Hope on the Horizon for Zimbabwe as health Ministry Signs Comprehensive abortion Care Guidelines

By Edinah Masiyiwa

The Acting Chief Director for Public Health, Dr W Nyamayaro, has signed off on the National Comprehensive Abortion Care (CA) Guidelines for Zimbabwe after more than a year waiting period. These guidelines follow the World Health Organisation’s Post Abortion Care Guidelines of 2022.  These guidelines will go a long way in saving many women and girls’ lives in Zimbabwe through comprehensive abortion care.

The CAC guidelines articulate the burden of unsafe abortion on the health delivery system as they highlight that each year, 4.7–13.2% of maternal deaths can be attributed to unsafe abortion. It is really encouraging that the guidelines now focus on comprehensive abortion care and not only post-abortion care, which is what the previous guidelines focused on. The CAC guidelines also highlight that unsafe abortion is one of the major public health problems in Zimbabwe. This recognition calls for more efforts to be put in place to reduce unsafe abortions. This focus on unsafe abortion indicates that the country is ready to tackle the problem of unsafe abortion to save lives.

While this is all positive news, I hope that the Ministry of Health will go further and 
examine whether the CAC is meeting all the needs of women and girls in Zimbabwe.  For 
instance, the guidelines highlight that abortion care will be given to those cases 
permissible under the current law. The law is however from 1977 and is no longer 
serving the present-day women and girls.

Zimbabwe is experiencing an increase in adolescent pregnancies, with most of them resulting in unsafe abortions.  A report by UNICEF Zimbabwe, the national assessment of adolescent pregnancy in Zimbabwe, was conducted to determine adolescent pregnancy prevalence in Zimbabwe and identify root causes leading to adolescent pregnancy, particularly in the wake of COVID-19. During that time, adolescent pregnancy was a significant problem with 69,000 girls aged 10 to 19 years giving birth in 2022.  A 10-year-old should not be giving birth. There are serious health, social and economic complications that come with adolescent pregnancy. Adolescents like Anna Machaya died at 15 years of age whilst giving birth, but she could have survived had the pregnancy been safely terminated.

Having CAC guidelines will go a long way in alleviating the challenges faced by women who have had abortions. It is encouraging that the CAC guidelines recognize the need for abortion services to be offered at all levels in the country as they highlight that “The government’s objective is to guarantee access to comprehensive abortion care to all the women who are at risk of complications of abortion. The service should also be accessible at all levels of health care in Zimbabwe including the primary level”.

The CACs are not all that Zimbabwe needs to save women from dying because of unsafe abortion. The Termination of Pregnancy Act (1977) needs to be reviewed. The Termination of Pregnancy Act has numerous gaps that have been identified. One of the gaps is the limited circumstances when legal abortion is allowed. It must allow adolescents below the age of 18 years to access safe abortion.

The popularization of the CAC guidelines by the Ministry of Health and Child Care and non-governmental organisations to communities must occur so that they are aware of the abortion services that can be offered at health centres. The awareness raising should also include the provisions of the current Termination of Pregnancy Act and highlight the gaps. There should be continuous information dissemination in communities to allow those who need abortion services to receive it. This way we will be able to fight the stigma associated with abortion.

As the country addresses the challenges brought about by unsafe abortions, we must also address ways to prevent unsafe abortions. One such solution is to allow abortion on demand. Another strategy is to allow sexually active adolescents to freely access contraceptives. Currently, only adolescents who are 16 years and above are allowed to get contraceptives.

Abortion care, particularly post abortion care for unsafe abortion, is very expensive. One of the recommendations from the Guttmacher study was to ensure adequate financing for health institutions to be able to provide the necessary abortion care.  The same study by Guttmacher Institute revealed that women who had unsafe abortion experienced delays in accessing treatment because of the costs of post-abortion care. Thus, adequate financing will therefore ensure the implementation of the CAC guidelines resulting in saving lives.

These guidelines are a step in the right direction for addressing unsafe abortions in Zimbabwe.

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