government will keep paying a huge cost of treating preventable complications of unsafe abortion until laws change.

“While we are still debating whether the law is right or wrong, women have not stopped terminating unwanted pregnancies. The complications of these abortions are overwhelming our hospitals, which are already struggling with shortage of staff and essential staff. Instead of improving our health care delivery, we are spending on treatment of unsafe abortions which could have been prevented if the law was not restrictive,” he says.

Due to shortage of syringes, two or three patients have to wait for a day to receive the outpatient procedure.

Mlangali’s team assists an array of patients, including victims of sexual attacks, girls rejected by their sexual partners and women who cannot afford to raise one more child.

“Some girls and women come to plead with us to help them abort safely, but we cannot because it is illegal. When we send them back today, we have to assist them when they return with life-threatening complications a few days later,” he says.

For the clinician, patients like Ndamyo personify a graver problem as most cases go unreported unless there are complications.

“Most patients come with serious conditions that wouldn’t have occurred had they come been prevented had they come earlier. At worst, we have to remove their uterus because they are so perforated and infected that we cannot do anything more,” Mlangali explains.

Apart from removing the remains using the manual evacuation syringe, the sessions include counselling and modern family planning.

He reckons: “Modern family planning can help reduce unintended pregnancies, but access remains low, especially in rural areas and among the youth who are sexually active. Unfortunately, the cost of providing post-abortion care is higher than preventing complications by removing the barriers that push women and girls to seek unsafe abortion,” he says.

A national debate is currently underway on whether or not to expand liberalise Malawi’s abortion law by providing more exceptions under which an abortion could be legally and safely obtained

Chiradzulu West legislator Mathews Ngwale is set to table a private members Bill for debate in Parliament during the current sitting.

However, Mlangali says the law may not pass because most lawmakers do not fully understand the problems health workers handle.

“We do our part and we expect the legislators to do their part. However, we need to provide information for the citizenry, lawmakers and policymakers to understand why we have to do something about this problem which we seldom discuss in public,” he says.

Ngwale, the chairperson of the Health Committee of Parliament, has “put his political career on the chopping board” by offering to adopt the exceptions recommended by the Law Commission, he states. According to him, the committee resolved to take the Bill to the National Assembly because the Ministry of Health appears reluctant to do it and save women.

“We cannot wait anymore,” he explains. “Time has come for our generation to put a stop to the needless deaths and suffering women suffer while we look away and debate whether abortion is right or wrong.

For the former nursing tutor and his committee which toured Karonga District Hospital to appreciate the magnitude of “the neglected challenge”, unsafe abortion is a public health issues, not a moral or religious question.

The Ministry of Health study estimated that a liberalised law and access to safe abortion in public health facilities would decrease postabortion care costs by 20 to 30 percent.

But Ngwale and his team face a tough test as the law reform faces resistance from some religious and cultural groups.

An opinion poll by this paper in October showed the Bill could suffer a whopping rejection if tabled for voting in Parliament.