Abortion and the moral dilemma; the contradictions of policy and practice

Moral dilemmas are situations in which an individual is faced by two conflicting ethical decisions, none of which overrides the other. Middle ground anti-abortionists reasoning often cite the moral dilemma as the reason why a definitive position on abortion cannot be reached. This article will look at the middle ground challenge of the moral dilemma as it relates to abortion in the context of Zimbabwe.

By Memory Pamella Kadau

Abortion in perspective

An abortion is the early termination of a pregnancy, which can happen spontaneously, as in the case of a miscarriage, or can happen when the pregnancy is ended by medical or surgical means. The World Health Organization (WHO) defines unsafe abortion as ‘a procedure for terminating an unintended pregnancy carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards or both’. A safe abortion ‘is a procedure that is completed with a method recommended by WHO, that is appropriate to the pregnancy duration, and when the person completing the abortion has the necessary skills (whether provider- or self-managed) and the environment meets established medical standards’.

WHO estimates that 1 in every 4 pregnancies end in abortion representing 25% of all pregnancies, globally. Medicins Sans Frontieres (2020) reports that there has been a major decrease in most leading causes of maternal deaths worldwide over the past two decades, ‘one glaring exception remains: unsafe abortion’. MSF reports that estimates put the number of unsafe abortions each year at over 25 million, with 97% of them in developing countries; which lead to at least 22,800 deaths and millions of serious complications.

In Zimbabwe, a 2018 study by PLOS ONE organization found out that 66,800 induced abortions had been performed in the country. By 2019, the Parliamentary Portfolio Committee on Health and Child Care estimated that abortion stood as high as 80,000 cases per annum. These statistics also corroborate with findings of a research conducted by Guttmacher on abortion in Zimbabwe in 2016 which found that an estimated 66,800 induced abortions occurred in Zimbabwe. This translates to 18 abortions for every 1000 women aged 15-49.

These global and national statistics show that if anything safe abortion is a basic healthcare need for millions of girls, women and any other who become pregnant worldwide. Yet globally, only 50 countries have changed their legal and policy frameworks to allow increased access to safe abortion and Post Abortion Care (PAC). This low number of countries changing their legal and policy frameworks means that for millions of women and girls access to safe abortion is elusive. This forces them to engage in unsafe and illegal abortion which exposes them to devastating health complications including death.

Abortion legal framework in Zimbabwe

In Zimbabwe abortion is regulated by the 1977 Termination of Pregnancy (TOP) Act which provides for abortion under very specific circumstances. The law provides for four conditions as follows:

(i) To preserve the physical health of a woman – when a medical practitioner satisfies that a pregnancy is high risk likely to compromise the health of a woman or even cause death, abortion is allowed.

(ii) In case of rape – when a woman has been impregnated following an incident of rape, they are allowed at law to terminate the pregnancy.

(iii) In case of incest – this is when sexual activities between two people too closely related, like a brother and sister, results in pregnancy then such pregnancy can be terminated at law.

(iv) In case of fetal impairment – where there is a serious risk that the child to be born will suffer from a physical or mental defect of such a nature that they will permanently be seriously handicapped.
These are the only four legally recognized situations for which abortion is provided for. The limited scope means that very few abortions out of the close to 100,000 that occur in Zimbabwe per year are within the law. The majority of the abortions are occurring in backyards and in unsafe ways. Women and girls chose abortion for a variety of reasons such as mental health, contraceptive failure, pressure or lack of support from a partner, lack of preparedness, poverty, social pressures, economic challenges and career choices among others.

Criminalizing abortion will not stop abortion

Legal efforts to prevent women and girls from accessing safe medical abortion have done nothing to stop abortion. The effect of criminalization has been to push women and girls to seek unsafe means to access abortion.

These unsafe abortions often result in lifelong medical challenges for women and girls or even death. News agencies and NGOs report extensively every year on ‘backyard’ abortion related deaths and the figures are shockingly very high. According to the Zimbabwe Demographic Health Survey (ZDHS,2015) maternal mortality rate reduced from 651 per 100 000 live births to 462 deaths per 100,000 live births (MICS 2019). Despite the reduction, the maternal mortality rate is still unacceptably high. Unsafe abortion is the fifth maternal mortality cause, however there isn’t much conversation on this and also legislation remains limited restricting women and girls to access safe legal abortion services.

Yet even these figures could be a tip of the iceberg as most ‘backyard’ abortions go unreported. Women and girls who find themselves with unintended pregnancies will almost always seek to terminate even if the law does not recognize their right. This is absurd as laws must work for the people and clearly the numbers of abortions show that it must be provided for at law. Moreover, abortion touches on fundamental rights of privacy and dignity of women which the State ought to respect, protect and uphold.

Attitudes and knowledge of health care providers and experts to abortion

A 2019 study by Madziyire et al in the Pan African Medical Journal which explored knowledge and attitudes towards abortion by health care providers and experts. The study interviewed a total of 227 and its findings showed that 25% of providers and 47% of experts knew all the four reasons above under which abortion is legal in Zimbabwe. This means is that there is a big gap which poses contradictions between policy and practice regarding abortion as genuine legal cases can be denied. If those at the point of provision lack enough knowledge and show attitudes which are inconsistent with legal provisions it only makes access of abortion services very difficult for women and girls needing them.

Furthermore, an investigative story by Anadolu Agency in September 2021 reported that even registered doctors and medical workers participated in abortion realizing between US$150.00 to US$200.00 per month. This shows that even within the health sector the current legal framework premised on the middle ground approach fails to address the issue of abortion and practice points toward legalizing abortion and its time policy followed suit.

From the foregoing, it is clear that contrary to middle ground reasoning, abortion is not a moral dilemma but rather a basic health need for women and girls. Evidence from the numbers of ‘backyard’ abortions, the plight of women and girls suffer as a result of unsafe abortion, and the attitudes and knowledge of health care providers, and experts all point to one conclusion; that Zimbabwe must reform its abortion laws to allow for accessible safe abortion and Post Abortion Care (PAC) and save the lives of women and girls.

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