Date: Sunday, July 29, 2012
Source: Sunday Times (South Africa)

Ban sparks abortion debate

Officials insist Marie Stopes are breaking Zambian law

‘Unsafe abortion is a major issue in Zambia. And the consequences are devastating for young women’

ZAMBIA’S Northern Province administrators would like the abortion law to be strictly enforced.

Provincial permanent secretary Emmanuel Mwamba on July 20 ordered Marie Stopes, the international reproductive health NGO that operates in 42 countries, to stop operations with immediate effect for conducting “illegal abortions”.

By so doing, the administration threw open the rarely discussed issue of unsafe abortions.

Safe abortion is virtually unattainable, grudgingly countenanced only at the end of an intricate procedure that allows it mainly on the grounds of threats to the mother’s life.

Deaths from unsafe abortions account for nearly a third of maternal mortality in Zambia, with girls and young women particularly at risk.

What attracted attention to Marie Stopes was a report it submitted to the Ministry of Health. It showed that between January and May this year, it conducted 490 abortions in the northern part of the country.

The administration labelled them “detrimental” because they were carried out “illegally”. Under the law, an abortion has to be certified by three doctors. The administration said Marie Stopes was not observing that requirement and was instead carrying out abortions based on “social reasons and conditions or merely on the basis that the pregnancy was unwanted”.

This was a violation of the law and the NGO had to comply with the suspension order. The provincial police chief was instructed to investigate and prosecute those involved. The NGO would not comment on the ban because the decision had not been officially communicated to it.

The Marie Stopes mandate is clear. Part of its “core business” is to prevent unsafe abortions worldwide. By increasing people’s ability to access sexual and reproductive health services where they live, it aims to help the 215 million women in the developing world who do not have access to modern forms of contraception.

It is part of the worldwide effort to reduce the 20 million unsafe abortions – about 6.2 million of which are performed in Africa – and prevent the 358000 maternal deaths that occur each year.

Studies show that almost all unsafe abortions – 98% – occur in communities with limited resources.

In Zambia, Marie Stopes takes the view that the procedure can be carried out legally, except that the shortage of medical staff virtually precludes the possibility of three doctors authorising it.

The organisation has insight into the Zambian problem: “Unsafe abortion is a major issue here in Zambia. And the consequences are devastating for our young women.

“The Ministry of Health estimates that it is the cause of nearly one-third of maternal deaths in the country, with young women particularly at risk,” wrote Dr Stephen Mupeta, clinical services manager for Zambia in a case study.

Mupeta observed that this was a paradox because “in Zambia, we have some of the most liberal abortion laws in Sub-Saharan Africa.

“Speak to anyone, however, and you begin to piece together the complex set of reasons that make so many women risk their lives to end unwanted pregnancies.

“You hear how many women don’t realise the procedure is legal. You hear about providers’ prejudices that mean women aren’t always offered the services they should be – even women who get the courage to go to a health centre for a safe abortion can be turned away by providers due to personal beliefs,” he wrote. “The stories are shocking: cassava roots, sticks and wire hangers forced into a woman’s uterus; herbs and poisons ingested; and women who have thrown themselves down stairs or attempted other physical injury.

“Women and girls go to extraordinary lengths in an attempt to end pregnancies in secret. Often they know how risky it might be, but they do it anyway.”

Marie Stopes wants to prevent unplanned pregnancies and tackle barriers to accessing safe services.

According to the NGO, it averted 1900 unsafe abortions and 6500 unintended pregnancies in Zambia last year.