Safe or unsafe abortion: which way?

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The Northern Province administration July 21 ordered the international reproductive health NGO, Marie Stopes out of the province and further, ordered police investigations into the 960 abortions that the NGO had reported to the Ministry of Health as having carried out in the area.
Permanent Secretary Emmanuel Mwamba said the abortions were illegal because contrary to the law they were carried out on the basis of social conditions or simply because the pregnancy was unwanted. The law required that an abortion be recommended by three different doctors on the basis of a threat to the mother’s life.
The administration said that the Marie Stopes abortions were therefore not only misplaced but a violation of the law. They had to stop forthwith and should be the subject of police investigations.
Several women’s interest groups have decried the decision because it can only force women to seek the deadly alternative-unsafe abortion.
But now even the Ministry of Health has endorsed the Northern Province position. Minister of Health Joseph Kasonde July 25 concurred that Marie Stopes had conducted illegal abortions under the authority of one instead of three medical doctors.
The decision did however still pose the urgent question of whether simply reading the riot act and ordering the NGO out in the name of the law could be the appropriate public interest reaction to what is already a serious public health problem in Zambia.
Ministry of Health statistics show that unsafe abortions account for fully one third of maternal deaths in Zambia and that it is girls and young women who are most at risk as they seek to terminate precisely for “social reasons” including simply that the pregnancy is unwanted.
Without clear information on the legal way out, they have taken matters into their own hands and sought to terminate by means that endanger their lives. Many have died and some have survived but with permanent disability. Unsafe abortions have exacted a heavy toll in young lives and there is still no let-up.
Reports continue of foetuses that are dumped on rubbish heaps in scandalized communities and there is also that recurrent but shameful story of dogs sometimes feeding on them.
These abortions are driven by desperation and even with the many deaths as a result young women never stop trying to terminate pregnancies by dangerous means  and yet the a procedure that can be carried out safely and is at least nominally legal in Zambia .
A Marie Stopes case study of the situation had this to say about the current state of play:
“The stories are shocking: cassava roots, sticks and wire hangers forced into women’s own uteruses; herbs and poisons ingested; and women who’ve 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.”
There is prejudice even among health providers. Stories abound of young women who through sheer neglect have bled to death even in medical institutions because the operatives consider the problem “self-inflicted” and therefore not really worth of attention.
Even women who summon the courage to go to a health centre for a safe abortion are known to have been turned away because the providers believe it is “sinful” or have other personal beliefs against abortion.
There is a strong case for a more open and realistic approach to the matter. The “dodgy” approach is not working and has led only to an accumulation of deaths. Safe abortions will save lives and end the unnecessary carnage.
This is the avenue that Marie Stopes who have been sent packing by the “vigilant” provincial administration offers –safe abortion which ensures that there is no damage and above all that the patient survives to live a normal life and have children at a more opportune time.
It is part of a worldwide effort to prevent unplanned pregnancies and to tackle the barriers that prevent women from accessing safe services. For, even worldwide, unsafe abortions unerringly exact a toll. Globally, deaths related to unsafe abortion constitute an estimated 13% of maternal mortality. Approximately 6.2 million unsafe abortion procedures are performed in Africa, 10.8 million in Asia, and 4.2 million in Latin America and the Caribbean each year.
In Zambia, Marie Stopes has an education campaign in communities about family planning and runs safe abortion services using modern, internationally recognized methods that are recommended by the ministry of health standards and guidelines.
Demand for the services is high and could be higher still if a more open policy was adopted and there seems no alternative in view of the carnage wrought by the present approach.
What Zambia needs is to weigh more critically the pros and cons of the matter. Safe or unsafe abortion should be a central point of focus.
It doesn’t seem the case that expulsion of safe abortion providers or criminalizing their effort can ever be in the country’s best interests. There is a need to be met and the non- open availability of the required services drives young women to desperation.
It seems to be time for more cohesive interaction with interest groups to reach an approach that will address the present carnage, to try and look the other way or merely score technical points will not do.
There are lives at stake and it makes little sense to chastise those who may be leading the way to the only destination that rational thought will lead everybody sooner or later.

By Our Correspondent



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Start: 2019-07-01 End: 2019-07-31