By MIRIAM ZIMBA –
SISTER Ireen Mulenga (not real name) is a midwife at the University Teaching Hospital (UTH), the country’s highest referral centre.
The operates from the obstetrics and gynecology department in Ward CO2, and most of her works involves attending to women with all kinds of reproductive health ailments.
She explains that most of the patients admitted to the ward with a limited bed capacity of 36, are young females, seeking medical services resulting from unsafe abortions.
On a daily basis, she is compelled to deal with cases of young teenage girls, who are rushed to UTH, sometimes lying helplessly, and at the brink of death due to profuse bleeding as a result of incomplete abortions.
“I have to receive these girls, some of whom come straight from home or other health centres, and quickly prepare than for emergency surgery, in order to save their lives,” she explained.
“This really makes my heart bleed, especially when it is too late for any medical intervention and we have to tell the relatives of the young girl that we were unable to save her life” Sr Mulenga added.
When women cannot make safe choices about their reproductive health, they resort to desperate measures to put an end to unintended pregnancies.
At least 40 million women around the world seek abortion each year 22 million of these put their lives at risk by turning to unskilled providers or unsafe methods because they lack safer options.
Even in countries where the law permits abortion, these services are not widely available.
For women in developing countries such as Zambia, access to safe abortion and other reproductive health care is limited, and women often lack knowledge, skills or social support to access these services.
Legal restrictions and cultural attitudes stigmatise abortion and women who are poor, young and otherwise marginalised face the greatest barriers and risks.
As a result, 22 million unsafe abortions occur each year and more than 47,000 women die, with more than 90 per cent of the women who die live in Africa and South Central Asia.
Even when abortion services are legal, women encounter barriers to access medical healthcare and the only key to addressing this injustice is to expand women’s access to safe and legal abortion.
Gender discrimination on the other hand, shapes women’s ability to make and exercise reproductive health choices, and abortion in particular is highly stigmatised in many settings.
Women’s ability to exercise their reproductive rights depends on supportive laws and policies at all levels and an end to the criminalisation of abortion where restrictive laws remain in place.
There are more than 1.7 billion young people aged between 10 and 24 years in the world-the largest population of young people in history adolescent girls aged between 10 and 19 years make up 70 per cent of all hospitalisation from unsafe abortion complications.
This age group accounts for about 46 per cent of deaths from unsafe abortions each year.
Studies have shown that young women aged between 10 and 24 are more likely to delay seeking help for abortion related complications than adults.
Although most African nations have some of the most restrictive laws on abortion, Zambia’s Termination of Pregnancy Act of 1972 permits pregnancy termination on health risk and other socio-economic grounds.
This came to light during a recently held media training meeting on the magnitude of unsafe abortions organised by Ipas Zambia.
Ipas Zambia country director Felicia Sakala explained that despite this relatively permissive environment, safe abortion services are not widely available in Zambia.
She believes that this has forced many women to seek unsafe abortion often under dangerous and unsanitary conditions.
With a maternal mortality ratio of 591 per 100,000 in Zambia, the death toll arising from unsafe abortion is still very high, and it is estimated that up to 30 per cent of these deaths could be as a result of unsafe abortions.
The Ministry of Health estimates that about 23 per cent incomplete abortions occur among women younger than 20 years, while 25 per cent of maternal deaths due to induced abortions occur among girls younger than 18 years.
Recent hospital-based studies show that 30 to 50 per cent of acute gynecological admissions are as a result of abortion complications.
Ms Sakala explained that in 2006, Ipas established a partnership with the Ministry of Health after being invited to help in the implementation of the Termination of Pregnancy (TOP) Act of 1972.
This was after recognising this problem, the government in 2008 initiated a strategic assessment of unsafe abortion in Zambia.
Getrude Tshuma, an obstetrics and gynecology consultant at UTH defines abortion as the end of a pregnancy that is below 7 months or 28 weeks, and that abortion could either be induced or spontaneous.
The Zambian legal framework on abortion (termination of pregnancy) is defined by four statutes, namely the Republican Constitution, the Termination of Pregnancy (TOP) Act Cap 304, the Health Professions Act and the Penal Code Cap 87.
Article 12(2) of the Zambian constitution provides for the general framework for abortion by stating that “A person shall not deprive an unborn child the right to life by termination of pregnancy except in accordance with the conditions laid down by an Act of Parliament for the purpose”.
While the TOP of 1972 and amended in 1994, aims at providing for safe and legal abortions through a safer environment.
There is only one ground for the termination of pregnancy in Zambia – that is if the continuation of the pregnancy is unsustainable owing to one or a combination of the following-risk to the life of the pregnant woman, greater than if the pregnancy were terminated, risk or injury to the physical or mental health of the pregnant woman.
Section 151 of the Penal Code provides that any person who with intent to procure the miscarriage of a woman, unlawfully administers to her or causes her to take poison or other noxious things or uses other means whatsoever, commits a felony and is liable to upon conviction to imprisonment for seven years.
While section 152 provides that every women being pregnant who with intent to procure her own miscarriage, unlawfully administers to herself any poison or other noxious thing, or uses for of any kind, or other means whatsoever or permits any such thing on her commits felony and is liable to upon conviction to 14 years imprisonment.
In line with the country’s strides to attain the globally prescribed Millennium Development Goal number five, which seeks to reduce maternal mortality by more than three-quarters, it is imperative that access to services for safe motherhood and other reproductive health services are increased.
Some of these interventions include rapid access to information on the provisions of the laws on safer and legal abortions to allow more women make informed decisions on their reproductive health, as opposed to desperate measures such as unsafe abortions.