VIOLET MENGO, Nchelenge
MONICA Mutambo of Kapepa village in Nchelenge district was the only girl in a family of nine.
She worked and was always a top student in her class; her desire was to become a lawyer.
Monica nurtured her dream passionately, so she continued to study hard.
The teachers at her school took particular interest in Monica’s studies and assisted her to achieve her dream of becoming a lawyer.
However, one fateful day on her way from school, she was attacked and defiled by an unknown man.
With little or no knowledge of where to go, Monica decided not to tell anyone about what had happened to her.
She only decided to go to Mutono Health Centre where she was told that she was two months pregnant.
The news of her being pregnant was shocking and disappointing. She saw her childhood dream of becoming a lawyer shattered and at that moment, her life crumbled.
Later, when she went back to Mutono Health Centre to get advice on how to procure an abortion, Monica was instead rebuked by the health personnel for being promiscuous.
Disappointingly, Monica, with the help of her friend, used some cassava stems to terminate the pregnancy.
No sooner had she inserted the cassava stems in her vagina than she started bleeding profusely and her friend was of little help.
Monica was later referred to Mansa General Hospital where her uterus was removed and would never be in a position to mother a child.
Monica’s case is an example of how young people die due to lack of access to information on reproductive health.
Many young girls and adolescents like Monica die as a result of unsafe abortions and lack of adequate information.
The World Health Organisation defines unsafe abortion as “a procedure for terminating an unintended pregnancy that is carried out by somebody who is not trained to do so or in an environment that does not meet the minimum medical standards or both”.
In other words, if a termination of pregnancy is to be done, it should be done by somebody who is trained and in an environment that is considered to be medically-acceptable.
In this case, an abortion can be conducted in an environment that has been certified by the Health Professions Council as being a medical facility.
In Zambia, because safe, legal abortion is inaccessible to many women, an unknown number of women each year resort to unsafe abortions, many of which are performed under unsanitary and unsafe conditions.
University of Zambia (UTH) head of obstetrics and gynaecology Bellington Vwalika explains that Zambia has the 1972 Abortion Act which is considered by many to be among the most liberal laws in the world.
“The law, to a great extent, allows an abortion to be safely procured in a hospital if the medical personnel certify in good faith that the pregnancy should be terminated,” Dr Vwalika said.
The Act itself spells out about four clauses under which termination of pregnancy can be done.
The first clause is that doctors should certify in good faith that the continuation of the pregnancy is a risk to the health of the mother.
The second clause is that doctors should certify that the continuation of the pregnancy will result in mental and physical injury to the health of the woman than if the pregnancy was terminated.
The other clause is that the continuation of the pregnancy will involve the risk of mental or physical injury to the children of this woman.
The last clause is that the continuation of the pregnancy will result in a congenitally abnormal foetus that is not compatible with life.
Dr Vwalika, who defines an abortion as ‘termination of a pregnancy before viability’, said the termination of pregnancy can be medically-induced or it can be induced by people who are not trained to do so.
“If you look at the second clause and looking at the social, mental and physical injury of the woman, it is very broad.
“For example, if a woman has many children or has contraceptive failure, she has a pregnancy that she did not plan for, so this can lead to a mental injury of the woman. This, therefore, becomes a mental injury and the clause can be used to medically terminate a pregnancy,” he said.
However, very few women who need an abortion often meet the requirement.
When Government noticed that there was an increase in the number of rape, defilement and incest cases, the Act was amended by the way of the Penal Code in 2005.
Dr Vwalika said with the Penal Code amendment, it also added that anybody who has had a pregnancy out of rape, defilement or incest could have an abortion.
The abortion law permits termination on health and socio-economical grounds and it requires three doctors in good faith to determine that the pregnancy should be terminated. It further states that one of the doctors should be a specialist in obstetrics and gynaecology.
The country only boasts of under 60 specialists, most of whom are located along the line of rail.
If a woman or adolescent like Monica in Nchelenge needed an abortion, where would she find a specialist to certify that she meets the requirement? This is an impediment to access the service.
In 2009, Government issued the standard guidelines which have further spelled out how to harmonise the provision of the service on abortion.
“Having a liberal law does not translate into service. Women do not necessarily access the service and there are several reasons,” Dr Vwalika said.
Among some of the reasons include the following:
The community is not aware about the law and that safe abortion can be provided.
A number of health workers do not know the issue regarding the provision of safe abortion to the full extent as allowed by the law.
“Clandestine activities, amongst health workers where some would ask for a fee before they carry out an abortion, have been an impediment for women to access the service,” he said.
Most women that have unplanned pregnancies are poor. Hence, they will go to people in their communities who can conduct the abortion at little or no fee.
Comprehensive abortion care (CAC) is only given to women that present themselves at a health centre or hospital after a failed abortion.
CAC means apart from treating the women for the complaint they have come with, they are provided with effective contraception.
The Ministry of Health (MoH) estimates that up to 30 percent of maternal mortalities are as a result of complications of abortions. These deaths occur mainly in young girls like Monica and vulnerable or poor women who cannot afford safe services.
Some studies suggest that if Government invested in the provision of safe abortion services, the treasury would save about US$13 per unsafe abortion treated.
IPAS Zambia country director Felicia Sakala said the organisation’s focus is prevention of unnecessary maternal injuries and death of girls and women
“We work in collaboration with the MoH to assist in identifying areas where our services are seriously required,” Ms Sakala said.
IPAS Zambia is currently operating in four provinces: Copperbelt, Central Southern and Lusaka.
VIOLET MENGO, Nchelenge