Doctors campaign for safe abortion in Zambia

SALLY CHIWAMA – WNN Features

United Nations Population Fund (UNFPA) Representative Deji Popoola said (in 2006) teenage pregnancy has become a crisis in Zambia

WNN Zambia: Selina’s gullet (where food passes) is constricted, burning and on fire. An opening has been created in her stomach in an effort to feed her because food and water cannot pass through the gullet. Next, she must undergo an operation to fix what’s left of her stomach. She must have another operation to take out her uterus as well because the dead fetus inside her is rotting in her womb.

At first glance it’s not easy to get the connection between a woman’s gullet and her uterus. But this is what happened to 25 year old Selina Mwendakula in a bid to terminate a 4 month unwanted pregnancy.

Although she is married with three other children, Selina did not want to carry the responsibilities of a fourth child. We think that all mothers should want their children. But conditions of desperation mark another choice. In desperation, Selina opted to terminate her pregnancy. To do this she took part in a personal ritual that almost killed her. She did two things. She drank battery acid in an effort to miscarry. And if this wasn’t enough, she also pushed an object painfully through her vagina and into her uterus in hopes for a speedy and uncomplicated miscarriage. But the miscarriage didn’t happen. And it wasn’t uncomplicated or speedy.

Selina is only one of hundreds of daily women admitted to the gynecology department at the UTH – University Teaching Hospital in Zambia’s capital, Lusaka. According to a 2004 report by the World Health Organization, “an estimated 68,000 women die as a consequence of unsafe abortion.”

Women in Zambia who resort to terminating their pregnancies with untrained abortion providers put their health and their life at serious risk.

Each day the gynecology department receives more than 200 cases of attempted self-inflicted abortion. 30% to 50% of the hospital beds in the GYN emergency ward are now dedicated to abortion related health service.

Lying in the emergency center at UTH, Selena wished deeply she had never tried to abort her child. “God has given me a second chance,” she said. Even with this wish, she knows that if her pregnancy had continued she would have never been able to find a home for her child. The hard facts today in the ongoing crisis of AIDS orphans in Zambia has raised the fear level on adoptions, causing many “outside of family” adoptions to come to a complete standstill.

“Mwandi mummy, if I hadn’t attempted this now it would have been a different story,” she said. “You wouldn’t be talking to me. Look at me. I’ve lost so much blood. Elo ichi chapamukosi (gullet) kaya (My uterus has been removed. I have nothing left),” said Selina in broken sobs.

“In addition to acid, I pushed a casaba stick through my vagina in hopes of perforating my uterus,” she said looking away.

Other women try sharp glass or wire for the same reason. In Zambian society desperate women, without access to standard reproductive healthcare, use the only desperate means they have available to make themselves infertile.

At a March 2009 conference held at the Pamodzi Hotel, doctors from Lusaka’s University Training Hospital gathered to discuss abortion, specifically safe abortion.

They met with Dr. Victor Mukonka, spokesperson and director of Public Health and Research at Zambia’s Ministry of Health, to discuss the issues surrounding safe and unsafe abortion in Zambia. “Abortion is a significant contributor to high maternal mortality in Africa, including Zambia,” said Dr. Mukonka opening the discussion.

Banner sign for a traditional healer in Nkumba, Zambia.
Banner sign for a traditional healer in Nkumba, Zambia.

Unsafe abortion for African women, especially those in Zambia, is one of the major causes of maternal mortality. The issue is controversial spanning reproductive rights and women’s rights in all African countries including Zambia. Because of the social stigma associated with abortion, the issues surrounding it are usually not discussed. Rights and laws are left to the doctors and lawyers and not to the women, even though more than half of the global deaths from unsafe abortion occur in Zambia.

Risks are greater here than anywhere else in the world.

“Abortion has always been an emotive issue,” said Dr. Mukonka. “It is important to remember that a lot of women are either dying or are suffering complications.”

The suffering can be vast. Every women who faces a decision to abort faces the possibility of death from poisoning by herbalists or from quack doctors who often work under very unsanitary conditions. Women can be their own greatest enemy, too, as they try anything they can, including drinking acid, to miscarry.

According to Dr. Mukonka, unsafe abortion in Zambia today contributes to 30% of all maternal deaths. With this, the imperative to stop women from dying unnecessarily has been an ongoing part of Zambia’s legislative attempt to follow The UN Millennium Development Goals, an international campaign which calls for specific programs that will, hopefully, help lift women out of poverty.

“Thousands of women die in African countries every year because they have no access to safe services,” said scheduled speaker, Dr. Eunice Brookman-Amissah, Vice President of Ipas Africa, an international advocacy group for women working to reduce abortion related death and injuries.

On reproductive choice, women in Zambia often face a solitary hardship in their home-life relationships when their husbands refuse to use condoms. “Women in Zambia have little power in sexual negotiation with their husbands,” quotes a 2003 University of California analysis report. Unwanted pregnancy is common. Making a life choice between buying food or birth control pills has an obvious answer. Because of society, fear, tradition and needs, many births still occur completely outside of medical supervision.

“The Ministry of Health is taking firm and steady action on maternal death,” continued Dr. Mukonka. “We are optimistic that time, along with the involvement of private/public partnership, will yield positive results to eliminate the unnecessary death of women from unsafe abortion. It should be noted that safeguarding women’s reproductive health is one of the key national health priorities, which is now (finally) receiving its due.”

In Lusaka, nearly 40% of all pregnancy related cases at UTH are related to problems of pregnancy rather than childbirth. 27% of these complications were for non-medical or self-inflicted abortions. Many abortions are still happening in Zambia with the help of  local traditional healers who know next to nothing about safety and sanitary procedures. Some of these healers actually suggest dangerous life-threatening procedures for women who are desperate to rid themselves of the looming life struggles involved with their pregnancy.

“Access to safe abortion is essential to human rights and to the health and lives of women,” said Dr. Brookman-Amissah. “Lack of access to effective contraception, stigma around abortion, gender inequalities, archaic colonial laws and ignorance among policy makers,” contributes to women seeking self-abortions and other unsafe procedures.

From 1982-1983, only 15% of all maternal deaths at UTH were due to clandestine illegally induced abortion. Recent studies in Zambia show that abortion is now listed among the top of five causes of death for women who are pregnant. Even with these frightening figures, condom use, within marriage or other consensual unions, to prevent pregnancy is very low

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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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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©Women News Network – WNN 2009