Human rights activists in Malawi have urged authorities to enact new Termination of Pregnancy legislation following revelations that 141,000 abortions occurred in the southern African nation in 2015.
According to research conducted by the US based Guttmacher Institute and the Centre for Reproductive Health at the University of Malawi's College of Medicine, the majority of the abortions were performed under clandestine and unsafe conditions and most of them resulted in complications.
Commenting on the development during the dissemination of the research findings in Blantyre on Thursday, veteran human rights activist Emma Kaliya said it was a pity that systematic discrimination of women continues despite the government signing many treaties.
"The statistics disseminated here are startling. It is a pity that women in Malawi continue to die from unsafe abortions and suffer in various ways despite government making commitment in the Constitution and through international treaties to ensure that women enjoy their sexual and reproductive health rights," said Kaliya.
She said that the issue of abortion in Malawi was a class issue as rich women and girls are able to access safe services in private clinics while poor women in the rural areas are the ones who resort to unsafe means to terminate unintended pregnancies.
Speaking at the same meeting, Centre for Solutions Journalism executive director Brian Ligomeka wondered why men who do not get pregnant are on the forefront of opposing abortion law review.
"Abortion mostly affects women and girls. Why is it that men who do not get pregnant and do not even bear the pain of childbirth are on the forefront of opposing abortion law review? Why don't men give women their freedom to make choices about their bodies?" questioned Ligomeka.
He added: "This business of making laws that govern the wombs of women when they are no laws that govern the anatomies of men is a human rights violation. Let women make decisions that affect their bodies freely and independently."
Ligomeka said Malawi had already made progress by drafting a new legislation that offers and guarantees women's right to access safe and legal termination of unwanted pregnancies.
"What is needed now is to take the draft law to Parliament. The beauty with the new law was that religious leaders had their input as some of them were commissioners of a special law commission which Malawi Government empanelled to review abortion law."
A Special Law Commission which included representatives from the Roman Catholic Church, the Evangelical Association, the Muslim Association and the Malawi Council of Churches drafted the yet-to-be passed Termination of Pregnancy Bill.
Besides the religious leaders' representatives, other commissioners who took part in drafting the Termination of Pregnancy Bill were from the Ministry of Health, the Judiciary, the Law Society, the Ministry of Justice and University of Malawi.
Meanwhile Simon Sikwese, executive director of Pakachere Institute of Health and Communication has urged various stakeholders to use the evidence which the researchers have disseminated to debate the issue soberly.
"A credible research on the issue of abortion has been made and the findings have been disseminated. It is now time for various stakeholders to use the available data in tackling the problem which is killing many women in Malawi," said Sikwese.
The new research has revealed that in 2015, an estimated 60 percent of women who had an abortion experienced complications that required medical treatment in a health facility.
"Our study found that in 2015, more than half of all pregnancies in Malawi were unintended, and almost one-third of those unintended pregnancies ended in abortion," said Dr. Chelsea Polis, senior research scientist at the Guttmacher Institute and lead author of the study.
She added: "Helping Malawian women avoid unintended pregnancy is critical to reducing the incidence of abortion and the complications and deaths that often follow unsafe, clandestine procedures,"
The study co-author Dr. Chisale Mhango, a senior lecturer at the University of Malawi's College of Medicine said unsafe abortion is one of the major causes of maternal death in Malawi.
According to recent estimates, complications from abortion are the cause of 6-18 percent of maternal deaths in Malawi.
"Restrictive abortion laws do not stop abortion from occurring, they just drive it underground, forcing women to resort to clandestine procedures, which are often unsafe... Addressing unsafe abortion is an urgent public health priority," observes Mhango.
Malawi's maternal mortality ratio remains one of the highest in the world--574 maternal deaths per 100,000 live births in 2014--and maternal deaths present a major public health challenge for the country.
The majority of induced abortion procedures in Malawi are performed under clandestine and unsafe conditions. Complications from abortions have been estimated to account for between 6 and 18 percent of maternal deaths in Malawi.
Abortion is only legal in Malawi to save a woman's life. Obtaining an abortion for any other reason is punishable by 7-14 years in prison.
A national debate is currently under way on whether or not to liberalize Malawi's abortion law by providing more exceptions under which an abortion could be legally obtained.
In Malawi, an estimated 141,000 abortions were performed in 2015. This number translates to a rate of 38 abortions per 1,000 women aged 15-49.
Within Malawi, abortion rates vary widely by region, from 29 per 1,000 women in the Central region to 61 in the Northern region.
In Malawi in 2015, 39 percent of pregnancies ended in planned births, 30 percent in unplanned births, 16% in abortion and 15 percent in miscarriages.
Malawi's abortion rate is similar to other countries in the region, including Tanzania (36 per 1,000 women) and Uganda (39), as well as to the regional rates for Eastern Africa (34) and Southern Africa (35).
A 2009 study estimated a substantially lower abortion rate in Malawi than the new estimated rate for 2015. Due to several methodological differences between the two studies, it is not possible to infer a trend on the basis of these two studies.
Out of the estimated 141,000 abortions performed in Malawi in 2015, approximately 60 percent resulted in complications that required medical treatment in a health facility.
An estimated one-third of the women who experienced complications from an abortion did not receive the medical treatment they needed.
The annual treatment rate for complications from abortion was estimated to be 14 per 1,000 women aged 15-49 in 2015.
A 2009 study estimated that more than one in four women who reached a health care facility for postabortion care had severe or moderate complications.
The majority of Malawi's postabortion care cases are treated at district hospitals (35 percent), health centers (22 percent and clinics (20 percent).
Treating complications of unsafe abortion represents a significant financial burden for the national health system in Malawi. A 2009 study estimated that a liberalized abortion law and access to safe abortion in public health facilities would yield a 20-30 percent decrease in postabortion care costs for the health system.
The researchers have made several recommendations including the need for Malawi to upscale family planning programmes with the aim of reducing the number of unintended pregnancies.
Another recommendation is that government should expand postabortion care services so that every woman who experiences complications from an unsafe abortion can get the care she needs. "Improving postabortion care services requires investments to adequately staff facilities, supply the appropriate equipment and medication, and train staff in how to provide postabortion care according to World Health Organization guidelines," says the report.
On law reform, the research has recommended that policymakers discussing Malawi's abortion law should consider the full range of available evidence on maternal deaths and injury in order to expand "access to safe abortion care."
While health workers, activists, moralists and religious fanatics are busy debating the issue in boardrooms and in the media, the sad part is that one in 29 girls at the age of 15 dies from a pregnancy-related condition.
According to reproductive health journalist Chembezi Mhone, when a girl or a woman makes up her mind to terminate her pregnancy nothing - not even the law or religious teachings - can stop her. If the hospital denies her access to safe abortion, she ends up seeking backstreet abortion whose complications would see her return to the same hospital that denied her safe abortion to receive post-abortion care.