Doctors campaign for safe abortion in Zambia

Mpongwe Hospital clinic for mothers. Image: Kathleen Paulson

“Very few people are aware, however, that termination of pregnancy is provided for in the laws in Zambia,” said University Teaching Hospital staff obstetrician and gynecologist, Dr. Ameck Kamanga.

Since 1972, Zambia has pushed through some of the most liberal reproductive rights laws in sub-Saharan Africa, as procedures of abortion have been legalized for health and social-economic reasons. But unsafe complications continue to be a major health problem for Zambian women who continue to seek alternative solutions to their pregnancies.

Abortion procedures at UTH are not always easy for the patients. Hospital policy restricts use of pain killers due to the costs, which causes women to go through severe pain in the process. Even with the pain, there is no shortage of patients at University Teaching Hospital.

“The public has to understand that even if Zambia was a rich country and all was available, unwanted pregnancies would always occur and when such a thing happens, a woman should be given a choice.” said Dr. Kamanga.

“Women of all nationalities and social standing, rich or poor, married or single, educated or uneducated, young and old, with or without children have abortions and have always had a need for terminating an unwanted pregnancy,” added Ipas director Dr. Brookman-Amissah.

Many women patients come to the hospital for the first time after someone they knew lost their health or died from a self-inflicted or unsafe abortion.

“A lot of women have died at the hands of ‘self styled experts’ who perform abortions in the back streets,” said Dr. Stephen Mupeta, a GYN intern at UTH. “These ‘experts’ come in all forms – elderly women, clinical officers, and even doctors who are out to make a quick buck. We offer our services with access to safe abortion almost free, but most people are unaware of this service.”

“It’s a pity that most of them come in (to the hospital) almost too late, after they’ve attempted to terminate (their pregnancy) on their own, as infections start to get septic and start to affect other parts of the body,” said Dr. Kamanga.

In Zambia the process called “termination of pregnancy,” also known as TOP, is a specialized procedure done only by specifically trained health care providers. These providers include doctors, mid-wives, clinical officers and nurses. In Zambia however, only licensed medical doctors are allowed to be in charge of a TOP procedure.

“I would like to emphasize that no matter who the health care provider is as long as they are not trained in termination of a pregnancy, they will not provide a safe abortion,” outlined Dr. Mupeta.

The GYN department at the University Teaching Hospital in Lusaka’s “unsafe abortion” cases make up a surprisingly large 30% of all cases at the hospital. These cases span from women who have taken an over dose of chloroquine, to others who have used a life threatening amount of herbs in their vagina, many come to the hospital very close to death. Still others die before they arrive after drinking such dangerous liquids as battery acid, all in the name of acquiring what should be a safe medical abortion.

Most women don’t want to talk to anyone about their procedures. They want to keep quiet on their decision to have an abortion. Even with liberal laws on abortion in Zambia, abortion is seen in society as something that should be kept invisible and unseen. After the abortion procedure is over the suffering is not. The suffering of women to decide the number of children they birth or not stays as a wound of consciousness in their hearts and souls.

Doctors working with safe abortion in Zambia have one thing in common. All of them want to see health care and TOP providers getting access to the training they need. Safety in abortion can save lives.

“People should be aware that they shouldn’t just go to anyone to get this service,” said Dr. Mupeta.

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[YouTube=http://www.youtube.com/watch?v=M1z1rdnaPVA?rel=0]

The impact of the Global Gag Rule on reproductive health programs in Zambia has been devastating to women. At a time when one in five adults is infected with HIV and nearly 70 percent of the population is under the age of 24, the gag rule has deprived Zambia’s primary family planning agency of critical U.S. assistance. This video is a Population International production. For more information go to: www.population.org

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For More Information on this topic –

- “Insuring Women’s Access to Safe Abortion”
Ipas Publications, March 23, 2009

- “Abortion as a Public Health Problem in Zambia” – Peter Sims
Journal of Public Health Medicine, 1995

- “Reproductive health in the news”
IPAS, April 2009

- “(un)Safe Abortion – A Review and Discussion Paper” – Siegrid Tautz
GTZ Worldwide with BMZ – Federal Ministry for Economic Cooperation and Development, Nov 2004

- “Global Agendas, Health Sector Reforms and Reproductive Health and Rights: Opportunities and challenges in Zambia” – Priya Nanda
Center for Health and Gender Equity
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Sally Chiwama, Women News Network – WNN correspondent and gender specialist reports from Mporokoso, Zambia. For her Aug 2008 WNN story feature, “When a Girl Child Stands Up and Wins,” Sally won a UNESCO and Internews Europe award, the Every Human Has Rights Media Awards, sponsored by The Elders, Internews International and The Global Forum for Media Development. As part of the Zambia Media Women Association (ZAMWA) Secretariat, Sally has represented ZAMWA in Kenya, Ethiopia and South Africa. In Oct 2008, she had a chance talk to women patients of Lusaka’s International Teaching Hospital for this story.

WNN founder/editor, 2007 Pushcart prize nominee, Lys Anzia, is a humanitarian journalist working on women’s rights and advocacy issues worldwide.
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Additional sources for this article include The Journal of Public Health, Oxford University, Ipas – Africa Alliance for Women’s Reproductive Health and Rights, World Health Organization, AIDS Policy Research Center – University of California, NPR NC Public Radio and University of Zambia Medical Library
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