The costs of abortion in Malawi

Underneath the din of politicians posturing about “life” and “choice,” beyond activists yelling about murder and rights, there are the stories of women who have had abortions. Despite the law in Malawi stating that abortion is illegal, evidence that women are constantly procuring abortions is rife as Cheu Mita found out.

In Sembène Ousmane’s book White Genesis, a teenager’s pregnancy is beginning to show. This causes her mother much grief, as the girl will not name the father. Suspicion in the village rests on a migrant labourer. He denies any involvement. An angry mob searches for the migrant worker for a few days. Eventually, the girl tells her mother the truth: her own father is also the father of her child.

From time immemorial, our cultures have had a way of disposing or hiding such abominations as they happen within families.

We have heard of all sorts of abortions happening in our communities, babies dumped in one place or another, and some women even reaching the point of losing their lives in the process of removing unwanted pregnancies. This is all apparent because of the restrictive law that Malawi has.

“Thirty percent of all maternal deaths in the country are due to unsafe abortions. It is worrisome because most of these deaths could be avoided,” said Grace Malera executive director of the Malawi Human Rights Commission.

Malawi’s current maternal mortality rate stands at 510 out of every 100 000 live births. Up to 30 percent of these  510 deaths  are probably related to complications of abortion.

She argues that even if Malawi were to try to reduce its maternal mortality rates as contained within the Millennium Development Goals, it would be impossible because women are still procuring unsafe abortions due to a restrictive law.

Sections 149 to 151 of the Penal Code makes acquiring an abortion a criminal offence and thus forces women to abort in secrecy.

Malera argues that a woman who has made up her mind to procure an abortion will do so at any cost.

Chikondi, a bubbly business executive, who is on the verge of getting married, says she chose an abortion while in school because she wanted to complete her education after discovering in the final year of her Bachelors Degree that she was pregnant.

“I was schooling in a country where raising a child would have been way beyond my means and I was there alone. The father of the child was a school mate who had been a friend for some time. It was a one-night stand, and I stood to lose out completely.

“I looked up options for abortion in the area where I was and called a clinic nearby which provided the service. I was escorted there by an older woman who understood my plight. We went in and the whole process took about 30 minutes and I was ready to go home with some pills in my hands.

“An abortion was not optional for me. I just had to have it if I were to go back home and face my parents,” she says.

Another woman, Mayeso, said she became pregnant while in secondary school and, as an orphan, had no way of raising the child that would be born.

“I was greatly troubled when I realised that I had missed my period. I told my cousin who told me about a place in Bangwe where I could go to the abortion. I think at the time, it cost K300 [$1.79] and she gave me the money and even escorted me.

“The clinic was located in an alley way and the doctor was curt in asking about what I was looking for. It seemed he was used to getting patients with problems similar to mine.

“The procedure didn’t take long, but it was painful. He then gave me Doxycycline and Panadol for the pain. The nurse came in and gave me cotton wool to protect myself so I wouldn’t stain. All the way home in the minibus I felt like I was about to die. I got home and literally threw myself on the bed.

“It took me a few days to get better and back to normal. However, I now fear that I may have contracted HIV from procuring that backstreet abortion. How sure was I that the tools used were properly sterilised?” were Mayeso’s sentiments, she is now HIV-positive.

Although the Malawian law is restrictive, women can go to government hospitals for post-abortion care without problems.

Medical experts argue that the cost of making abortion available is cheaper than the provision of post-abortion care (PAC).

According to a consultant gynaecologist at Mwaiwathu Private Hospital Dr. Edgar Kuchingale, one of the country’s main referrals Queen Elizabeth Central Hospital (QECH) receives between 10 to 30 post abortion cases on daily basis.

He said PAC for an outpatient costs government between K6 000 ($36) to K10 000 ($60) and the amount doubles for a day’s admission.

Said Kuchingale: “It costs women between K3 000 [$17] to K12 000 [$72] in smaller private clinic while the renowned bigger private hospitals charge between K10 000 to K30 000 [$180] to acquire post abortion care.”

According to Ipas, an organisation that is working on advancing women’s health rights including advocating for safe abortion, reducing cases of unsafe abortion would save money for government.

“Current post-abortion care procedures are much more expensive than safe abortion would be, if implemented,” reads the report from Ipas.

Godfrey Kangaude, Policy Associate for Ipas, said abortion is “an open secret”. He commented on a study done by the Ministry of health on abortion in Malawi.

“The study found out that police and legislators, knew about availability of abortion services in Malawi,” said Kangaude.

It is also argued that abortion, which falls under an offence against morality, is ungodly for a God-fearing nation like Malawi.

However, Malera argues that if the lawmakers were looking at laws that are stipulated in the Bible, then adultery, which is openly practised in Malawi, should also be a criminal offence.

“The Ten Commandments talk out against adultery, but our lawmakers only speak to issues that affect a woman’s life,” she said.

With the availability of the internet, women are able to find options which are available to them to secure an abortion.

One website http://www.nice-a-beauty.com/use-misoprostol-cytotec-abortion-pills.html actually suggests procuring a medical abortion using misoprostol if abortion is prosecuted in your country.

It states that Misoprostol (cytotec) can be taken not only vaginally but also orally.

“The oral method is preferable if abortion is prosecuted in your country. If you use oral way, you guarantee no piece of pills can be found in case you need to go to hospital. Any blood test will show that you have taken Misoprostol (Cytotec), and no way to prove that you tried to do an abortion,” reads the statement on the site.

A quick walk into some of the local pharmacies made it possible for Nation on Sunday to acquire some Misoprostol with advice from the pharmacist that eight tablets, selling at K400 ($2.40) will eliminate a pregnancy.

“The first four tablets will do the trick, but taking another four will help clear the womb,” advised the pharmacist.

The information sheet included in the packet says Misoprostol is used for the treatment of duodenal and gastric ulcers, prevention and treatment of postpartum haemorrhage, treatment of incomplete abortion and miscarriage, treatment of missed abortion in the first trimester and treatment for intrauterine foetal death and for cervical ripening.