The abortion debate: What choices are there for women?

“The late Mutinta (her real name hidden), was living with an adopted family after they rescued her from prostitution, from which she had been earning some money to support her poor parents. At 18, she was in Grade 7 following efforts by the family to take her back to school (At this age most girls her age are have already completed secondary school)

She had gone to visit her mother during December holidays and unfortunately got pregnant. When she came back to her adopted family, she never told anyone what had happened and again asked for a weekend to go visit her mother.

She procured back street abortion and developed complications which she was not willing to disclose to anyone, not even her adopted parents and just pretended to have some pain in her feet. By the time the doctor recommended for an X-ray, her condition had deteriorated and four days later, she died.

She did this regardless of the legal implications of the act (Abortion in Zambia is legalised and anyone performing illegally is liable to imprisonment). Her concern must have been more of ‘ what people will think’ and considering that the mother was barely able to provide for any of them, She was also concerned with how she would take care of the baby when she couldn’t take care of herself and her education would come to an end.

The debate on abortion is always an emotive one, and one that many times seems to demonize people who are either in support or on the opposing. Some also consider it very sacred that speaking about it is an abomination.

Religious leaders have also come out strongly on the “sanctity of life”, to condemn the legalization of abortion arguing that every individual is entitled to life.

In most African countries, abortion is only allowed when the health of the mother is at risk. Some however have very liberal laws like in Zambia where it was legalized in 1972 on various factors and can easily be procured at places like the University Teaching Hospital (UTH), for as little as K 10,000.

Regardless of the ongoing debate in various countries, women will choose to abort whether it’s legal or not, others will choose to keep their babies, but the issue is, abortion is widely contributing to maternal mortality rates.

Doctor Mubiana Inambao, one of the gynecologists in Zambia says every minute there is a pregnancy taking place in all situations, whether in marriage, planned or unplanned. However, he says n unplanned ones; victims seek ways to terminate the pregnancies. “Those with money access facilities while those with no money will seek cheaper means which include herbalists, back street abortions and these create a lot of complications later on evening leading to death,” he says.

It is said that countries where comprehensive reproductive health laws have been instituted including safe abortion, the maternal mortality rates have reduced dramatically.

In Zambia, the Ministry of Health (MoH) is offering training to doctors on the process of performing a safe abortion. This is to deter quacks from performing unsafe abortion. However the training is only restricted to doctors, leaving out clinical officers and nurses. “This is one of the major obstacles we are facing since there are not many doctors in the country”, says Dr. Mutinta Muyuni from UTH, during a media training on safe abortion organized by Planned Parenthood Association of Zambia (PPAZ)

The Nepalese government legalized abortion in the first 12 months of pregnancy following amendment to Nepal’s civil Code. The country’s Maternal Mortality Rate (MMR) reduced from 539 per 10,000 live births in 2004 to 289 in 2006, something that the experts attributed to legalizing of abortion. The country hopes to bring down the MMR to the target of 134 by 2015.

A three-month survey conducted in the country by the international reproductive health organisation Ipas from April 2008 showed that, legal abortions are safe and that less than two percent of women out of 7007 that were trailed suffered post-abortion complications of low to moderate severity.

Zambia has legalized abortion on health factors and socioeconomic grounds, making the country to have one of the most liberal laws on abortion in sub-Saharan Africa.

Termination of Pregnancy Act of 1972 allows an abortion to be performed if three registered medical practitioners are of the opinion formed in good faith that (a) continuation of the pregnancy would involve risk to the life or of injury to the physical or mental health of the pregnant woman, or of injury to the physical or mental health of any existing children of the pregnant woman, greater than if the pregnancy were terminated; or (b) that there is substantial risk that if the child should be born, it would suffer from such physical or mental abnormalities as to be severely handicapped.

A person who performs an abortion in violation of the provisions of the Act is subject to the punishments prescribed in the Penal Code of 1 November 1931 for the performance of an illegal abortion. The person will serve fourteen years’ imprisonment if he or she with intent to procure a miscarriage, unlawfully administers a noxious thing or uses any means. A woman who undertakes the same act with respect to herself or consents to such an act is subject to seven years’ imprisonment.

The Government has however expressed concern about the high incidences of illegal abortion in Zambia. Many studies have also shown that illegal abortion is one of the major causes of the high rate of maternal mortality in the country (591 deaths per 100,000 live births). A study conducted at the University Teaching Hospital (UTH) between 1982 and 1983 found that 18 per cent of all maternal deaths were due to complications from incomplete induced abortions.

The Ministry of Health’s Standards and Guidelines for reducing unsafe abortion Morbidity and Mortality rate in Zambia 2009 found that unsafe abortion remains a challenge in the country despite an abortion law that is considered favorable and a liberal continent policy framework to which Zambia subscribes. It continues to state that with a maternal mortality of 591 per 100,000 live births, it is estimated that up to 30 percent of these live deaths could be resulting from unsafe abortion.

In Kenya however, the case is different. Abortion remains restricted on health factors under the current constitution. Efforts to include changes in the ongoing constitutional review have hit a snag as opposing groups have come out in protest. While pro-life who believe in the sanctity of life principle argue that human life which they say begins at conception, should be protected at all costs and that abortion should not be legalized, pro-choice support the rights of the mother to be given priority over the unborn child.

The draft constitution has however favored the pro-life, stating that (section 26) every person has a right to life, life begins at conception and that abortion is not permitted

But at the same time, second part of section 26 (4) it sates, “unless in the opinion of a trained health professional there is need for emergency treatment or the life or health of the mother is in danger or if permitted by any written law.”

This is the part that is making the church in Kenya reject the draft constitution, advocating for total prohibition of abortion.

In 2004, a study report that was released and had made suggestions to legalize abortion in Kenya to reduce maternal mortality also sparked a heated debate. Pro-life organizations claimed that preventing unwanted pregnancies was a better way of reducing the deaths than legalizing abortion.

The study, ‘A National Assessment of the Magnitude and Consequences of Unsafe Abortion in Kenya’ had recommended that "There should be a review of the policy and law on abortion in Kenya." Currently, abortion may only be allowed if the pregnancy seemed a threat to the woman’s life.
The study was carried out by the Kenya Medical Association, Federation of Women Lawyers (Kenya Chapter (FIDA-K), Ministry of Health and International Projects Assistance Services (IPAS) – a United States-based organization that lobbies for women’s reproductive rights.
The report indicated that about 300,000 abortions are performed in the country each year, causing an estimated 20,000 women and girls to be hospitalized with related complications. This translated into a daily ‘abortion rate’ of about 800 procedures – and the death of 2,600 women every year.

In 2007, Kenya suffered Post election violence following disputes over who had worn the elections between the current President Mwai Kibaki and Prime Minister Raila Odinga. As a result many women and girls were raped by various riotous groups of men. Some husbands of rape victims (women) abandoned them. Children were born with no knowledge of who their fathers were and until now, most victims continue to suffer from stigma except for those who have managed to access counseling services.

Many hospitals recorded various cases of rape. One victim recounted in an interview how her husband was killed while she was gang raped. The gangs took advantage of this more vulnerable sex to rape and leave them for dead. In the process, some succumbed while others were lucky to be taken to hospitals by good Samaritans, where they were able to recount their horrifying tales.

In Tanzania, abortion also remains on restrictions and any person procuring is subject to 14 years imprisonment while the person permitting it may serve up to seven years in prison.
However, the law states an abortion may be performed to save the life of a pregnant woman. Section 230 of the Code provides that a person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon an unborn child for the preservation of the mother’s life if the performance of the operation is reasonable having regard to the patient’s state at the time, and to all the circumstances of the case. In addition, Section 219 of the Code provides that no person shall be guilty of the offence of causing by willful act a child to die before it has an independent existence from its mother if the act was carried out in good faith for the purpose of preserving the mother’s life.

Uganda also allows abortion on the basis of health. A legal abortion must be performed by a registered physician. Although the law does not require the approval of a committee, the consent of two physicians is usually sought before a legal abortion can be performed.

The debate however continues in many countries, meanwhile women and young girls continue to suffer not knowing what the various governments can do to save this situation

Pro-Choice activists argue that a woman has a right to abortion, and that doctors should be allowed to abort a life threatening pregnancy, or in cases of rape and incest. Pro-Life activists however argue that abortion denies an embryo or fetus the right to live.

“The fact is that no one ever wants to have an abortion; no one sits down and plans how they're going to get pregnant and then abort to prove that women have rights to their own bodies or whatever, says Dr. Mutinta.

During a journalist workshop in Kitwe, organized by Zambia Media Women Association (ZAMWA) in Collaboration with Ipas, to train them on strategies to address unsafe abortion in Zambia Dr. Inambao said no woman likes to have an abortion and neither does a medical person like to perform abortions just for the sake of it
In his paper, “The Concept of Comprehensive Abortion Care (CAC), Clinical Aspects of abortion, the doctor said women frequently found themselves in desperate situations and therefore always weigh options of carrying the pregnancy or having an abortion.

He called on women to adopt safe methods of abortion instead of illegally procuring it. The doctor mentioned common methods used by women to induce the pregnancies illegally include detergents, battery acid, knitting needles, and homemade concoction’. This he says later makes them develop complications like infections with sequel of infertility, bleeding or sometimes death.

Dr. Inambao says currently in Zambia, 30 percent or maternal mortality is due to abortion complications adding that despite Zambia having a favorable abortion law, several objections were hindering the implementation of the abortion law.

The World Health Organization (WHO) estimates that there are 4.2 millions unsafe abortions annually in Africa and 44 percent of global maternal mortality are related to abortion in Africa.

Meanwhile, Ms Pauline Banda, Features Editor of Daily mail notes that illegal abortions are popular to conceal unwanted pregnancies.

In her presentation on Media and Abortion during the PPAZ workshop, she said the media has been constrained in reporting on abortion and journalists have to do undercover reporting to get information.

“Most times, abortion is one of the least reported issues in the media because of its secrecy. It is a big story that should be given due attention,” she added.