The cost of silence: How Malawi’s restrictive abortion laws are endangering lives

By Rosalia Kapiri

Lilongwe, November 23, Mana: A few months after delivering her third child, Margaret Kawala of Traditional Authority Dzoole in Dowa District discovered she was pregnant again. The news filled her with despair. After discussing it with her husband, the couple sought an abortion at a nearby hospital. However, healthcare workers declined, citing fear of legal repercussions.

Desperate and without options, Kawala turned to a herbalist for an unsafe abortion.

“I had no choice but to seek help from a herbalist who gave me a concoction. It was a decision my husband and I made together,” Kawala recounts.

She continued to narrate that a few hours after taking the herbal mixture, she began experiencing excruciating pain.

“It felt like a grinder was cutting through my womb. I started bleeding heavily and eventually lost consciousness,” she says.

Her relatives rushed her to a private hospital, where her condition was deemed so severe that she was referred to Kamuzu Central Hospital.

“I had lost so much blood, and the doctors told me my womb was damaged. The only solution was to remove my uterus. It was heartbreaking to learn I would never give birth again,” she recalls tearfully.

Her suffering didn’t end there. A year after her uterus removal, her husband left her, saying he wanted more children, a possibility she could no longer offer.

Kawala’s story mirrors the pain of many Malawians, including widower Humphrey Zembeni from Kamwana Village in Lilongwe. Zembeni lost his wife after an unsafe abortion. Despite being on contraceptives, she fell pregnant with their seventh child.

“We weren’t ready for another child, so we sought help from a traditional healer,” Zembeni explains.

“The concoction caused severe bleeding, which resulted in a punctured uterus and internal injuries. Tragically, these injuries led to her death.

“It is Malawi’s law on abortion that killed my wife. That law is a killer and should be repealed,” Zembeni laments.

According to a 2017 report on the Incidence of Induced Abortion in Malawi, unsafe abortions contribute to 18 percent of maternal deaths in the country.

Coalition for the Prevention of Unsafe Abortion (COPUA) Vice Chairperson, Dr Amos Nyaka, explains that the problem has worsened over time.

“From 2009 to 2015, the abortion rate was 23.5 per 1,000 women aged 15 to 45. By 2022, this figure rose to 38 per 1,000 women,” says Dr. Nyaka.

A 2015 study by the Guttmacher Institute and Malawi’s College of Medicine revealed that over 140,000 women and girls induced abortions that year.

Dr. Nyaka further notes that most women seeking abortions in Malawi are married.

“Malawi’s abortion law permits termination only when the life of the pregnant woman is at risk. However, you cannot stop someone who has decided to terminate a pregnancy, leading them to unsafe methods,” he adds.

Data from government health facilities showed that in 2022 alone, over 36,000 women and girls sought post-abortion care from government hospitals due to complications from unsafe procedures.

Nyaka notes that this places a significant burden on healthcare resources that could be used for other priorities, underscoring the potential benefits of legalizing safe abortion in the country.

At the request of the Ministry of Health, a special Law Commission reviewed the Penal Code provisions related to abortion, and in 2015 proposed the Termination of Pregnancy (ToP) Bill .

The bill included other four permitted grounds for terminating pregnancy namely; pregnancy would be allowed to be terminated if it would endanger the life of the pregnant woman, prevent injury to the physical and mental health of the pregnant woman, there is severe malformation of the foetus so that it cannot survive after birth and finally if the pregnancy is a result of rape, incest or defilement.

However, despite these guidelines for the termination of pregnancy, there has been resistance from religious groups, as well as cultural, societal, and traditional communities.

Human Rights Lawyer, Chrispin Sibande, says people need to understand what the law says as not everyone has grasped the exact guidelines stipulated in the bill.

“There is need for mass awareness on this. The bill says termination of pregnancy shall not be provided because a woman demands the service but rather the health provider authorised by law to terminate pregnancy would determine whether the legal grounds for termination exist,” Sibande explains.

Sibande further explains that restrictive laws instil fear in women, discouraging them from seeking safe options for terminating a pregnancy and that this fear drives many to pursue secret and unsafe abortions, which significantly increase maternal mortality rates.

He also highlights that such laws contribute to stigma surrounding abortion, subjecting women to societal judgment, social isolation, and emotional distress.

COPUA Chairperson, Emma Kaliya notes that the law on abortion dates way back in the 1930s hence the need for review.

Kaliya says Malawi should protect the rights of women including allowing them to access safe abortions so that they can live in good health.

“Abortion is a challenging issue. Religious leaders should try to resolve the dilemma by letting the state do its work to protect the health of women,” Kaliya said.

Executive Director for the Centre for Solutions Journalism, Brian Ligomeka, commends the government for its efforts to reduce maternal mortality, including raising the legal marriage age to 18 and enacting the Gender Equality Act.

Ligomeka emphasizes the need to pass the ToP Bill, “When passed, this bill will significantly reduce unsafe abortions in Malawi,” he asserts.

At a media workshop in Lilongwe, Ligomeka urged journalists to cover sexual and reproductive health issues professionally, highlighting topics like fistula, abortions, and contraception to promote informed public discourse.

The stories of Margaret Kawala and Humphrey Zembeni underscore the urgent need for Malawi to reform its abortion laws.

Unsafe abortions continue to claim lives and devastate families. By legalizing safe abortion and increasing public awareness, Malawi can protect its women and reduce maternal deaths caused by unsafe procedures.

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