Unpacking Zimbabwe’s post abortion care responsibility and gaps

By Memory Pamela Kadau

Across the world, abortion related complications constitute part of the major reasons women seek
emergency obstetric care. According to the Post Abortion Care Consortium, Post abortion care (PAC)
consists of emergency treatment for complications related to spontaneous or induced abortions. It also
includes family planning and birth spacing counseling, and provision of family planning methods for the
prevention of further mistimed or unplanned pregnancies that may result in repeat induced abortions.
Comprehensive PAC also includes services such as medical assessment for sexually transmitted
infections, including HIV/AIDS.

Zimbabwe, like other 180 countries, is bound by the 1994 International Conference on Population and
Development (ICPD). All the countries agreed that no matter what an individual country’s official position
on legalities of abortion, they would commit to provide health care services to women who need them.
Paragraph 8.25 of the 1994 ICPD convention states that, “In all cases, women should have access to
quality services for management of complications arising from abortion. Post abortion counseling,
education and family planning services should be offered promptly, which will help to avoid repeat
abortions.” It therefore means that Zimbabwe has a responsibility to provide quality PAC to all women
regardless of how a termination of pregnancy has occurred. It should be commended that Zimbabwe
public health services offers PAC services to women and girls.

It is important to note that abortion-related complications can result in severe morbidity. This is moreso,
in a situation where safe abortion is either unavailable or restricted, as the case with Zimbabwe’s
Termination of Pregnancy (ToP) Act. The limitations in access to safe abortion has seen the country
experiencing tens of thousands of unsafe or ‘back yard’ abortions each year. Worldwide, especially in
developing countries, abortion-related complications are a significant and preventable cause of maternal
mortality. Research shows that these account for 8–9% of maternal deaths globally, with 42 to 63 women
dying out of every 100 000 abortions.

[pullquote]Furthermore, a review of 70 studies from 28 countries estimated that at least 9% of women admitted to hospital for abortion-related reasons had a near-miss event, i.e., they had complications, such as severe hemorrhage, that would have most likely resulted in death had they not made it to hospital.[/pullquote]

However, in Zimbabwe, public health facilities are ill equipped to provide comprehensive PAC services especially in rural areas, informal urban settlements, mining, and farming communities. In most of these areas, cases of repeat abortions are common, and these can be reduced by integrating contraceptive services in abortion and post-abortion care services.

According to one study by Riley, Madziyire and Chipato; an estimated 65,000 abortions occurred in
Zimbabwe in 2016, and 40% resulted in complications that required treatment. The study evaluated two
components of quality of care: structural quality, using PAC signal functions, a monitoring framework of
key life-saving interventions that treat abortion complications; and process quality, which examines the
standards of care provided to PAC patients.

The research found critical gaps in the availability of PAC services; only 21% of facilities had basic PAC
capability and 10% of referral facilities had comprehensive capability. For process quality, only one-fourth
(25%) of PAC patients were treated with the appropriate medical procedure. The health system had only
41% of the basic PAC facilities recommended for the needs of Zimbabwe’s population, and 55% of the
recommended comprehensive PAC facilities.

These findings illustrate the large gaps in the availability and distribution of facilities with basic and
comprehensive PAC capability in the country. These structural gaps are a contributing barrier to the
provision of quality PAC services to all women needing them. The gaps are even more stark in rural,
informal peri-urban, mining and farming communities where health facilities are either not available or
poorly equipped. It is therefore clear that the country need to increase focus and investment in
expanding the provision of and improving the quality life-saving PAC services.

This is more important and urgent because PAC has been shown to lower mortality and morbidity related
to unsafe abortion, and to reduce future unwanted pregnancies by providing contraceptive services.
Additionally, Zimbabwe is bound by the 1994 ICPD to which it committed to address abortion-related
morbidity and mortality through the provision of quality health care. Part of the commitment must extend
to reforming abortion laws to make safe abortion available to all women requiring it.

In conclusion, evidence shows that despite the global commitment in 1994 by countries like Zimbabwe to provide quality post-abortion care, in practice there is still a long way to go. Increasing the provision of such care is essential to reduce the level of abortion related morbidity and mortality which is a major concern for women. Greater emphasis should be placed on preventing unwanted pregnancies and  nsafe abortion, and on improving access to PAC in health-care facilities (by fully funding PAC), especially in marginalized communities. In fact, missed opportunities to improve women’s health and
wellbeing include lack of access to safe abortion and PAC services. Making these available would go a long way in enhancing the bodily integrity of women in Zimbabwe.

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