LILLIAN BANDA, Lusaka
ZAMBIA is said to have one of the most liberal abortion laws in Sub-Saharan Africa. The country’s law permits abortions to be carried out on wide range of health as well as socioeconomic grounds.
But if a snap survey conducted in Lusaka by this author is anything to go by, one can safely say there still remains a lot to be done to educate the public about the existence of Zambian abortion laws.
Most respondents expressed ignorance about the existence of legislation permitting the termination of a pregnancy on given grounds. A substantial number of them seemed to think that a health facility should be able to provide abortion services on request or as a favour.
“I do not know whether it is legal or not. But I think one can be assisted to have one if you convince personnel at a health facility. I hear they can use their discretion provided you agree to the terms,” said a 23-year-old woman.
“I hear there is a law that allows a woman to terminate a pregnancy only if her life is at risk. In that case, medical personnel are permitted to terminate that pregnancy,” said a 42-year-old man.
The few that are aware of the law, its provisions as well as guidelines, said it is favourable and progressive.
Recently, Centre for Reproductive Health Education (CRHE) had called on the general public to acquaint themselves with the provisions of the Termination of Pregnancy Act Chapter 304 of the Laws of Zambia, which is usually referred to as the TOP Act.
“How many people know that abortion is legal in Zambia? But these are things that people need to be aware of for them to make informed choices,” said CRHE executive director Amos Mwale.
“Abortion is very much legal in Zambia; but it has to be qualified. The only challenge is that currently, we do not have enough specialists to perform legal abortions as required by law.
“But the fact still remains that abortion services are needed because there are and will always be valid reasons for terminating a pregnancy.
“However, we are not sure how many people are aware of the law pertaining to the legal termination of a pregnancy, hence the need for education and awareness programmes around the TOP Act,” explained Young Men’s Christian Association of Zambia executive director Fredrick Chitangala.
Dr Chitangala was quick to point out that raising awareness on the matter could be seen as a way of encouraging women and girls to abuse the law.
“The idea is simply to let people know about the existence of the law and its provisions. Currently, we do not know how many people know, one has the right to terminate a pregnancy under certain conditions.
“There might be some that may try to take advantage and abuse it, such things are likely to happen. But that should not stop well meaning persons or establishments from educating the public about the existence of the TOP Act.
“It is an established fact that women and girls are needlessly dying in compounds and rural areas as a result of unsafe abortions. They are taking harmful concoctions and seeking the services of unqualified and unauthorised persons thereby putting their lives in danger,” Dr Chitangala said.
In Zambia, termination of a pregnancy is legally permitted if continuing a pregnancy poses a risk to the life of the pregnant woman, her physical or mental health or that of any of her existing children, greater than if the pregnancy were terminated, a child born of the pregnancy would suffer from physical or mental abnormalities as to be seriously handicapped.
The law requires three physicians’ consent to the procedure. One of the three physicians consenting to an abortion must be a specialist in the branch of medicine in which the patient is specifically required to be examined.  In emergency situations, only one physician’s signature is needed.
In 2009, the Ministry of Health produced standards and guidelines for reducing unsafe abortion, morbidity and mortality to help interpret this legislative framework.
It is important to note that induced abortion is only allowed under circumstances and conditions already alluded to under the TOP Act.
Section 151 of the Penal Code states that any person who, with intent to procure the miscarriage of a woman or female child, unlawfully administers to her or causes her to take any poison or other noxious thing or uses any force of any kind or uses any other means whatsoever, commits a felony and is liable upon conviction to imprisonment for a term not exceeding seven years.
And Section 152 of the Penal Code further says that any woman who administers any poison or noxious thing or uses any force of any kind or uses any other means or permits the same to be done commits a felony and is liable to imprisonment for 14 years.
However, Part II of Section 152 states that any female child being pregnant who, with intent to procure her own miscarriage, unlawfully administers to herself any poison or other noxious thing or uses any force of any kind commits an offence and is liable to such community service or counselling as the court may determine, in the best interests of the child.
This is on provision that where a female child is raped or defiled and becomes pregnant, the pregnancy may be terminated in accordance with the TOP Act.
Section 153 extends liability to people who supply to, or procure for, any person anything knowing that it is intended to be unlawfully used to procure an abortion.
It states that any person who unlawfully supplies to or procures for any person anything whatsoever, knowing that it is intended to be unlawfully used to procure the miscarriage of a woman or female child, whether she is or is not with a child, commits a felony and is liable, upon conviction, to imprisonment for a term not exceeding 14 years.
Because a lot of it is done secretly, many incidences of unsafe abortions go undocumented and figures are mainly estimates.
However, reports on abortions in Zambia suggest that despite having a law in place that permits induced abortion on given grounds, the majority of people are not aware of it.
The Zambian government estimates that 30 percent of maternal mortality is attributable to unsafe abortion. Unsafe abortion is also a significant cause of morbidity. There are no nationally aggregated data on the induced abortion incidence whether safe or unsafe. Abortion services are provided by facilities owned by government and non-governmental organisations in Zambia.
The World Health Organisation estimates that around 22 million unsafe abortions are said to take place worldwide each year, almost all in developing countries.
Unsafe abortion occurs when a pregnancy is terminated either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.
In 2008, there were an estimated 47,000 deaths due to unsafe abortion. Africa is disproportionately affected, with nearly two-thirds of all abortion-related deaths.
In developing countries, around five million women are admitted to hospital as a result of unsafe abortion every year, while more than three million women who have complications following unsafe abortions do not receive care.
The annual cost of treating major complications from unsafe abortion is estimated at US$680 million.
The United Nations further notes that almost every abortion related death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion, and timely care for complications.
In developed regions, it is estimated that 30 women die for every 100,000 unsafe abortions. That number rises to 220 deaths per 100,000 unsafe abortions in developing regions and 520 deaths per 100,000 unsafe abortions in sub-Saharan Africa.
Mortality from unsafe abortion disproportionately affects women in Africa. While the continent accounts for 29 percent of all unsafe abortions, it sees 62 percent of unsafe abortion-related deaths.