Wednesday, January 30, 2019

Abortion in Southern Africa

In Africa more than 4 million unsafe abortions are performed each year. One out of every 150 African women who have an unsafe abortion dies from complications, and countless others come away scarred physically or emotionally. 

The World Health Organization reports that “in developed regions, it is estimated that 30 women die for every 100,000 unsafe abortions. That number rises to 220 deaths per 100,000 unsafe abortions in developing regions and 520 deaths per 100,000 unsafe abortions in sub-Saharan Africa.”

Changing the law is essential but isn’t a cure-all.

A United States government policy reinstated by Trump blocks federal funding worldwide to nongovernmental organizations that provide any kind of abortion service including advocacy, referral and counseling.  Known as the “Global Gag Rule,” this policy blocks U.S. aid to nongovernmental agencies that offer any services related to abortion. Among other consequences, women in developing countries face less access to information, contraception and legal abortion. Health practitioners in Lesotho who used to offer free contraceptives, family planning advice and abortion counseling no longer have the funding to continue. Since Trump’s expansion of the U.S. policy, family planning groups have had to radically downsize outreach efforts as well as services within their facilities.

In Lesotho, a predominantly Catholic country, women who get abortions face social ostracism as well as arrest. Leaving Lesotho to have the procedure isn’t an option for most women. Women know that safe, legal abortion is available in South Africa, but they can’t afford the private doctors’ fees in that country.

Lesotho’s Minister of Health, Nkaku Kabi, announced that Queen Mamohato Memorial Hospital, the country’s only referral hospital, is filled to capacity with women suffering from the effects of unsafe abortions.

Various methods are used in these unsafe procedures, with one of the most common involving “abortion pills” that induce labor. These pills, used “off label,” can cause incomplete abortion, which often leads to dangerous bleeding. Other illegal termination methods include ingesting dangerous substances such as brake fluid or bleach. Complications from unsafe abortions cause a shocking number of deaths among women in Africa compared with other parts of the world. Illegal abortions can result in a range of life-threatening complications, according to Matsebo Mpeta, a nurse-clinician at the referral hospital. Some women develop sepsis, a dangerous response to an infection often caused by the material used in the procedure or by an unclean clinical environment. Other women die from infection itself, loss of blood or harm to the organs or genital tract. Those who survive unsafe abortions often face serious and lasting health consequences. Women can become infertile if the uterus is damaged—or has to be removed—due to chemicals or instruments used to terminate the pregnancy. Urine or stool incontinence caused by injury to organs is another common lifelong consequence. Mpeta also reports mental health issues associated with unsafe abortion, including depression, anxiety attacks and suicidal tendencies. She has seen women and girls become severely traumatized, and she describes some as “mentally challenged” after their experiences.
In several cases, pregnant women have been too frightened to get illegal abortions so they have had their babies and then committed another crime of despair called concealment. The Lesotho Penal Code states: “A person who disposes of the dead body of a new-born child with intent to conceal the fact of its birth, whether the child died before, during, or after birth commits an offence.”
Although abortion has been legalized in neighboring South Africa, of the estimated 260,000 abortions performed there each year about half are illegal. Many qualified South African health care professionals refuse to perform abortions because it violates their cultural or religious beliefs. These practitioners can refuse to perform the procedure if they conscientiously object to it, but they are legally bound to refer patients to safe abortion providers. According to Amnesty International, this guideline isn’t well regulated and the result is lack of access to safe procedures. Economic and geographic factors also make it difficult for women to access safe abortions. Most South African health care professionals work in the private sector, leaving a dearth of available doctors in public health centers, which are the only affordable option for much of the population. Compounding the problem, women in rural areas have little access to safe terminations because they lack transportation to appropriate facilities.

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