Malawi: Married Women Topping Unsafe Abortion List-Study

Blantyre — More married women are said to be demanding unsafe abortion more than their unmarried counterparts, the Magnitude of Unsafe Abortion in Malawi study has revealed.

The study which was conducted by the Ministry of Health across the country says, 81.1 percent of women who participated were indicated to be married and 14.2 percent were single women.

"This means that not only single people would want to terminate a pregnancy but married women too for various reasons. Since the country’s laws are restrictive, these women resort to using unsafe means and lose their lives along the way," said Reproductive Health Officer for MoH, Laston Chikoti in his presentation at a media workshop held in Blantyre on March 4-5.

He pointed out that the study also revealed that many women procure abortion at eight weeks old (two months).

Chikoti further said, half of the participants of the study were under 25, primary school drop outs and many of them were from rural areas.

"This affects the rural poor women a lot, so much that they resort to having unsafe abortions because they can’t pay for a safe one elsewhere," he said.

According to Chikoti, the high number of married women procuring abortion is an indication that many married women may not be accessing family planning methods, citing the Malawi Demographic Study (DHS) of 2010 which indicates that only 42 percent of women in the country access contraceptive methods.

Dr Ausbert Msusa of department of Obstetrics and Gynaecology at the College of Medicine said 27.6 percent of married women have unmet needs of family planning methods.

"One in five of the women that seek post abortion care are reported to have been using contraceptives at the time of falling pregnant," he said.

In Malawi, abortion is an offence under the penal code so much that a woman who is pregnant cannot go to the hospital to have it terminated. However, MoH statistics indicate that women are still procuring unsafe abortions.

National Coordinator for Women and Law in Southern Africa, Research and Education Trust, Seodi White told Mana in an interview that Malawian doctors are scared to conduct abortion on women who want to do it because they are not allowed by the law.

"We can no longer pretend that this is not happening. Marriage is considered a ‘holy institution’ but look at what the statistics are saying. A woman may need an abortion for various reasons and these could be positive reasons as well," she said.

White added: “Government allows for post abortion care but not safe abortion and there is need for MoH to provide clear guidelines on how abortion should be done and this could be approved by government.”

According to the Coalition for the Prevention of Unsafe Abortion (COPUA), three to four women die due to unsafe abortion daily.


India launches new initiatives to improve access to safe abortion care

imageThe government of India has launched two national initiatives aimed at saving women’s lives by making comprehensive abortion care accessible to more women. Even though India enacted a liberal abortion law more than 40 years ago, an estimated two-thirds of abortions in India are unsafe and a woman dies from complications of unsafe abortion every two hours.

The initiatives were launched at a national consultation organized in May by the federal Ministry of Health and Family Welfare and Ipas. The two-day consultation brought together nearly 200 representatives of federal and state governments, civil-society organizations, development partners and medical professionals. Dr. Rakesh Kumar, the Ministry’s Joint Secretary for Reproductive and Child Health, said it was the largest-ever meeting of its kind in India and had served, in particular, to raise state governments’ awareness of the need for safe, comprehensive abortion services.

The first initiative is a national training package on comprehensive abortion care. The package includes standardized manuals for trainers and providers, up-to-date information on medical termination of pregnancy and operational guidelines for implementing agencies. The second initiative, a mass media campaign, will use television and radio spots to raise public awareness that legal, safe abortion services are available.

During the consultation, federal officials reemphasized their support for proposed amendments to India’s abortion law which would, among other things, expand the base of abortion providers by authorizing midlevel providers to legally perform abortions. They also reiterated their commitment to address the negative impact on safe abortion services created by the drive to prevent gender-biased sex selection.

 Other key issues discussed at the consultation were the need to provide postabortion contraceptive services to women who desire it—particularly young women—and to develop effective service delivery approaches that include post-training support for providers.

Highlighting the fact that action for safe abortion care is vital for the health of Indian women, the Health Secretary Lov Verma said he is proud that the government and other stakeholders are taking action on this “sensitive yet critical issue.”

Greens launch push to decriminalise abortion in NSW

Abortion would be decriminalised in NSW under a proposal to be put forward by the Greens and welcomed by health groups and advocates, who say NSW has some of the most restrictive laws in Australia.

Greens MLC Mehreen Faruqi will take the first step on Thursday to introducing a bill that would remove abortion from the Crimes Act entirely, by giving formal notice of her intention to the Parliament.

Ms Faruqi said she wanted to work with Liberal and Labor parliamentarians on the bill, which she said was the first to decriminalise abortion in NSW. However, one Labor MP has warned it could have unintended consequences if opponents amend it to further restrict abortion access.

Abortion now is a crime, although court decisions have established that it will not be found unlawful if a doctor believes it is necessary to save the woman from serious danger to her life, or mental or physical health. It is believed to be one of the more commonly performed medical procedures in Australia, at about 70,000 annually.

Ms Faruqi said getting the law through would not be easy, ”especially as many people are not even aware of the shaky status of the current law”.

”We don’t know yet if we are going to be able to get it through, but the recent debate about the foetal personhood laws show how much demand there is for this now,” she said.

A bill, known as ”Zoe’s Law”, which defines a 20-week-old foetus as a person is before the upper house after passing the lower house in a bill that saw parties vote along conscience lines.

Michael Moore, the chief executive of the Public Health Association of Australia, said abortion was a medical issue.

”The religious drivers in politics have for a long time placed this medical procedure in criminal law, but that is a complete anomaly,” he said.

”For women who have plenty of money and can travel it makes no difference … but for women who are less well-off, who have two or three children already and cannot move around easily, it creates very difficult circumstances.”

An obstetrician and gynaecologist from James Cook University and an abortion advocate, Caroline de Costa, said the present law left doctors to take on the criminal risk of deeming an abortion ”necessary”.

”It helps keep abortion as a separate area of women’s health, and women’s reproductive health, and it keeps it stigmatised,” she said.

She said abortion performed by a doctor is still controlled by criminal law in NSW and Queensland, but not in Victoria and Tasmania.

Labor shadow attorney-general Paul Lynch said he believed the bill would be given a conscience vote by Labor. But he said: ”Once you let the cork out of the bottle”, there was a risk such a bill could be amended by opponents to restrict access further.

Labor health spokesman Andrew McDonald said while he was disappointed to not have more notice of the move, he would consider voting for it and would discuss it at Labor caucus.

”It’s a very fraught area, but it’s one where we would definitely look at the bill,” he said.

Health Minister Jillian Skinner declined to comment.

Is abortion law due for a shakeup?

Abortion legislation has been politically neglected since the late 1970s, when the current law was introduced. But is it finally time for a rethink? The Green Party thinks so, but others are unconvinced. Shabnam Dastgheib reports.

Abortion. A heated, inflammatory, polarising topic. In a largely desensitised world, it remains one of the few issues that can still raise the hackles of the most mild-mannered of people.

Around 15,000 New Zealand women abort pregnancies each year. Many experts agree the law needs some updating to reflect current practice, but for decades abortion has been a political hot potato left untouched.

The Green Party, with a new proposal to remove abortion from the crime statutes, has reignited debate leading up to this year’s election. The party says its proposal would reduce stigma and judgment surrounding the procedure, though a legal expert says the policy is too vague and will be met with strong opposition.

The Greens’ reform would mean a woman seeking an abortion would not need external approval as she does now.

Anti-abortion groups, and those happy with the status quo, say the proposal would provide a system of “abortion on demand” where women could access abortion whenever they wanted - ironically this is exactly why pro-choice groups are in favour of law reform, saying abortion should be readily available to any woman who wants one, as with any other medical procedure.

But Voice for Life administrator Steve Jaunay said it was “sensationalism” for the Greens to claim abortion needed to be decriminalised.

"The law states specifically that a woman is not able to be charged but that a provider may be if the procedure is conducted outside certain legal parameters."

A woman could request an abortion on the grounds that continuing the pregnancy might place her in danger of having mental health problems, he said. “Add to this the fact that having an abortion increases the risk of mental health problems, and you have the awful irony of the situation. A young woman would be encouraged by our culture to get rid of the ‘problem’, and ends up with a worse problem.

"The groups that are trying to promote a further relaxing of laws surrounding abortion refuse to look at or believe any research that might indicate that abortion could be dangerous to a woman," Jaunay said.

One of those groups, the Abortion Law Reform Association, says it is not right that New Zealand still classes abortion under the Crimes Act. National president Morgan Healey said this created stigma, when abortion needed to be treated as a health issue. “Women are not trusted to make the decision for themselves which creates barriers.”

Delays created by the current restrictions meant abortions were not conducted as early as they should be, causing unnecessary health risks, Healey said. “There should be no grounds needed for an abortion. A woman makes the decision herself and goes to her own doctor and is offered counselling, if that’s what she wants, and then she has the abortion.”

Prime Minister John Key has said he is in favour of women having the right to choose but he thought the current system was fine. The Greens disagree, saying their policy would make the law more honest, thereby making the practice safer and fairer.

University of Otago professor of law Nicola Peart said the Greens would struggle with their proposal in the current climate. “The legislation probably does need to be revisited but this legislation has not been touched for good reason. It’s a very high risk policy to take on.”

She said the proposed changes would make a major difference to the process around abortion but the policy as it had been put forward was “kind of vague”.

Peart said trying to make changes to abortion law after 20 weeks gestation, when a child could technically be born and live a normal life was going to be hugely controversial. “You’re moving into the area where you’re going to encounter an enormous amount of opposition to that.”


It took almost a month from the time one woman made the decision to abort her pregnancy to the day she underwent the procedure.

Along the way she needed to obtain a referral from her own doctor and certificates from two other doctors declaring her mentally unfit. She had two ultrasounds, an appointment for a blood test, a half-day examination and run-through of what would happen on the day and then another half day for the actual abortion.

"I was really confused about why it was all so necessary to make me say the words again and again and again. Declaring myself mentally unfit to two different strangers was incredibly difficult."

She found the process emotionally taxing, punctuated with moments of panic that she may not get approval.

The woman had a surgical abortion last year, where the cervix is stretched and the contents of the uterus suctioned out under local anaesthetic. “The very act of removing an embryo is so against what being a woman is - there’s not a woman who would take this lightly. No matter how young or inexperienced, this is not the morning-after pill, it is such a hugely loaded thing. Anyone who knows anything about it wouldn’t want to go near it if they didn’t have to.”

The 30-year-old became pregnant following a one-off night with her ex-boyfriend. The morning-after pill hadn’t worked. “The reality of it is we don’t have one form of contraception that is 100 per cent so this needs to be an option.”

On the day of her abortion, she was asked to wait in a tiny clinic space with eight or so other women before being ushered into a room lined with beds separated by curtains. She could hear others going into the adjoining abortion room and then coming out before it was her turn. “The actual abortion is done very quickly and they were very responsive when I was upset, which was really good. There was a bit of pain but it was a numb pain. They offered me lollies and a cup of tea afterwards.”

Her abortion was free of complications, and she was lucky to be backed by a supportive family and an employer who granted her a lot of leave to work through the process. “I think it can be done in a more humane way and not to have a very fragile, already physically unwell, really sick woman go through this horrible process if she has made the choice.

"Any woman who chooses to have an abortion does not think she has a life that can support bringing up a healthy, cared for child. Surely that’s the crux of it. Financially I was in no position to begin to care for a child, I couldn’t even afford a private abortion."

Her abortion was publicly funded as opposed to the $1000 cost of a private abortion. She believed resources could be better spent on counselling or guidance services than funding the current hoops women had to jump through.


Grounds for an abortion come under the Crimes Act.

Rape is not considered grounds but may be taken into account

Abortion is legal if two consultants agree the pregnancy would seriously harm the woman’s physical or mental health, or there is a substantial risk the child would be born seriously disabled

A woman needs a referral from her doctor, as well as blood tests and ultrasounds

An operating surgeon needs to be willing

Two certifying consultants need to agree; one must have experience in obstetrics Abortions after 12 weeks must be carried out at a licensed hospital

After 20 weeks abortion can only be performed if there is threat to the mother’s life or risk of permanent injury

There is no legal age limit for seeking or having an abortion.

- Sunday Star Times


No More Deaths Because of Unsafe Abortion – Information is Just a Call Away

Every year more than 15,000 women die because of post partum haemorrhage and every day 10 women die because of unsafe abortion in Pakistan. If you know a woman who does not have access to hospital at the time of delivery or who wants to access safe abortion, then contact on the number provided.

‘If my father came to know that I was raped, he would kill me’ – Shaista*

Shaista, 24 years old belongs to a middle-class family from Peshawar. She recently completed her Master’s degree from the University of Peshawar. Her father was strict and never allowed her to work outside the house, so she stayed at home most of the time helping her mother with the house work. Once her friend organized a birthday party and Shaista decided to go along with three friends who lived in the same street as her. On their way back home, their car was hit by some guys, and they came out of the car and raped Shaista and her friends. They screamed for help, but there was no one to help them on that empty road after sunset. She was worried that if her father came to know that she was raped, she would be killed. She was depressed and traumatised. She decided to consult a psychiatrist. She told her family that she is taking cooking classes in an academy, but her father was not in favor of this so he restricted her from going out of the house. It was the most terrible moment for her when the pregnancy test was positive after she missed her period. She decided to go to a doctor for help, but the attitude of the doctor was rude and unprofessional and he demanded a high fee which she could not afford. The doctor was reluctant to help her as she was unmarried. Shaista is not the only one, there are many girls who have no choice and either commit suicide or choose to have back street abortions.

According to an estimate by the Guttmacher Institute, 890,000 women have unsafe abortions every year in Pakistan, 30,000 women die because of pregnancy related issues and 197,000 are hospitalized as a result of complications. Talking about sexual and reproductive health in a 97% Muslim majority country is taboo. According to Pakistani law, abortion is permitted only to save the life of the woman, to preserve physical health, and to preserve mental health. There is a lack of abortion services in Pakistan and services providers provide biased and judgmental services charging huge sums of money with a minimum fee of US$95. According to an Asia Safe Abortion Partnership report, 67% of medical professionals in Pakistan have an unfavorable attitude to abortion and 81% want stricter laws regarding abortion. Women who are unmarried, cannot afford and do not have access to health care services, and therefore prefer to choose backstreet abortion clinics where unsafe procedures threaten health and lives. The justice system in Pakistan is also not women-friendly and Shaista decided not to lodge an FIR after her rape as it would reveal the incident and make her vulnerable to violence from her parents and family.

At Aware Girls, we are working to empower young women, enabling them to take control of their own bodies. ‘Aware Girls’ is a young women led organization established in 2002, working in the North Western Pakistan Khyber Pakhtunkhwa Province. Aware Girls, in collaboration with Asia Safe Abortion Partnership and Women on Waves launched the Sahailee Hotline [1] in June, 2012. ‘Sahailee’ is an Urdu word which means female friend.

Aware Girls is not trying to argue for or against the legitimacy of abortion; for us, the most important thing is to prevent the loss of women who die because of  unsafe abortions. So, despite the risk involved, it is very important for us to reach women who need assistance. This hotline provides information on safe medical abortion, sexual and reproductive health services, contraceptives, sexually transmitted diseases and domestic violence, usage of Misoprostol for safe abortion and postpartum hemorrhage. The information on the hotline is given according to the World Health Organization guidelines. The hotline is working to save the lives of thousands of women in Pakistan who die unnecessarily each year. After the launch of the hotline, there was strong opposition, but the hotline has continued to deliver the information to women who are in need.

A hotline counselor at Aware Girls said, ‘Before, the word abortion seemed to me like a sin. I was not the only one who thought like this, all of my class fellows were of the same opinion. This hotline is a part of my life now and I am determined to save the lives of the women.’

Huma*, a caller, shared, ‘Sahailee hotline understood my situation, was in regular contact with me and guided me in a very supportive manner. Sahailee hotline helped me regardless of my marital status. I do not have words to express my gratitude to Sahailee hotline and their team’.

This hotline was expanded to Balochistan in 2012 which is another very fragile province of Pakistan having borders with Afghanistan. Balochistan has high rates of unsafe abortion because of the restrictive environment regarding abortion. The hotline information is disseminated among the women of Balochistan through different strategies like engaging community women and students. Values clarification and attitude transformation meetings have been organized with women’s groups, health-care providers, and local organizations to reduce the stigma and taboo related to abortion.

Based on a very successful experience in Pakistan, Aware Girls decided to extend the safe abortion hotline to Bangladesh [2] in October 2013. It has been estimated that every year 800,000 abortions are being performed in Bangladesh and at least 8,000 women are dying from abortion related complications every year. As estimated 572,000 women suffer from unsafe abortion complications each year and only 40% of them receive treatment from health care facilities. Therefore the hotline was launched and in the first four months we have received 400 calls, which is a tremendous achievement.

Three referral directories have been developed: one for Khyber Pakhtunkhwa, the second for Balochistan and a third for Bangladesh identifying the existing service providers and referring the callers to them if someone wants to have surgical abortion.  These hotlines are working to drive progress towards the MDGs – the Millennium Development Goal that aims to cut maternal death by three quarters by 2015 – but it seems hard to achieve. Besides restrictive laws, there is less investment in family planning in Pakistan contributing to maternal deaths and health complications.

More than 11,000 calls have been received on these hotlines in three years since June 2010, both in Pakistan and Bangladesh. We receive calls both from married and unmarried women. The information on all these three sites is given in local languages. The following numbers can be contacted for further information:

+92 315 917 0408 (Languages: Urdu, Pashto [3])

+92 344 805 3864 (Languages: Balochi, Brahvi [4])

880-1853 892424 (Languages: Bangla [5])

*Callers’ names have been changed to protect their privacy.