THE mourners gathered in the village wore sombre faces and the grief expressed in most of bowed heads was enough to touch even the strongest of hearts.
Huddled in one corner and sobbing silently, Salome Mziray thought of the lifeless body of her only daughter lying in the local hospital’s morgue and her thoughts went to the day she held her in her arms as a baby.
Her daughter Salma was supposed to celebrate her 19th birthday in two days’ time and she had great plans for her future, which, thought her mother, were going to be buried with her. Salma’s young life was cut short after she attempted an abortion through a local ‘mid wife’, who rumor has it that she is responsible for almost 80 per cent of all the abortions in the village, Salma’s attempt went terribly wrong.
Although pregnancy termination is restricted by law in Tanzania, it is widely practised and almost always unsafe and contributes to the country’s high maternal morbidity and mortality. Yet the majority of abortion- related deaths are preventable, as are the unintended pregnancies associated with abortion.
As the legal option is practically impossible, many women try to abort the pregnancies themselves or turn to unskilled practitioners. Methods can include the use of herbs, high doses of antimalarial drugs, washing detergent, ash, cassava stems or contraceptive pills.
In some cases the women experience severe bleeding, infection, complications during a later pregnancy or even death. Surveys of health facilities and health professionals and reviewed population and fertility data, estimate that 66,600 women received postabortion care in health facilities for complications resulting from unsafe abortions in 2013.
Contrary to widespread belief, a health care provider is not required to consult with other providers before performing an abortion. In addition, the law does not specify what level of provider may perform a legal termination.
Given the absence of interpretation by Tanzanian courts and the contradictory laws and policies, women and health care providers may lack a comprehensive understanding of the content and scope of the law on abortion.
Given the legal restrictions associated with abortion, it is difficult to obtain reliable information on its prevalence and to assess the magnitude of the morbidity and mortality associated with it.
No national abortion incidence data are available in Tanzania, however, estimates for regions of Africa indicate that unsafe abortion is common and represents the majority of induced abortions. “About 40 per cent of women who have abortions in Tanzania experience complications serious enough to require treatment,” says Dr Pasiens Mapunda, a Public Health Consultant.
He however says that only 40 per cent of women with complications actually received the needed treatment, adding that the quality of care in some settings is questionable and knowledge about correct dosage and use is limited.
Dr Mapunda says that legal environment that will allow safe abortion in cases of rape, sexual assault, incest and to health and life of the pregnant woman will significantly reduce the number of unsafe abortions and thus contribute significantly to the reduction of deaths due unsafe abortions complications, with consequent reduction of the maternal morbidity and mortality in Tanzania.
“In addition to post-abortion care services, Tanzanian women need better access to a full range of contraceptive methods and family planning counseling so they can make informed decisions,” he says.
A report by the US-based Centre for Reproductive Rights indicates that Tanzania’s law and policies on abortion remain unclear and are often inconsistent. The country actually ratified the African Charter on Human and People’s Rights protocol on the Rights of Women in Africa in 2007.
It allows medical abortions in cases of “sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the foetus.” But Tanzania has not yet adopted these provisions into its laws.
According to a report published in 2015 titled ‘Incidence of Induced Abortion and Post-Abortion Care in Tanzania’ the highest abortion rates and ratios are found in the Lake Zone and Southern Highlands, where rates of treatment for induced abortion complications are also highest “In addition to post-abortion care services, Tanzanian women need better access to a full range of contraceptive methods and family planning counseling so they can make informed decisions,” says Dr Rashid Mtalusito.
He says that levels of unintended pregnancy vary across societies and over time; however, because no reversible method of birth control is perfect and few human beings use methods perfectly, women will always experience unintended pregnancies. He says even safe abortion in developing nations carries risks that depend on the health facility, the skill of the provider and the gestational age of the fetus.
“With unsafe abortion, the additional risks of maternal morbidity and mortality depend on what method of abortion is used, as well as on women’s readiness to seek post-abortion care, the quality of the facility they reach, and the qualifications and tolerance of the health provider,” he concludes.