By Khumbo Chisi
At 439 deaths in every 100 000 live births, Malawi’s maternal mortality rate remains high.
However, there is a disparity between the realities of women dying from pregnancy-related complications and remedies currently in place.
For instance, while unsafe abortions causes about 18 percent of these deaths, Malawi retains one of the most restrictive abortion laws globally.
This pushes women and girls to seek unsafe abortion in fear of parental reaction, partners denying responsibility, economic struggles to raise the child, desire to continue with school, uneasiness to marry and religious expulsion .
According to the Penal Code, a woman can be jailed for three to 14 years for terminating a pregnancy except to preserve her life.
Regardless of this colonial law, Malawian women and girls still procure unsafe abortions. In effect, no religion or law has stopped them from procuring abortion when they so wished.
When a woman does not want to keep a pregnancy, she will do anything to terminate it
Besides, women who seek abortions come from all sectors of life—rural and urban, educated and illiterate, religious or not, Muslims and Christians.
However, evidence shows secret abortions have deadly consequences on women and the nation.
Some of those who procure clandestine abortions seek post-abortion care in hospitals and most of them are adolescents.
This suggests that more women secretly undergo the life-threatening procedure, dying unnoticed if they do not seek medical help.
The fear of being jailed drives women to desperately conceal or self-manage complications of backstreet abortion instead of seeking medical assistance.
Due to stigma, women who abort hardly disclose their complications, making it difficult to get timely medical help.
Even those who disclose get to the nearest hospital when their wombs are extensively damaged or infected—often too late to save their lives.
This is why unsafe abortion remains one of the top five killers of pregnant women in Malawi.
In 2009, a Ministry of Health study showed that government spends up to K300 million on post-abortion care.
Yet evidence shows that the neglected killer affects poor women in rural areas worse than their wealthy urban counterparts who easily access safe abortion in private clinics.
This deadly divide persists although Malawi signed the Convention on the Elimination of all Forms of Discrimination against Women (Cedaw) adopted at the United Nations General Assembly in 1979.
In 2006, the Cedaw Committee expressed alarm at “the persistent high maternal mortality rate, particularly the number of deaths resulting from unsafe abortions, high fertility rates and inadequate family planning services, especially in rural areas, low rates of contraceptive use and lack of sex education.”
The core rights issues in reproductive health are the ability of women to make decisions over their lives, such as determining when to start a family, its size, and the interval between children. These rights entail that women should be able to make decisions about reproduction free of discrimination, coercion and violence.
So far, Malawi has failed to meet the Cedaw Committee’s call on “the State party to integrate a gender perspective in all health sector reforms, while also ensuring that women’s sexual and reproductive health needs are adequately addressed”.
Government should create an enabling environment for health workers to provide safe abortions.
Liberalising the country’s restrictive abortion laws will enable both poor and rich women to access safe abortion.
A proposed law to be tabled in Parliament this month seeks to permit health centres with midwives to safely terminate pregnancies in the first 13 weeks.
If the Bill passes, health centres that provide basic emergency obstetric care may also provide manual vacuum aspiration. Clients in the second trimester of pregnancy shall be referred to hospitals.
Similarly, first trimester women seeking abortion on medical grounds or any other considerations stipulated in the Bill shall be referred to the hospital for expert assessments.
Additionally, community, district and central hospitals will perform all types of terminations of pregnancy using both medical and surgical means.