Stigma a factor in unsafe abortions in Lake Zone

19Nov 2019
Lusekelo Philemon
The Guardian
Stigma a factor in unsafe abortions in Lake Zone

WHEN she joined secondary education, Epiphania had a dream of becoming a medical doctor some day. But that dream has been cut short after conceiving at the tender age of 17.

At the time, Epiphania was only in Form Three. Things became more complicated when she thought of how to break the news of the pregnancy, taking into account that her father was a senior and respected church member.

She thought of the community and her colleagues—she was one of the choir members in the church. Worse still, Epiphania was also confused when she came to realize that the man behind the pregnancy was nowhere to be seen.

The only option she had was to terminate the pregnancy. But, how she can terminate the unexpected pregnancy, which was a difficult question to her. She resorted to ask one of her closest friends on simple ways of doing so. She tried swallowing herbal concoctions and various pills, but in vein.

When she was three months pregnant, she could no longer hide her condition from the school authorities, and she was expelled from school.

Epiphania, a tall, slim ambitious young girl, who spoke on condition that her full name not be used, says she became desperate for an abortion. 

She gathered all the pills she could find and swallowed them as advised by her friends. 

Vicious labor pains started almost immediately and lasted for two days before her aunt took her to the nearby health facility in the area located 20 km from Mwanza city centre. She managed to terminate the pregnancy, though her uterus was destroyed and doctors removed it for the safety of the girl.

Epiphania terminated her pregnancy due to the unknown fears and stigma from the people around her taking into account that abortion is unacceptable in the society, where tradition and taboos are very strong. 

Like many teenagers and young women use precarious methods to terminate their pregnancies, irrespective of the dangers of such acts to their health and souls too.

Strict abortion laws and ignorance about contraception—and cultural and religious beliefs that prohibit its use – force thousands of women and teenagers every year to turn to illegal and unsafe abortion—a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both. 

Abortion, whether safe or unsafe, is a common event worldwide, whereby approximately one in four pregnancies ended in an induced abortion during the period 2010-2014.

These abortions, often used as a means of birth control, are increasingly becoming a major medical, health and social problem in Tanzania. 

The Lake zone has by far the highest abortion rate of 51 abortions per 1,000 women," said part of the study titled: "Incidence of Induced Abortion and Post-Abortion Care in Tanzania."

“Abortion is a big problem in our country, especially for the urban adolescents,” said Dr John Chacha, Mwanza-based gynecologist and obstetrician.

 “We’re talking about young people—girls and boys who by the age of 10, 12, 13 have had their first sexual contact,” Dr Chacha says.

 “We are only seeing one aspect of the problem—unwanted pregnancies. Saving their lives is not the end of the story. Sexuality has a lot to do with culture, education, family units and economic factors,” the experienced gynecologist says.

There is general knowledge about contraception among young women in the country, but little practical information, Dr Chacha says.

According to him,  college students are the main victims of unsafe abortion, as at that time they become free and freedom exposes them to sexuality and very few are aware of using protective gears as in most cases family planning efforts are meant for married women, not the young unmarried women.

“This is one of the serious challenges that most young women  at risk as once a young woman is pregnant, she often finds that she cannot turn to her family or the health care system for help.”

Magu District Medical Officer (DMO), Dr Maduhu Nidwa also shares nasty experience in his career, saying: “Two years ago, I received one case of a university student who attempted to terminate pregnancy using unsafe methods, who didn’t want to disclose to any because of the fear of being stigmatized. But, she died as she lost lots of blood before reaching the health facility. To me, this was a nasty experience.”

However, Dr Nidwa suggests the need to scale up reproductive health education as many young girls seem to be unaware of the challenge. 

 “So, to me I think something needs to be done to rescue young girls from the traumatic experiences they are going through (unsafe abortion),” Dr Nidwa insists. 

Edith Shadrack, Magu District Reproductive and Child Health Coordinator (DRCH-CO) also admits: “This is a serious challenge in our community. As district authorities, we’re scaling up reproductive health education to the youth and the response has been positive.”

“At Kisesa Health Centre youth are being trained on all issues related to reproductive health and their response has been positive and we’re planning to spread the idea to other health facilities in the district whereby youth will be informed on all issues including dangers of unsafe abortions,” she says.

Mwanza Regional Commissioner, John Mongella sees that areas as challenge and already his office in collaboration with other players are investing heavily on young girls to ensure that they stay longer in schools hence discourage early pregnancies.

He says in doing so, “we’re investing in building hostels as part of the remedies to discourage early pregnancies and marriages.”

 “We want to see girls get pregnancy  when they are matured enough to take the motherhood responsibilities…and this will make the region and the country have healthier people, who can contribute positively to the country’s development,” he says.

“All these are some of our strategies to reduce the global maternal mortality ratio less than 70 per 100,000 live births by 2030 as stipulated in the UN sustainable development goals (SDGs).”

Tanzania is the 17th highest adolescent fertility rate in Africa—the rate has increased from 116 to 132 between 2010 and 2015 as per Tanzania Demographic Health Survey (TDHS). Teenage pregnancy has increased by 4 percent in Tanzania since 2010 by 2016 one in 4 adolescent aged 15-19 has began childbearing, the survey says. 

Tanzania’s national abortion rate—36 per 1,000 women of reproductive age—is similar to that in other East African countries. 

According to the World Health Organisation (WHO), an estimated 22 million unsafe abortions take place in Tanzania, as in many other low income countries. 

Unsafe abortion represents one of the leading causes of maternal deaths in Tanzania. According to the Ministry of Health and Social Welfare, 16 per cent of maternal deaths are due to complications from abortion; this is comparable to the proportion of maternal deaths from unsafe abortion in Eastern Africa (18 per cent).

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