The National Convening on Sexual Reproductive Health Rights was organised by TAWLA on October 13, 2016 to provide a platform for open discussion of the sensitive subject of unsafe abortion in Tanzania.
More than 120 people participated, including MPs, government officials from Ministry of Constitutional and Legal Affairs, Ministry of Health, and local government, judges, lawyers, medical practitioners, teachers, gender equity advocates, including myself, youth representatives and other CSOs, development partners and the media.
Induced abortion is the termination of pregnancy before 28 weeks. Unsafe abortion is performed by unskilled persons or in unapproved premises or both. The tragedy is that appropriate medication is widely available in Tanzania to safely terminate pregnancy in the early stages, but information is not widely available. As the facts show, restrictions on safe abortions have not stopped abortion – they have driven it underground and made it unsafe.
The situation: Tanzania has one of the highest maternal mortality ratios in the world (410 per 100,000 live births); 16 to 30 per cent of maternal deaths are due to complications from unsafe abortions. Each year, 405,000 Tanzanian women have abortions, mostly hidden. Forty per cent result in complications that require medical treatment and a large portion are adolescents 15-19 years old. Unsafe abortions account for one-third of hospitalisations for complications related to pregnancy, an indication of the costs involved. The most contentious fact to me is that 60 per cent of Tanzanian women with abortion complications do not receive needed medical care. They are often denied their right to medical services because of stigma and outright discrimination.
Many women cannot afford to provide for another child, especially without strong public social welfare systems. Poor girls from less advantaged families are more likely to seek unsafe abortions because they lack family and financial support to do otherwise. Many girls are driven to unsafe abortion because they fear stigma and punishment from family, peers, school and community for becoming pregnant outside of marriage. The present government policy of mandatory pregnancy tests of schoolgirls and automatic expulsion will surely worsen the situation. Too often girls have been raped by family members or close family friends, or their teachers, but lack family and community support.
The situation is preventable – if all girls and women had access to correct information about sexual and reproductive health and their rights, to safe contraceptives, and to quality reproductive health care. As the ‘best practice’ of Ethiopia showed, if girls/women have access to safe abortions, the rate of maternal mortality would drop dramatically. Families and communities need to recognise girls/women’s rights to control their bodies and value their lives. As participants noted, it is time to bring abortion ‘out of the shadows’ as was done with HIV/Aids.
The legal context: Many women and health care providers are not aware that the Tanzanian Penal Code allows for safe abortion when it is to preserve the life of the pregnant woman. Even fewer know that the 2002 and 2016 Post-Abortion Care Clinical Skills Curriculum—the primary government document focusing on post-abortion care (PAC)—explicitly states that Tanzanian law allows therapeutic abortion, including to save the mental and physical health of the pregnant women. However, there are no specific guidelines on performing safe abortion and clarity on who is supposed to perform it, the law only says a “skilled person”. Does it mean a nurse or a medical doctor?
Tanzania ratified the Maputo Protocol on the Rights of Women in Africa which allows abortion in cases of rape, incest or if the pregnancy endangers the woman’s life, mental or physical health or the life of the foetus (Article 14). The government has not yet incorporated these provisions into national law.
What needs to be done?: To my mind, an urgent step is to ensure that all girls and women access quality medical treatment after unsafe abortion; along with safe contraception to avoid unwanted pregnancies. Information about the existing law allowing therapeutic abortion needs to be disseminated widely, and guidelines prepared and shared on performing safe abortion. Further advocacy is needed for the domestication of the Maputo Protocol, especially Article 14, into Tanzanian Legislation.