It is time to act: Deaths and morbidity from unsafe abortion

30Dec 2019
Kenneth Simbaya
The Guardian
It is time to act: Deaths and morbidity from unsafe abortion

ADOLESCENTS and young girls are still facing a number of challenges when it comes to accessing effective and affordable contraceptives, including emergency contraception.

Reports have it that, despite family planning being mentioned as one of the most life-saving, empowering, and poverty fighter in families and nation at large; contraceptive prevalence in the country has remained low with statistics showing that only 38 percent of married women are using the services.

According to the Tanzania Demographic and Health Survey 2010, less than one in 10 (nine percent) of sexually active youth who want to avoid pregnancy use modern contraceptives. Worryingly, 22.8 per cent of young women between the ages of 15 and 19 are mothers.

Grace (not her real name) is one of the teen girls who fell into that trap as at her tender age she found herself opting to terminate a three months pregnancy, after her boy friend coerced her to do so.

“It is so risky, I could have died that day, many women probably die…I remember one of my friends also barely died after conducting an abortion to an eight months pregnancy,” she says.

“After realizing that I am pregnant, I informed the man who was responsible for it, who then asked me to terminate the pregnancy. I refused, but he insisted, and finally I had no choice, but to succumb to his pressure,” testifies Grace who still lives with her parents in Magu District, Mwanza Region.

According to her, the pregnancy termination procedure was aided by her girlfriend whom she said had terminated her four-month old pregnancy in the past. When asked whether at that time she was using any family planning method she confided that she was using traditional method (calendar).

Grace narrates that, to have the procedure performed, she told her parents that she was traveling to see her aunt who lives in another village, instead she went to her friend’s home, swallowed the two tablets she doesn’t know to date, and inserted the other two into her private parts. The tablets, according to Grace were brought by her intimate partner who was responsible for the pregnancy.

She succumbed to the pressure from her boyfriend because she wanted to protect the relationship. The lady’s incident confirms women and girls powerlessness in sexual reproductive matters, something that aggravates harm in cases of unwanted pregnancy.

Echoing Grace’s experiences, Ester Mgaya says she also conceived when she was in Form Three and she was aided by her friend.

“I had no way than to remove the pregnancy because I wanted to continue with my studies, I seriously went ill for two weeks, frequent fevers and I bled profusely,” she narrates.

Another young girl aged 25, from Nyegezi suburb of Mwanza city says that she had abortion two years ago when the pregnancy was two-month-old.

For Grace and nearly half the population of Tanzania who may become parents prematurely, what matters is access to acceptable, affordable, and sustainable services provided through efficient, effective support systems.

Data shows that, every year in Tanzania at least one million women and girls get unwanted pregnancy, of the one million unwanted pregnancies 39 percent end in abortion. 405,000 Tanzanian women and girls have induced abortion 40 percent of them experience complications that require treatment, but 60 percent of those requiring medical treatment do not get the medical treatment they require.

“We received a case here for Post Abortion Care (PAC), of a lady who induced at home, when she was admitted she had already had infections, we ended up removing her uterus, she didn’t die,” says Maduhu Nidwa, Magu District Medical Officer (DMO).

He says: “When we asked her, the lady admitted to have an induced abortion after the pregnancy was rejected by the man who was responsible.”

On another experience, Dr Maduhu says: “Four years ago I met with a girl, who had attempted terminating her pregnancy, but unfortunately the process was incomplete, so she started bleeding and got infections, she bled until blood cells (DIC) that help blood to clot finished.

“When she was brought at the hospital her blood group wasn’t there, we gave some blood products, when we got her blood group came, we gave her nine blood units, on the fourth day, she experienced kidney failure, and we referred her to the zonal referral hospital but, she died.”

In 2018, Magu District, according to Dr Maduhu recorded 325 patients who sought comprehensive Post Abortion Care (cPAC), and this year between January and October the district admitted 246 patients for cPAC.

Abortion complications can be prevented and when present can be treated if there is appropriate use of cPAC.

In Ukerewe District, teenage pregnancy is also too high. When asked the Ukerewe DMO, Dr Raphael Mhana on cPAC admission, Dr Mhana admitted that adolescents and young girls out number adults.

UMATI’s Advocacy, Communication and Public Relations Officer Josephine Mugishagwe says to minimize devastating impact caused by unsafe abortion, the ‘Harm Reduction Model’ needs to be rolled out across the country.

The model, according to her, promotes the provision of support to women with unwanted pregnancies to the extent allowed by the national legislation. Institutions implementing the model have been supporting prevention generally and prevention of unsafe abortions in particular.

She notes that the model opposes unsafe abortions and poorly performed abortions that put women’s lives and health at risk. It seeks to create conditions that reduce these risks, is grounded in health professionals’ medical duty and professional responsibility to protect women’s health and ensure that they have access to information.

“The model has already been implemented in Tanzania, showing high effectiveness and acceptability by both clients and providers,” Josephine says.

She adds that the harm reduction approach has a long history of effectiveness in the public health field, particularly in the context of reducing HIV transmission risk among drug users.

“It is grounded in the principle of providing health education and other services without prior moral judgment, professionals provide information in order to reduce the risks associated with a specific practice.”

She further says, harm reduction services for unsafe abortion provide clients with information and support so that they can make informed, responsible and autonomous decisions, the model create an opportunity for women to access life saving contraceptive services.

“The harm reduction model stems from the international human rights framework, specifically the right to health, dignity, physical integrity, liberty, autonomy, equality, information, privacy, freedom from cruel, inhuman and degrading treatment and the benefit of scientific progress,” Josephine clarifies.

The harm reduction model to prevent unsafe abortion was developed in 2001 by Iniciativas Sanitarias (IS), an association of health professionals in Uruguay, as a response to the problem of unsafe abortion, which was one of the principal causes of maternal death in the country. Abortion was not legal in this South American country. By 2004, there was already a clear decrease in the number of emergency visits to the hospital for abortion complication and in the number of maternal deaths for this reason