Abortion figures underscore need for more reproductive health education

An estimated 70,000 illegal abortions take place in Zimbabwe every year, says a new report by the UN Children's Fund (UNICEF). The UN agency called for a national education drive to raise awareness of sexual and reproductive health. According to UNICEF's 'Children and Women's Rights in Zimbabwe - Theory and Practice', legal abortion is permitted only under certain circumstances, making it very difficult to access. The Termination of Pregnancy Act of 1977 permits the procedure when the life of the woman is endangered, the child may suffer a permanent physical or mental defect, or the foetus was conceived as a result of rape or incest. Termination may take place only at a designated hospital, with the written permission of the hospital superintendent; in cases of suspected birth defects, or life and death situations, the authority of two medical practitioners is also required. For rape, a certificate by a magistrate is needed, and is issued only after consideration of a police report and an interview with the victim. The laborious process of satisfying these conditions, coupled with the fact that legal abortions are not free, have led to a growing 'black market' for the procedure, where back street terminations are often performed by unskilled personnel in unhygienic surroundings. Illegal, self-inflicted abortion methods are thought to include the consumption of detergents, strong tea, alcohol mixes and malaria tablets; other methods include the use of knitting needles, sharpened reeds and hangers. The health ministry began a post-abortion care programme five years ago at the Harare and Parirenyatwa hospitals, two of the country's largest referral centres, to care for women suffering from induced and spontaneous miscarriage. Tsungai Chipato, one of the programme doctors, said on average between six and 10 women were treated daily at each institution. Professor Jonathan Kasule, from the Obstetrics and Gyaenocology Department of the University of Zimbabwe's Medical School, told IRIN that the bulk of patients seeking help at the post-abortion care centres were in the 15 to 24 age group. "They come in bleeding, with septic reeds stuck in their private parts, and if you do not immediately work on them, they die - it is one of the commonest causes of maternal mortality," he said. Edna Masiiwa, director of Women's Action Group (WAG), told IRIN that knowledge of the abortion law was vague and few women were aware of the post-care abortion programme. Kasule pointed out that people were also generally unaware of the emergency or morning-after pill, Positinor-2, available at pharmacies. UNICEF noted that the onset of sexual activity among the youth in Zimbabwe occurred at an average age of 14, but they were often uninformed where pregnancy was concerned. The report said a 1999 survey indicated that "25 percent of youth think that a girl could not get pregnant the first time she has sex, and 40 percent believe that a girl cannot get pregnant if she has sex standing up". Masiiwa added that for girls the first sexual encounter was normally "unplanned". According to the report, adolescents participating in the survey said most of them used abortion as a family planning method, "due to the difficulties encountered in accessing family planning services". Service providers tended to rely on national laws and policies that generally upheld parental consent requirements for adolescents; adults commonly believed that access to contraception and information about it promoted promiscuity; married adolescents could access contraceptives more easily than their unmarried counterparts, all of which contributed to the stigma involved in accessing contraception. Kasule said Zimbabwe's uptake of oral contraception was relatively high - 56 percent - but there was still a significant gap. Masiiwa said sex education in schools needed to be stepped up to make girls aware of the conventional contraceptive options available. Her organisation had run a programme in Beitbridge, on the South African border, where, "in 2005 few were even aware of the female condom and yet it was introduced in the late 1990s". She stressed that use of the male condom also had to be promoted. Broader abortion legalisation was thought to be unlikely, as the country was largely Christian and conservative, with a strong pro-life lobby. Feltoe believes that even if abortion were to be legalised, Zimbabwe lacks the medical facilities to handle large-scale lawful termination. "Abortion would be a low priority in the context of things," he told IRIN. "There is already huge stress on the current health facilities, and it would meet resistance from nurses and other health staff."