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Mozambique takes first step against backroom abortions

Mozambique's legislature is expected to pass a bill to legalize abortions in March in an effort to reduce the country's high rate of unsafe backroom abortions. 

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In practice, application of the decree varies widely, and its impact has been limited to two or three hospitals. In the capital, Maputo, women have long been able to obtain voluntary abortions in a quasi-legal setting, while in Tete, Madeira performs abortions only when a woman’s health is at risk. 

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Though it remains among the highest in the world, Mozambique’s maternal mortality rate has fallen by more than half in the last twenty years, aided by economic growth and the expansion of formal health services, such as care by professional midwives and growing access to family planning. Still, clandestine abortions continue.

Several health professionals at Tete suggested that adolescents bear the brunt of the complications that stem from unsafe abortions. Looking back on her own experience, Isabel said that she “knew nothing and didn’t use condoms.” It was only with her mother’s guidance that she used the relatively safer method of Cytotek, a drug used legally in several countries for medical abortions.

By contrast, Dr. Madeira said he often sees patients whose parents learn of their daughters’ abortions only when they bring them to the hospital. The Ministry of Health now includes information about the risks of unsafe abortion in a sex education program in secondary schools, and distributes family planning materials through "youth-friendly services" aiming to improve access among sexually active minors.

The pressures that cause teenage girls in Mozambique to seek abortions are probably growing: contraception use is still under 20 percent and adolescence in Mozambique is something of an emergent phenomenon. “Before, either you were a child, or you had your initiation, and you got married, and then you got kids,” Dr. Geelhoed explains. “Now you go to school, and if you get pregnant during school time, it’s very unlikely that you’ll be able to continue.”

Evidence from other countries suggests that legalizing abortion contributes directly to reducing maternal mortality. In the United States, rates of complications from abortion dropped dramatically in the four years following Roe v. Wade; in Romania, maternal mortality fell by two-thirds following the ouster of dictator of Nicolas Ceausecu, who outlawed abortion and contraception.

In moving towards legalization, the Mozambican government is hoping to replicate the experience of its neighbor South Africa, where legalized abortion contributed to a 91 percent drop in the maternal mortality rate over five years in the 1990s. Yet the examples of South Africa and Zambia, another of Mozambique’s neighbors, have also shown that the widespread social stigma continues to fuel clandestine abortions even after legalization.

Mozambique’s proposed law would require a referral from two doctors, and parental authorization for minors. For a procedure that is most often performed by midwives and nurses under a veil of secrecy, it remains to be seen just how much will change.

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