Whether or not we choose to ignore it, abortion is happening in Malawi. Cheu Mita spoke to gynaecologist Dr Bonus Makanani on the impact of abortion on the health care system in Malawi. Excerpts:-
What are the current numbers of females seeking assistance for post- abortion care at Queen Elizabeth Central Hospital?
We see anywhere between 10 to 20 such cases every day. In fact, most of our daily new admissions to the gynaecology ward in Chatinkha are abortion related.
With the law only accepting patients for post-abortion care, what are the implications on the health budget?
The cost of post-abortion care is incurred at many levels-human resources, medical and surgical supplies, accommodation and all that goes with it such as water, food, electricity and sanitation. This includes transport costs if cases are ferried in by ambulance. If the case is critical, intensive care may be needed. The nationÃ¢â‚¬â„¢s health budget is limited with many competing needs. The question we should be critically asking perhaps is, would legalising abortion services impact on the cost of post-abortion care?
How much does the abortion cost if performed by the hospital and how much does it cost to provide post-abortion care?
This is not always easy to work out as it is influenced by many factors: what type of hospital, the level of skills of the provider, whether there are complications or not. For example, in Uganda, they were able to show that the cost of abortion was lower in a legal setting that allowed elective abortion, than in the restrictive legal setting. It was also noted that the cost was reduced when services were available at all service levels. In US dollar terms, in a restricted setting where complications were treated at a tertiary level, the cost was as high as $45 (K7 515). Where services were available at all service levels and mid level providers treated most cases, the cost was $25 (K4 175).
Is there a statement you can make, in relation to abortion, regarding attaining MGD 5 which deals with improving maternal mortality rates?
Abortion-related deaths are a reality and to a large extent avoidable. There are many ways to avoid this. Some people will only consider ways that will prevent women getting pregnant in the first place. This is too simplistic in my view. Unplanned and unwanted pregnancies will always happen, and some women will seek abortion as a solution to their predicament. This inevitably leads me to the thorny issue of whether abortion should be legalised, much more so than the current law allows. Let us debate these issues openly and comprehensively. Wide consultation is needed in order to come up with a position that is acceptable to Malawians.
What qualifies a woman for an abortion?
To a large extent, this is usually determined by the legal environment in which we find ourselves. However, the health consequences or complications of a pregnancy on a woman will influence the medical decision to perform an abortion or not. These might be physical or mental. Medical issues, legal issues, reproductive health issues, moral issues, religious issues and human rights issues must all be considered. It can be very complicated!
What are some of the unsafe abortion methods used by women in Malawi?
The most common is insertion of an object into the womb through the cervix. Sticks, wires, leaves and detergent soap are some of the things used. Some women have ingested all sorts of pills. The women are usually assisted by relatives, friends, traditional healers and in some cases health workers.
What percentage of maternal deaths does abortion contribute?
Worldwide, approximately 13% of maternal deaths are a result of unsafe abortion. In Malawi, abortion may contribute up to 30% of maternal deaths. The exact figures are hard to come by as there are many cases that go unreported and, therefore, are not counted. The sad thing is that a good number of these abortion-related deaths are preventable.
Are rape victims given the liberty to abort?
This is not such a straightforward issue. Women who have been sexually abused are a very traumatised lot. Different people cope differently. Where a pregnancy has come about as a result of rape, it is important to identify and deal with all the issues such a woman may present. A lot of counselling is needed and provided. This option is available to the woman if she so wishes.