By CHRISTINE MWAABA –
IN many European countries, abortion remains one of the most common medical procedures performed with nearly a third of women having an abortion by the age of 45.
It is not the same with their counterparts in African countries where there is shame and stigma around abortion with stories of the practice rarely spoken of.
Given that traditionalists and the clergy will continue to hammer away at abortion access and actively discourage women from having an abortion, it makes the practice a closely-guarded secret.
Sadly, this culture of discouragement means that a woman who has an abortion faces an ever-increasing amount of judgment and shame.
Against this background the levels of desperation faced by young women just for one to have unsafe abortion exposes them to unforeseen dangers.
Desperate women, facing the financial burdens and social stigma of unintended pregnancy believe they have no other option even if it means having unsafe abortions.
Many have resorted to several methods of unsafe abortion which include drinking toxic fluids such as turpentine, bleach, or drinkable concoctions mixed with livestock manure.
Other methods involve inflicting direct injury to the female organ by inserting herbal preparations into the cervix using a twig, coat hanger, or chicken bone into the uterus.
Other methods include placing inappropriate medication into the female organ or rectum.
Unskilled providers also improperly perform dilation and curettage in unhygienic settings, causing uterine perforations and infections.
Methods of external injury are also used, such as jumping from the top of stairs or a roof, or inflicting blunt trauma to the abdomen.
The burden of unsafe abortion lies not only with the women and families, but also with the public health system.
Every woman admitted for emergency post-abortion care may require blood products, antibiotics, oxytocics, anesthesia, operating rooms, and surgical specialists.
The financial and logistic impact of emergency care can overwhelm a health system and prevent attention to be administered to other patients.
Zambia National Traditional Councillors (ZNTC) Director Iress Phiri says the issue of unsafe abortion needs to be addressed before many young women die when the scourge can be avoided if one seeks the right information on the best way to avoid unsafe abortion.
Ms phiri says it is the responsibility of the community, medical staff, the church and traditionalist to ensure that the issue of unsafe abortion is addressed to avoid losing young girls in the communities.
“Parental guidance, religious guidance, common norms, issues of gender empowerment and the church have the bigger role to play so that people especially women are aware of the dangers of unsafe abortion”, she says.
A gynaecologist at the University of Zambia Getrude Tshuma says unsafe abortion might cause death due to haemorrhage, infection, sepsis, genital trauma, and necrotic bowel.
Dr Tshuma says the practice may include poor wound healing, infertility, consequences of internal organ injury for instance urinary and stool incontinence from vesicovaginal or fistulas), and bowel resections.
She says other immeasurable consequences of unsafe abortion include loss of productivity and psychological damage.
“Though women may not want to become pregnant, because of personal reasons, health considerations (such as HIV) socioeconomic concerns, cultural reasons, relationship problems, or the desire to stop childbearing/space but still unsafe abortion is still not the solution to these problems”, she says.
IPAS Zambia is an organisation whose mission is to improve women’s lives to have access to sexual and reproductive health services especially comprehensive abortion care with a special focus on preventing unsafe abortion, improving treatment of its complications, and reducing its consequences.
IPAS Programme Manager Patrick Djemo says that the organistion works with the Ministry of Community Development, Mother and child health along with other stake holders, to reduce abortion related deaths.
Dr Djemo explains that it is unfortunate that the numbers of the monthly average case load of unsafe abortion by some provinces for the year 2014 are alarming.
The average case loads for 2014 were as follow, central province had 201, Copperbelt 763, and Lusaka Province had 228.
The percentages of the age groups were 17 per cent for those aged 19 years and below, 29 per cent were between 20 and 24 whilst 54 per cent were 25 and above.
Dr Djemo says this is a reflection of just some of the provinces in Zambia conducted by IPAS adding that if IPAS was to collect all the data from all the provinces the number would triple the number of the total of the three provinces.
He says some patients have died on the way to the hospital when complications arise from the unsafe abortion which they would have done at home or in an environment where they are no qualified medical staff.
“Sometimes we might save them while in other instances we might lose them”, he says.
May be the reason why most young women would rather have unsafe abortion is because unsafe abortion has restrictive abortion laws.
The Zambian abortion law (termination of pregnancy) is defined by four statutes: the republican Constitution (Cap 1), the termination of pregnancy Act (Cap 304), the health professions Act (24/2009) and the Penal Code (Cap 87).
Each of these statutes has a specific purpose with the Bill of rights Article 12(2) providing for general framework for abortion: “A person shall not deprive an unborn child of life by termination of pregnancy except in accordance with the conditions laid down by an Act of Parliament for that purpose.”
Termination of Pregnancy Act –Cap 304 enacted in 1972 and amended in 1994 is permitted if continuance of the pregnancy would involve risk to the life of the pregnant woman; or risk of injury to the physical or mental health of the pregnant woman; or risk of injury to the physical or mental health of any existing children of the pregnant woman; greater than if the pregnancy were terminated.
A substantial risk is that, if a child was born, it would suffer from such physical or mental abnormalities such as to be seriously handicapped.
However, the Penal Code was amended in 2005 due to the escalating number of gender-based violence cases.
In particular, sections 151 to 153 dealing with abortion were amended to include terms as female child and rape.
Liberty Christian centre deacon Babwitso Kaunga says it is imperative that the church takes up a critical role in ensuring that unsafe abortion is not practiced by young women in the communities so that their lives can be saved.
Deacon Kaunga says if one is unable to take care of the child, there are other options like giving the child up for adoption.