By Mildred Mushunje (PhD) & Dean Mutata (BSc, MSc)
Background
Zimbabwe’s health crisis is often framed in terms of economic decline or health financing gaps. Yet there is another crisis, silent, gendered, and entirely preventable, rooted in abortion policy inaction. Trapped between inherited colonial law, religious anxiety, and political discomfort and misinformed moralistic judgemental attitudes, Zimbabwe’s abortion discourse has remained stagnant, while women continue to die. The cost of this inaction is not abstract; it is counted in maternal deaths, post-abortion costs, unsafe procedures, and lifelong health consequences for young women- all of which are preventable.
Evidence illustrates the scale of the problem. An estimated 18 abortions occur per 1,000 women aged 15–49, translating to approximately 66,800 abortions annually (Guttmacher Institute, 2018). Yet fewer than 1% of these occur within the legal framework. The last comprehensive abortion research was conducted by Guttmacher in 2018, and based on current trends, statistics of unsafe abortions have significantly increased. This stark disparity demonstrates that Zimbabwe’s law does not prevent abortion; it merely forces it underground.
Maternal mortality remains unacceptably high. Current preliminary census-linked estimates place the maternal mortality ratio at 212 deaths per 100,000 live births, far above regional and global targets[1]. Though above regional targets, this marks an improvement as follows:
- maternal mortality rate for 2022 was 368.00, a 17.49% decline from 2021.
- In 2021, it was 446.00, a 17.37% increase from 2020.
- In 2020 it was 380.00, a 2.06% decline from 2019[2].
Health facility data indicate that abortion-related maternal deaths accounted for approximately 25% of all maternal deaths in Zimbabwe in 2018, underscoring unsafe abortion as a major contributor to maternal mortality. These complications, haemorrhage, uterine perforation, and infertility consume scarce health resources while causing entirely preventable suffering.
At the centre of this crisis lies the Termination of Pregnancy (TOP) Act of 1977.Despite progressive policy commitments to health and development, Zimbabwe’s restrictive Termination of Pregnancy Act of 1977 continues to impede safe access and fuel clandestine abortion, forcing the health system to treat preventable tragedies. Zimbabwe is party to the to the Maputo Protocol and yet the implementation of this protocol remains limited.
The Law and Consequences
The TOP Act of 1977 permits abortion only under three defined circumstances: Threat to the woman’s life, severe physical or mental abnormalities, the foetus has severe physical or mental abnormalities, or the pregnancy results from unlawful sexual intercourse (rape, incest). These provisions are entangled in procedural barriers that make lawful access nearly impossible. Requirements for multiple medical certifications, legal confirmation in cases of sexual violence, and approval from designated legal officers (Magistrate) create delays that are incompatible with the time-sensitive nature of abortion care.
For adolescents, rural women, survivors of sexual violence, and those without financial means, these administrative hurdles are insurmountable. The result is predictable: women seek alternatives outside the formal health system. Backyard abortion is not a cultural anomaly; it is the rational response to a system that blocks safe, legal care.
The Dangerous Comfort of Inaction
In Zimbabwe and many countries with restrictive abortion laws, inaction is often justified as moral neutrality or respect for religious and moral values. It is a political choice with negative health consequences. Preserving restrictive laws in the name of social cohesion or religious appeasement does not prevent abortion; it simply transfers risk from the state to women’s bodies[3].
Religious and cultural beliefs deserve respect, but they cannot serve as the basis for public health policy. When ideology overrides evidence, health systems fail their most vulnerable populations. The 2023–24 Zimbabwe Demographic and Health Survey (ZDHS) reports neonatal mortality at 37 deaths per 1,000 live births, the highest ever recorded. Inaction, particularly when driven by fundamentalism, becomes a form of harm.
Correcting the Narrative: It is about public health and access to health services
The damaging myth in the abortion debate is the idea that proactive legal reform promotes moral decay. This framing is both inaccurate and counterproductive in achieving positive health outcomes. Revising administrative grounds to access safe abortion care is not an endorsement of abortion as a moral good; it is an acknowledgement of reality and a commitment to protecting life and health.
The goal is not to encourage abortion, but to prevent death and health-associated impairments. Legal frameworks that remove barriers enable health systems to function effectively, reduce the need for emergency interventions, and uphold dignity. The real moral failure lies in allowing preventable deaths to continue in the name of abstract values.
Conclusion- From Silence to Responsibility
The battle before Zimbabwe is not between belief systems, but between action and neglect. Women are already making reproductive decisions; the question is whether the state will ensure those decisions are navigated safely or abandon women to risk and punishment. Revisiting the TOP Act is not radical. It is responsible governance and gender equality. It is evidence-based public health policy. And most importantly, it is a step toward saving lives. The cost of inaction is high on a crumbling health system. Let us act now to avert unnecessary maternal mortality.
[1] https://dhsprogram.com/pubs/pdf/PR160/PR160.pdf
[2] https://www.macrotrends.net/global-metrics/countries/zwe/zimbabwe/maternal-mortality-rate
[3] https://www.pulp.up.ac.za/images/edocman/edited-collections/abortion_law_reform/Chapter%2012.pdf
