LUSAKA, ZAMBIA – Nancy, 21, who requested to go by her middle name to protect her privacy and her family, says she almost died after undergoing an illegal and unsafe abortion recently.
Nancy, who resides in the Kaunda Square area of Lusaka, Zambia’s capital, became pregnant after her stepfather raped her on several occasions. In October 2011, Nancy found out that she was pregnant. She says she wanted to terminate the pregnancy because she was scared her mother would chase her out of their home if she found out.
Nancy says she first tried to terminate the pregnancy herself by taking a mixture of medications.
“But I was not sure if they would work,” she says. “So when I was close to two months pregnant, I went to a place somewhere near home that a friend in the neighborhood told me about.”
With teary eyes, Nancy says she obtained an illegal abortion from a “quack” in the small room of a house not far from her home. Quack is the local term for practitioners of illegal abortions.
A few days after the abortion, Nancy started feeling excruciating pain in her lower abdomen. When she could no longer endure the pain, she went to a reputable clinic to receive treatment.
She has recovered physically but is still coping with the emotional pain.
“I feel so bad about having had an abortion,” she says. “But I had to.”
Nancy says she refuses to report her stepdad for raping her because it would cause too many complications in her family. Instead, she has moved to her aunt’s house because she is still traumatized from the experience.
Abortion is legal in Zambia in certain circumstances under an act that is considered liberal regionally. But international organizations and local activists say that there are still many barriers to obtaining a legal and safe abortion, leading to injuries and sometimes death for pregnant women who seek procedures from illegal practitioners. Meanwhile, others say abortion should never be legal in a Christian nation such as Zambia. Various nongovernmental organizations are working to provide sexual and reproductive health information and services, especially to youth.
A 2011 report for the U.N. Committee on the Elimination of Discrimination Against Women conducted by the Center for Reproductive Rights, a nongovernmental organization dedicated to universal reproductive freedom, alerted the committee to “the continuing high rates of maternal mortality and morbidity, particularly due to deaths and disabilities resulting from unsafe abortion that occur in spite of Zambia’s comparatively liberal abortion law.” The report attributes 30 percent of maternal deaths in Zambia to unsafe abortion.
About 600 women obtained legal and safe abortions from 2003 and 2008 in Zambia, while 52,800 women were admitted to hospitals with abortion-related complications during the same period, according to research conducted in 2009 by the Department of Community Medicine at the University of Zambia using data from five major hospitals in the country. Moreover, the data showed an increase in complications from unsafe abortions over the years, with nearly double the women admitted for complications in 2008 than in 2003.
Namuchana Mushabati, a legal officer at the Zambia branch of Women and Law in Southern Africa, a research and educational trust, says that the country’s Termination of Pregnancy Act, sometimes called the TOP Act, gives pregnant women in precarious situations access to safe and legal abortion services. She says its existence likely reduces the number of women who suffer complications from unsafe abortions, such as severe bleeding, perforation of the uterus and intestines, damage of the genital tract, infections, infertility and even death.
The Termination of Pregnancy Act, which was enacted in Zambia in 1972 and amended in 1994, deems abortion legal in Zambia under certain conditions. These conditions include: when the pregnancy would risk the life of or could injure the physical or mental health of the pregnant woman or of any existing children greater than if the pregnancy were terminated or when the child would be born with a serious mental or physical disability.
The abortion must be approved by three medical personnel – including one doctor who is a specialist – and performed in a clean, safe and registered environment by a registered medical practitioner. The only exception is when it is an emergency in terms of the pregnant woman’s life or health. The woman must also choose to have an abortion in a free and informed manner without coercion.
Edford Mutuma, executive director of Planned Parenthood Association of Zambia, a nongovernmental organization that offers sexual and reproductive health services, says that seeking an abortion from trained personnel in a clean environment reduces the risk of maternal mortality. He says it also lessens the chance of complications that can result from unsafe abortions, ranging from excessive bleeding to depression.
Still, several aspects of the law are unclear. The act does not mention whether an abortion is legal when the pregnancy results from rape or defilement. But according to the Ministry of Health’s Guidelines on Legal Safe Abortion in Zambia, abortion services are permitted for women who have been raped and minors who have been defiled if they are able to provide proof. Minors must also have their parents’ or guardians’ consent.
Mushabati says that otherwise, abortions are illegal in Zambia. She says that the penalty for performing or undergoing an illegal abortion is seven years in prison.
Zambia has one the most liberal abortion laws in sub-Saharan African, according to a U.N. report. Still, safe and legal abortion remains largely unavailable, a 2006 World Health Organization report notes. Even with the Termination of Pregnancy Act in place, women in Zambia fail to access safe termination of pregnancy services because of several barriers.
Barriers include a lack of access to correct information about sexual and reproductive health rights, stigma from society, negative attitudes by providers at health centers and poor-quality services, according to Youth Vision Zambia, a nongovernmental organization that advocates for sexual and reproductive health care and rights for youth.
Nancy says that if she had known she could have obtained a safe and legal abortion as a victim of rape, she would have sought one at a registered center instead of from a quack. Nancy says she only recently learned this – as well as about the existence of the act in general – while listening to an educational radio program on health.
Mutuma says Nancy’s is not an isolated incident.
“Even with the TOP Act of 1972 in place,” Mutuma says, “women in Zambia still fail to access safe termination of pregnancy services because they are not aware of the TOP Act of 1972, because services are not readily available in all health facilities, fear of stigmatization and objection by service providers to offer the services due to several factors, such as religious beliefs and personal [conscience].”
Another barrier is clear information on the circumstances under which abortion is legal, as information varies from source to source. The Ministry of Health found in 2008 that many health providers even weren’t aware of the requirements for legal abortion, according to a report by the Guttmacher Institute, a U.S.-based institution that researches sexual and reproductive health.
In addition to making the law clearer, others say that the government needs to revise certain parts of the Termination of Pregnancy Act in order for women to use its provisions effectively.
Rhoda Beupe, a young women’s rights activist, says the act’s requirement of three doctors’ consent is unrealistic because there is a shortage of doctors in most parts of the country.
“If the requirements stipulated in the laws of Zambia for one to obtain safe abortion services are too stringent, then definitely a lot of women will go to the quacks, where they can secretly get unsafe and illegal abortion services,” Beupe says. “So I really think certain areas of this law need to be revised.”
On the other hand, others say the act should be abolished because abortion should not be legal under any circumstances.
Ronald Makumbi, pastor of Divine Pentecostal Church in Lusaka, says the Termination of Pregnancy Act contradicts Zambia’s values as a Christian nation because the Bible does not permit the termination of life.
“I am not aware about this law, and I don’t want to say much about this issue because you know the Bible says, ‘Thou shall not kill,’” he says. “This means no one’s life should be terminated, even the life of an unborn baby.”
He says biblical law is higher than federal law.
“The Bible is the supreme law that no one can question, and I don’t understand why Zambia as a Christian nation would have a law that permits safe abortion when abortion is an unchristian act,” he says.
Margaret Mitaba, youth field program officer for the Society for Women and AIDS in Zambia, a grassroots organization, says solutions must address the root of the problem – the high rate of unintended pregnancies, which leads to the high rate of unsafe abortions. She attributes these pregnancies to women’s lack of access to family planning services and accurate information about sexual and reproductive rights.
“Many women in Zambia are unable to obtain family planning services due to a number of factors,” she says, noting long distances to health services in rural areas and cultural and religious beliefs that discourage women from accessing family planning services as some of the primary factors. “This results in unintended and unplanned pregnancies, unsafe abortions and increased deaths due to pregnancy-related complications.”
Chilambe Katuta, director of programs at Youth Vision Zambia, says that the organization is dedicated to providing correct and consistent information on sexual and reproductive health, including abortion, in order to reduce deaths from unsafe procedures. He says Youth Vision Zambia conducts community dialogue sessions in various communities within Lusaka on the dangers of abortion and the need to prevent unintended pregnancies.
“We have also translated the TOP Act of 1972 into local languages so that the people at the grassroots are able to understand the provision of the Zambian law on abortion in their local language,” he says.
Amos Mwale, executive director at Youth Vision Zambia, says the organization’s new text messaging project will complement government efforts to address young people’s sexual and reproductive health rights and needs. Zambians can now text 4391 on all mobile networks operating in Zambia to request information on sexual and reproductive health from trained counselors, who pledge to respond within 24 hours.
