By Memory Pamella Kadau
Zimbabwe’s recent revision of its Comprehensive Abortion Care Guidelines marks a significant step forward in addressing the persistent challenge of high maternal morbidity and mortality linked to complications of abortion (Zimbabwe Ministry of Health and Child Care, 2023). Despite previous efforts, the burden remains evident, with abortion complications ranking as a major cause of maternal deaths in both rural and urban settings, according to a community-based study conducted by the Zimbabwe National Health Department (Zimbabwe National Health Department, 2022). This study further revealed that abortion complications accounted for 15% of maternal deaths in rural areas and 23% of maternal deaths in urban areas (Zimbabwe National Health Department, 2022).
The need for comprehensive reform is underscored by the significant delays women face in accessing post-abortion care, as highlighted by data from several research works. Delays in treatment, often due to financial constraints, lack of transportation, and long distances to health facilities, exacerbate the risks and consequences of unsafe abortion or miscarriage. Moreover, the lack of post-abortion care services in primary health centres, particularly in rural areas where they are most needed, further impedes access to timely and appropriate care.
Compounding these challenges is the financial barrier faced by many women seeking post-abortion care, with some public facilities requiring payment for services that are meant to be provided free of charge. This practice not only delays treatment but also perpetuates inequalities in access to essential healthcare services. Additionally, the use of surgical procedures not recommended by the World Health Organization (WHO) or national guidelines further increases the risk of complications and undermines the safety and effectiveness of abortion care.
In response to these systemic issues, Zimbabwe’s revised guidelines prioritize the adoption of evidence-based recommendations, aligning with WHO guidelines on abortion care. By ensuring facilities are adequately equipped, staffed, and trained to provide recommended medicines and procedures, particularly manual vacuum aspiration and the use of approved medications, the guidelines aim to improve the accessibility, safety, and quality of abortion care services, particularly at the primary health centre level. This holistic approach emphasizes the importance of addressing barriers to care and promoting evidence-based practices to safeguard the reproductive health and rights of women in Zimbabwe.
Legal gaps persist
While the Comprehensive Abortion Care guidelines represent a significant step forward in addressing the healthcare needs of women and girls in Zimbabwe, existing legal barriers continue to restrict access to safe abortion services, perpetuating risks to women’s health and rights. The Termination of Pregnancy Act of 1977, while providing limited legal grounds for abortion under specific circumstances, imposes stringent requirements and procedural hurdles that often impede timely access to care. For instance, the Act only allows abortion in cases where the woman’s life or physical health is at risk, the foetus is likely to be born with a serious defect, or the pregnancy results from unlawful intercourse. However, the Act mandates cumbersome certification processes involving multiple physicians and judicial authorities, as well as restrictions limiting abortion provision to designated institutions.
These legal restrictions pose significant barriers to access for women and girls in need of abortion services, particularly those residing in rural or underserved areas with limited access to designated healthcare facilities. Moreover, the narrow scope of permissible grounds for abortion fails to adequately address the diverse circumstances in which women may seek to terminate a pregnancy, such as cases of fetal anomaly, sexual violence, or socioeconomic hardship. As a result, many women resort to unsafe abortion methods or delay seeking care due to fear of legal repercussions, exacerbating the risks to their health and well-being. Therefore, while the introduction of Comprehensive Abortion Care guidelines is a positive development, Zimbabwe needs to undertake robust legal reforms aligned with international best practices to ensure that women and girls have access to safe, legal, and timely abortion care that respects their rights to autonomy, dignity, and healthcare.
Conclusion
In summary, the revised Comprehensive Abortion Care guidelines in Zimbabwe offer a significant step forward in addressing women’s reproductive healthcare needs. While they provide essential guidance for healthcare providers, they cannot fully overcome the existing legal limitations surrounding abortion access. The Termination of Pregnancy Act of 1977 remains restrictive and cumbersome, hindering women’s ability to access safe abortion services. Moving forward, comprehensive legal reforms are necessary to align abortion laws with international standards and ensure women’s reproductive rights are upheld.
In the next instalment, I will provide a deeper analysis and propose advocacy efforts that are needed to explore how the guidelines can be effectively implemented to improve abortion care and promote women’s bodily autonomy.
