Will legal abortions stem maternal death rate in Mozambique?

Maputo - The push for the new legislation, officially introduced earlier this year, has come from the Mozambican health ministry, arguing that unsafe abortion is the third leading cause of death among pregnant women in the country. Mozambique has one of the highest maternal death rates in the world.

Botched abortions accounted for an estimated 11% of maternal fatalities registered at the central hospital in Maputo, the nation's capital, in the 1990s. More than 40% of the cases of serious pregnancy complications treated at the hospital's maternity clinic are said to be the result of clandestine abortions.

"These are only the cases of people who went to the central hospital," said Graça Samo, executive director of the Women's Forum, an umbrella organisation for women's rights' nongovernmental organisations. "It does not count the people who don't come in, who die in rural clinics. And often when someone dies, the family will never say what really happened".

Samo said although the Women's Forum had hosted workshops where the issue has been discussed, the organisation itself has not staked a position because there are conflicting opinions among the various member groups.

Samo, though, personally supports legalisation. Despite the extreme hardship often suffered by women with unwanted pregnancies, abortions will happen, whether it is legal or not, Samo argued, making it critical to ensure it is done safely.

"You cannot imagine the means people use for unsafe abortions," she said. "It can be a pen, a piece of wood. It can be whatever it is. The biggest thing for me is, why would women do that? What does it take? They know they are putting their life at risk".

Lack of debate

Other than some media coverage, there has been very little public debate on the issue of legalisation, and leaders of the Roman Catholic Church in the country have complained that their voice, which is firmly against abortion, has been shut out of what they consider to be a closed process. Apart from being a sin, Church leaders argue, abortion is also a foreign import contrary to African cultural norms.
A recent pastoral note distributed by the country's Catholic bishops said that they empathised with those wanting to reduce the maternal mortality rate and promote women's rights. "Despite that, we affirm that abortion is not the solution for these situations," read the letter. "Its liberalisation/legalisation on the one hand vulgarises and objectifies women, and on the other hand corrupts youth and trivialises the sacred power of procreation."

Worldwide, some 68,000 women die annually due to unsafe abortions, according to the United Nations World Health Organisation. Nearly all of these fatalities occur in developing countries, where access to safe abortion is often highly restricted by law, or by lack of available medical services, or both. In the decade since South Africa removed restrictions on the procedure, abortion-related maternal mortalities dropped by 91%, according to Ipas, a United States-based abortion rights organisation.

In Mozambique, the law outlawing abortion, except in cases where the mother's life or health is endangered, dates to the late 19th century, when the mainly Catholic Portuguese controlled the country. The other major creed in Mozambique is Islam, a faith that also does not support abortion.

Rape was common during Mozambique's 17-year civil war, and doctors in some urban centres routinely carried out abortions under these circumstances and have continued to do so, 15 years after the end of the conflict. But at a fee of US$25, a safe abortion is beyond the reach of the vast majority of Mozambicans.

If the law is changed, it will allow for the expansion of safe abortion services, and for foreign donors to fund them. "Changing the law and removing the stigma and taboo that surround abortion also allows women to openly seek and receive safe services and for their communities to offer the support they need for this," said Dr Eunice Brookman-Amissah, the Ipas vice president for Africa.

Mozambique is one of 21 countries to ratify the 2003 Maputo Protocol, which addresses women's rights in Africa, including reproductive rights.

Article by courtesy IRIN