Mozambique takes first step against backroom abortions

After undergoing a back-room abortion as a 15-year-old, Isabel considers herself among the lucky ones. Ten years later, she has a healthy five-year-old son, while several of her friends will forever be unable to have children. Women in her neighborhood have lost their lives. 

"I knew that something could happen to me," Isabel recalls, sitting on a plastic chair outside her home, "but I risked it."

In Mozambique, where abortion remains illegal under any circumstances, the government has come to regard the ravages of clandestine abortions as a major public health problem. According to the Ministry of Health, they are responsible for more than half of visits to obstetric and gynecological services nationwide, and more than 5,000 maternal deaths each year. The true number is probably much higher, since many women die without reaching a hospital or at a stage when they are not visibly pregnant.

“Around the world, clandestine abortion is a leading cause of maternal death, and one of the hardest to get good data on,” says Dr. Diederike Geelhoed, a physician with the International Centre for Reproductive Health (ICRH). “ The [World Health Organization] estimates that more than 5 million clandestine abortions occur annually throughout Africa, while only 100,000 abortions that take place in a safe, legal setting.

In March, the Mozambican legislature is expected to pass a bill that would revise the country’s draconian abortion law and legalize voluntary abortions in the first 12 weeks of pregnancy. In doing so, Mozambique would become the ninth African country to liberalize its abortion policy in the last decade. Since 2003, 28 countries have ratified an African Union protocol supporting the right to abortion in cases of rape, incest, or high-risk pregnancies. In these incremental changes, there may be signs of a continental shift.

At the Tete Provincial Hospital around the corner from Isabel’s home, Dr. Clemente Madeira, director of obstetric and gynecological services, regularly treats women suffering from complications following clandestine abortions. Many of them have drunk laundry detergent or bitter concoctions offered by traditional doctors or purchased pills from off-duty health workers. Many have hemorrhages, sepsis, and perforated uteruses, and face lifelong infertility or even death.

“The ones who lose their lives are the ones who delay their visits to the hospital,” Dr. Madeira says.

Abdul Carimo, who led the legal reform team that drafted the proposed law, argues that it will save lives. “Only by offering legal, controlled, sanitary means of abortion... will we be able to keep women from taking these risks,” he says.

It is a view that some officials here have held for more than 20 years. Mozambique’s current law is a legacy of the Portuguese colonial penal code, inherited at independence and unchanged since 1886. Though prosecutions are rare, it carries a sentence of up to eight years in prison for providers and pregnant women alike, and girls as young as 16 have been arrested for seeking to interrupt unwanted pregnancies.

In 1990, alarmed by by the country’s astronomical rates of maternal mortality – more than 1,000 women died for every 100,000 live births – the minister of health authorized first-trimester abortions in cases of rape, incest, and high-risk pregnancies. But the measure was limited to the country’s main hospitals and did not carry the force of law. According to Mr. Carimo, many doctors are unaware the decree exists, or object to performing abortions on moral grounds.

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