Stigma and bureaucracy drive maternal deaths

Parity Zulu, 17, constantly recited a Biblical verse asking God for protection from her persecutors while her mother ferried her to hospital following complications from the teenager’s illegal abortion.

Her mother, Margaret, was unaware that her daughter had paid K350,000 (US$74) for a back-street abortion three days earlier. “All the way to the hospital I asked my child what happened. She wouldn’t tell me. Then she began to sing Psalm 57, a cry for help. I began to suspect she was aborting a pregnancy,” she told IRIN.

At the hospital’s emergency admission desk, Zulu’s medical condition was immediately apparent to Nurse Serephina Moonde. “I can tell a botched abortion as they come in through the doors – on average I see up to ten new patients a day. Women and young girls coming in, bleeding – sometimes we can save them; other times, like in Parity’s case, it’s too late – their wombs are rotting and they have lost too much blood.”

Moonde said she had seen the results of the horrific methods women sometimes used to induce abortion: drinking crushed glass boiled with coca-cola, inserting crudely sharpened wooden sticks into the cervix, taking heavy doses of anti-malaria tablets, and even ingesting poisons such as battery acid.

Zambia’s maternal mortality rate of 591 per 100,000 live births is one of the highest in the world, according to the 2008 Demographic Health Survey (DHS), the most recent.

One-third of maternal deaths are thought to be the result of abortion, but a shocking statistic is that 80 percent of the women who die from abortions are under the age of 19.

Abortion law

The Zambian Termination of Pregnancy Act 1972 is based on British colonial legislation, which permits abortion when continuation of the pregnancy can be proved to be detrimental to the mother, or the child, or both.

The law states that those wanting a termination must seek the consent of three physicians, but this requirement may be waived, if the abortion is deemed an emergency, to save the woman’s life or prevent grave permanent injury to her physical or mental health.

In 2009 the University Teaching Hospital (UTH) in the capital, Lusaka, the country’s largest medical facility, recorded 5,295 abortions, of which 5,246 were a consequence of incomplete abortions; 31 women died as a result of complications.

Only nine terminations of pregnancies were performed at UTH in 2009, according to the provisions of the law, down from the 2008 figure of 126 legally performed terminations.

Dr Peter Mwaba, UTH’s managing director, told IRIN that the hospital was a place of last resort, and the statistics did not include women seeking help for complications from an abortion at other public or private clinics.

He said many women did not have access to effective contraception, and there were gender inequalities as well as deeply entrenched stigmas around abortion, which contributed to women practicing self-abortion or seeking other unsafe procedures. Women seeking to terminate pregnancies were also making use of the greater availability of a variety of drugs at pharmacies and private clinics.

It was the attempts to procure abortions this way [unsafely] that brought on the complications – it was basically guesswork, and that was why women arrived at hospitals “half dead”, he said.

Holo Hachoonda, a clinical director at the Planned Parenthood Association (PPAZ), told IRIN that many health practitioners did not understand the abortion law, and were reluctant to provide these services.

“People still do not see abortion as a right backed by law. They still also have not gotten used to the thinking that a woman has rights over her own body, and can make decisions about something like abortion,” he said.

Mary Beth Jones, 46, decided to seek an abortion after falling pregnant with her fifth child. At the clinic she was asked why, as a married woman who had no health issues, she wanted an abortion. Had she had committed adultery?

“They wanted me to tell my husband, go through couple counselling, etc. I also felt they were judging me, and I was afraid that there would be no confidentiality, as we were being lumped together like naughty children and lectured. I can imagine how horrible it must be for a young girl seeking an abortion,” she told IRIN.

Jones resorted to a herbal remedy from a traditional healer to induce a miscarriage. “I haemorrhaged so badly I ended up in hospital and had to have my womb removed. Needless to say, I am now a divorcee.”

Religious barriers

In an effort to improve the efficacy of the Act, in June 2009 the government launched the Standards and Guidelines for Reducing Unsafe Abortion Morbidity and Mortality in Zambia, for interpreting the 1972 legislation.

The guidelines provided for abortions to be performed in the interests of a women’s physical or mental health; nurse practitioners had been trained to provide medical abortions and first-trimester abortions; women no longer had to stay overnight in hospital after the procedure. Family planning services, including abortion services, have been extended throughout the country.

However, the biggest challenges to abortion are the deeply held religious views that think girls engage in sex when they should not, and see abortion as a sign of promiscuity.

Zambia’s more than 11 million people are predominantly Roman Catholic, but conservative evangelical churches have grown considerably in recent years; in combination these represent a formidable degree of social disapproval of terminating pregnancy.

Suzanne Matale, Secretary-General of the Christian Council of Zambia (CCZ), the Catholic Church’s mother body in Zambia, told IRIN that life began at conception. “There are no grey areas, no room for discussion. We condemn abortion. It’s an absolute no-no.”

Government spokesman Ronnie Shipakwasha, a Pentecostal church elder, told IRIN the abortion law would not be touched until there had been wide consultations with medical authorities, policy-makers and religious bodies.

He did not provide a timeframe, and there has been no call for this dialogue; he said the law, read in conjunction with the guidelines, was sufficient to ensure safe abortions.

“We just need to make this information available,” he said. “We are a Christian country, so the church’s teachings on morality are a major factor in how we deal with the issues of abortions.”

[IRIN]