by Nondo E. Ejano, Women Promotion Centre; Kigoma

Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative in all Africa and in Tanzania particularly. As with other more visible global-health issues, this scourge threatens women throughout Tanzania.

The annual number of induced abortions in Africa rose between 1995 and 2003, from 5.0 million to 5.6 million. In 2003, most of the abortions occurred in Eastern Africa (2.3 million), Western Africa (1.5 million) and Northern Africa (1.0 million). In Eastern Africa the rate was 39 abortions per 1,000 women aged 15-44 and in Tanzania abortion complications contributed 18% of maternal deaths in 2008 (The National Road Map Strategic Plan To Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania, April 2008).

Unfortunately, unsafe induced abortion is one of the most neglected and “unspoken” problem, a taboo and difficult topic of health care in Tanzania as in many places of developing countries (WHO 2004). Women that have or need abortions often think they are an exceptions, they are in shame, are scared and do not speak following the existing restrictive abortion law and religious fundamentalism. This make hard to know the magnitude of the problem as in such a setting it is difficult to get reliable information about the proportion of alleged miscarriage due to unsafe induced abortions.

In Tanzania, induced abortion is only legally available if the pregnancy is a threat to the woman’s life (The World’s Abortion Laws 2008). Consequently, women who want to terminate an unwanted pregnancy have to resort to illegal interventions and thereby put their lives and health at risk.

The problem of unsafe induced abortion is reflected in hospital statistics, which show significant numbers of alleged miscarriage. For instance, in hospitals in Zanzibar, in Mwanza Region and in Kagera Region, abortion complications are listed as number 2–4 on the hospitals’ top 10 admission causes, only exceeded by malaria, acute respiratory infections and anaemia (The Tanzanian Health Management Information System 2006). Yet hospitals often see the ghastly results of botched abortions by untrained practitioners. “Very sharp objects are inserted into the vagina to disturb the pregnancy,” said John Bosco Baso, a spokesman for Marie Stopes Tanzania, which runs a network of health clinics here. “The women get infections, they get fever, and some die. Many of them hide it. We only see them at the critical stage, when there’s infection.”

However evidence points in the direction that the majority of the women are admitted because of complications after an unsafe induced abortion (Rasch et al. 2000, 2004; Singh et al. 2005) and many women in rural Tanzania have testified to know one, two or more of their relatives who died attempting to induce an unsafe abortion (WPC survey, 2009).

This proves that the lack of access to safe abortions, does not make women not to seek abortions, it just forces women to take risk and try unsafe methods – “they go to people without medical knowledge, they punch their bellies, they insert sharp objects in the uterus. This is a reality that we know of, many of us have heard those stories; some of us lost friends or family to unsafe abortion. Women die because of those unsafe practices” testified a woman leader in rural Tanzania.

What should be done in this country?

• Legalizing abortion would be a simple way to access safe abortion methods which is absolutely necessary to prevent women from dying and from suffering the long term health complications. This is a matter of social justice and would open space to talk about this community issue.

• Introducing Misoprostol (already introduced by the Ifakara Health Institute at ANC visits in four districts – Kigoma, Kilombero, Rufiji and Ulanga -) as a component of a Comprehensive Abortion Care (CAC) at multiple levels of health system including village-level health post should be seen as a strategy to prevent these unnecessary deaths of women.

• Educate people and disseminate information on medical abortion with misoprostol should gives them the possibility to take informed decision about abortion with the little risk on their lives and health.

• Increased accessibility, availability and affordability of this life-saving pill (Misoprostol) should help to most rural women prevent themselves from unsafe abortion as the country is still facing shortage of skilled health professionals.