• SAFE abortion services are not widely available in Zambia and this forces many women to seek unsafe abortion often under dangerous and unsanitary conditions.
By MIRIAM ZIMBA –
SNART Lungu, now in her mid 50’s is a Lusaka-based successful business lady, married with only one daughter.
Unlike most affluent women who choose to have smaller families, Ms Lungu would have wanted to have more than one child, but circumstances have not allowed her to do so.
The story behind all this dates as far back as 1978 when she had just qualified to the University of Zambia (UNZA).
Qualifying to UNZA, was a source of pride for her family, especially her father Yona Lungu.
However, her celebrations were short-lived after she discovered she was three months pregnant a few weeks before the scheduled date to report at UNZA.
For fear of disappointing her father, she decided that an abortion was her only way out of this mess, and consulting some of her peers, she finally settled for the idea of using a sharp knitting wire inserted through her vagina to pierce the foetus.
“I thought I followed the instructions to the letter, especially after noticing some blood stained discharge,” Ms Lungu recounted.
A few days later, when she was convinced she had successfully executed the secret abortion, she began to experience some excruciating lower pelvic pains.
When all home remedies failed, and the pain worsened, she was later rushed to a health centre where her parents were informed that she was almost 16 weeks pregnant.
She was later referred to the University Teaching Hospital (UTH), where it was discovered that she had sustained severe injuries to her cervix and uterus, making her vulnerable and almost unfit to carry the pregnancy to full term.
“I was advised to remain on bed rest, and close monitoring by health workers, because I was too weak to carry the pregnancy to full term,” she narrated.
This was how her dream of making it to UNZA was shattered, and after she delivered her daughter -Taonga, her uterus was removed due to permanent damage.
When Taonga fell pregnant in 2003, during her final year at the Copperbelt University, Ms Lungu strongly advised her against terminating the pregnancy, owing to her personal experience.
Many women have been rendered infertile, and suffered all kinds of injuries some of them permanent and with deformities.
UTH consultant gynaecologist and obstetrician Gertrude Tshuma defined abortion as termination of pregnancy by the removal or expulsion of a foetus or embryo from the womb prior to viability.
She explained that abortion could either be spontaneously, usually referred to as a miscarriage or it can be purposely induced.
“The term abortion most commonly refers to induced abortion (termination of pregnancy),” she explained.
According to World Health Organisation, unsafe abortion is defined as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both.
Out of the estimated 205 million pregnancies occurring each year worldwide, approximately 42 million abortions are performed, 20 million of which are classified as unsafe.
Globally it is estimated that unsafe abortion causes 13 per cent maternal mortality while the 2007 Zambia Demographic Health Survey (ZDHS) indicates that in Zambia, maternal mortality ratio stands at 591 per 100, 000 live births.
Locally, 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.
Dr Tshuma, who is an advocate of abstinence as opposed to abortion, is of the view that abstaining from pre-marital sex could reduce on the number of unintended pregnancies, and in turn reduce on the complications that result from unsafe abortions.
UTH senior registrar for gynaecology and obstetrics Samson Chisele, explained that the most commonly used means of unsafe abortions are sticks, sharp objects, tablets (which are crushed and inserted through the vagina), as well as herbal concoctions sourced mostly from traditional healers.
“Other people abuse medications used to procuring safe abortions in hospitals to illegally carry out abortions, but in an unsafe environment and usually done in the communities,” he explained.
Dr Chisele explained that most of these unsafe abortions are incomplete and result in complications such as injuries to the birth canal and uterus, profuse bleeding, infections leading to sepsis, and may require surgical corrections.
“When the uterus is perforated as a result of using sharp objects, the patient tends to bleed profusely, and most of them are brought to the hospital in a state of shock,” he explained.
Dr Chisele explained that even older married women also present complications as a result of unsafe abortions, mostly because they are not aware that they could access these services at health centres.
However, 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.
Panos Institute of Southern Africa (PSAF) also believes that issues relating to safe motherhood through improved maternal health services are critical to the development of a country like Zambia.
PSAF executive director Lillian Kiefer challenged the media to highlight issues relating to maternal health in order to ensure improved health service delivery.
“We are also advocating for strengthening of health delivery system so that there are better referral systems and the supporting infrastructure such as good road, telecommunication and better health facilities, advocate for improved access to safe abortion services and to increase good nutrition education at community level especially for children under five and pregnant women,” she explained.
In commending the efforts made by the Zambian government in improving maternal health care, Ms Kiefer called for continued collaborative efforts to ensure a further reduction in order to meet the Millennium Development Goals (MDG’s) which seek to further reduce maternal mortality rates in Zambia to 162 per 100,000.
The Zambian legal framework on abortion is defined by 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”.
The only ground for the termination of pregnancy in Zambia is only 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.
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 a 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.
Clearly, with these figures, abortions are a threat to efforts aimed at promoting safe motherhood, through reduction of maternal mortality, and improving maternal health service provision.
It is imperative that as the government continues to improve maternal health service provision in the country in order to meet the MDG targets, issues surrounding unsafe abortions should also be prioritised.
