By Edinah Masiyiwa
As the country undergoes the budgeting process for the year 2025, it is time for the Zimbabwe Ministry of Health and Child Welfare to prioritise women’s access to maternal health services. The focus especially should be put on comprehensive abortion care guidelines as it greatly contributes to a reduction of maternal mortality.
This article will focus on the importance of having a well-funded post-abortion care programme.
Zimbabwe has the highest contraception prevalence rate in sub – Saharan Africa but also one of the highest maternal mortality ratios in the world. Currently, the maternal mortality ratio is at 363 deaths per 100000 live births. Complications around unsafe abortions are also contributing to maternal deaths, including from severe bleeding from a perforated uterus and severe infections arising from retained products of conception.
Despite the abortion restrictions, the lives of women who have had unsafe abortions in Zimbabwe have been saved through post-\abortion care, a programme that the Ministry of Health and Child Care has put in place. Without this programme, many lives would be lost due to unsafe abortions.
The World Health Organisation (WHO) defines post-abortion care as Provision of services after an abortion, such as contraceptive services and linkage to other needed services in the community or beyond. It can also include management of complications after an abortion. The abortion care guidelines by WHO further highlight that legal restrictions and other barriers mean many women find it difficult or impossible to access quality abortion care and they may induce abortion themselves using unsafe methods or seek abortion from unskilled providers. Legal status of abortion makes no difference to a woman’s need for an abortion, but it dramatically affects her access to safe abortion. The same guidelines further state that between 4.7% and 13.2% of all maternal deaths are attributed to unsafe abortions, which equates to between 13 865 and 38 940 deaths caused annually by the failure to provide safe abortion.
A study done by the Guttmacher Institute in 2016 revealed that nearly all abortions in Zimbabwe are clandestine, with many resulting in complications that require medical treatment. Dr E Sully who was one of the researchers in the study had this to say about post abortion care, “Women in Zimbabwe who experience complications from unsafe abortion face many obstacles to receiving the treatment they need.”
The programme is there on paper, but women cannot access it.
There are several challenges faced by women as they seek post-abortion care. Firstly, only a small percentage of health facilities have the capacity to provide basic or comprehensive post-abortion care services. Secondly, women delay access to the service because of lack of money or lack of transportation. Thirdly, health facilities frequently run out of essential supplies like misoprostol, blood for transfusions, and intravenous antibiotics. Finally, there is the stigma associated with abortion that results in women delaying to seek post abortion care. A census of 227 facilities providing post-abortion care in Zimbabwe revealed that many women face judgmental attitudes and social stigma when seeking care.
The work that is being done by some organisations to request a review of the Termination of Pregnancy Act is taking time. In order to save lives, the focus should meanwhile be put on the Comprehensive Abortion Care Guidelines which provide for post-abortion care. The guidelines highlight that, each year, 4.7–13.2% of maternal deaths can be attributed to unsafe abortion. Guidelines clearly outline the burden of unsafe abortion in Zimbabwe which requires a strong post-abortion care programme.
I therefore call upon everyone to continue raising awareness on the importance of safe post-abortion care. Refer everyone who has had an unsafe abortion to the nearest health facility for post-abortion care. I also call upon the Ministry of Health and Child Care to put enough resources in health centres so that women have quality services. A study done by Guttmacher Institute revealed that health centers did not have the essential supplies for post-abortion care such as misoprostol, blood and antibiotics. It is therefore important for the national health budget to ensure all the supplies are available for post-abortion care if we are serious about saving lives.
Health workers should be trained to address abortion stigma so that women who have had unsafe abortions feel safe to seek health services.
Finally, I call for the government to allocate 15% of the national budget to the Ministry of Health and Child Care as per the Abuja Declaration.
