By Mildred T. Mushunje (PhD)
Background
Abortion is a public health and human rights issue which remains highly stigmatized regardless of efforts to liberalise it. Zimbabwe is one of the countries with high cases of unintended pregnancies among adolescent girls, which contributes to unsafe abortions (ZDHS, 2015) and these account for about 5% to maternal deaths (Ministry of Health, 2015). Contrary to populist belief, abortion is permitted under the colonial Termination of Pregnancy Act of 1977 which allows for abortion under the specific circumstances of rape, incest and to save the woman’s life or preserve her physical health, or foetal impairment. Adolescents are defined by the World health Organisation (WHO) as those between the ages 10-19 years and young people as those aged between 10-24 years old. Adolescents account for almost one-quarter of the female population in Zimbabwe, and little is known about their experiences with abortion (Guttmacher, 2021). 22% of adolescent females aged between 15-19 years have begun childbearing and 70,000 illegal abortions are performed in Zimbabwe annually, many of them involving adolescents under 16 years old (Guttmacher, 2021).
According to Guttmacher (2016), adolescent girls and women in Zimbabwe had an estimated 45,000 unintended pregnancies in 2016, accounting for 17% of all unintended pregnancies in the country. The proportion was also higher among adolescents living in urban areas (53%) than among those in rural areas (35%). A higher proportion of unintended pregnancies ended in abortion among unmarried adolescents (13%) compared with married adolescents (6%), and among adolescents living in urban areas (25%) rather than rural areas (1%). Adolescents in rural areas have lower abortion rates which could be explained by limited information on available SRH services and the provisions of the ToP and forced marriages.
Challenges faced by Adolescents in accessing services
Adolescents are a diverse group and often face a multitude of challenges in obtaining sexual and reproductive health services, one of which is abortion services. Challenges include but are not limited to teenage pregnancies[1], child marriages[2], maternal mortality[3], unsafe abortions[4], Gender based violence[5], and high HIV prevalence[6].. These challenges reflect that sexual reproductive health constitutes an important aspect in public health. Attitudes and social norms have negatively impacted on the advocacy agenda for SRHR services and safe legal abortions. Adolescents’ ability to meet their reproductive health needs are often determined by factors such as marital status and urban or rural residence (Guttmacher, 2021). Barriers that keep adolescents from meeting their sexual and reproductive health care needs put these young girls at risk for unintended pregnancy and increase the chances that they will need to seek an abortion, which in most instances is unsafe. The limited/restricted access to SRH services for adolescent girls and young women is one of the leading causes of clandestine abortions.
Consent confusion:
Age of consent to services, though meant to protect children against sexual abuse and child marriages should not be used to deny adolescents SRHR services for those who require these. According to demographic health data for Zimbabwe, nearly 40% of girls and 24% of boys are sexually active before they reach the age of 18. A series of inconsistencies in the country’s legislative and policy framework related to sexual and reproductive health has contributed to significant confusion over whether people below the age of 18 need parental consent to access sexual health services. The limitation of access to sexual and reproductive health services to persons above 16 years of age is often linked to the age of sexual consent, which in Zimbabwe was set at 16 by the Criminal Law (Codification and Reform). The recent Zimbabwe’s Constitutional Court ruling suggests that the legal age of sexual consent should be increased from 16 to 18 years old. The notion is that a person under the age of 16 cannot legally have sexual intercourse and, therefore, can only access SRHS with a police report or adult company. If a child under the age of 16 years cannot legally consent to sexual intercourse at law, it is then presumed that a child under the age of 16 years does not need contraceptives or other SRHS, which is a belief that prejudices adolescents and has resulted in unintended pregnancies amongst adolescents. In Zimbabwe, the push to remove age restrictions on access to sexual and reproductive health has been conflated with the lowering of the age of consent. This confusion is compounded by various circles that advocate to raise the age of sexual consent from 16 to 18, in line with the constitutional provision that only people aged 18 and above are allowed to marry. The conflation of sexual consent and the age of marriage, informed by cultural and religious attitudes, has negatively impacted on adolescents’ access to SRHR services further pushing them to clandestine abortions.
A Call to Act
It is imperative that stakeholders prioritise the protection of adolescents from unsafe abortions by:
- Removal of age restrictions in accessing reproductive health services by adolescents, to enable them to access prevention tools which protect them from unintended pregnancies and unsafe abortions.
- That the age of consenting to sexual activity and the minimum age of marriage should not be linked to the age at which adolescents can access sexual and reproductive health information, education and services.
- Urgent review of the outdated ToP and consideration of the expansion of circumstances for a termination of pregnancy.
- Awareness raising and sensitization on the right of adolescents to access sexual and reproductive health information and services.
- Provision of age-appropriate Comprehensive sexuality education which goes beyond abstinence-only approaches
- Make SRHR services accessible and affordable to adolescents
[1] ‘17% of adolescents between 15-19 have ever been pregnant’- The Government of Zimbabwe National Adolescent and Youth Sexual Reproductive health strategy II (2016-2020), pg 04 [2] ‘One in four adolescents of 15-19 were married or in union by age 18’-ibid, pg 04 [3] Maternal Mortality rate in Zimbabwe is around 400 per 100 000 live birth, 24% of these are 15-19 year olds, ibid, pg 04 [4] 70, 000 illegal a year abortions take place in Zimbabwe- http://www.irinnews.org/featur e/2005/03/30/abortion-figures-underscore-need-more-reproductive-health-education [5] 13,9% of females of 18-24 years have experience physical and sexual violence- The Government of Zimbabwe National Adolescent and Youth Sexual Reproductive health strategy II (2016-2020), pg 06 [6] HIV prevalence is high among adolescent girls than boys- ibid, pg 05
