Malawi: reducing abortion-related deaths

Unsafe abortion is one of the main causes of the high rate of maternal deaths in Malawi.

This was the grim conclusion of a 2011 study commissioned by the Malawi Ministry of Health.

The rate of abortion in Malawi is high compared to global averages. And unsafe abortion is particularly high among young women: around a third of adolescents aged 15–19 reported having a close friend who tried to end a pregnancy, as did a fifth of those aged 12–14.

Despite the restrictive abortion laws – legal abortion is only permitted to save the life of the mother – many women faced with unplanned pregnancies have no choice but to seek the services of unqualified backstreet abortion providers, often with life-threatening consequences.

Why so many?

A number of factors lie behind these statistics.

The age of sexual consent is 13 in Malawi, while the minimum age for marriage is 18, or 15 with parental consent.

Malawians start sexual activity at a young age: 37% of girls and 60% of boys aged 15–19 have had sex, and a third of young women have begun childbearing.

Ignorance, misinformation and reluctance to use health services also play a part in making Malawian teenagers particularly vulnerable to poor sexual and reproductive health, including complications from unsafe abortion.

Contraceptives hard to access

Young people saw prevention of unplanned pregnancy as a necessary first step in reducing abortion-related deaths.

However, their access to contraception is limited by a number of factors including the lack of availability of methods most suitable for young people, such as condoms or emergency contraception; inaccurate information and fear of contraceptives; gender inequality and inability to negotiate safe sex.

Judgmental attitudes of health providers and religious and cultural conservatism are also a problem.

In an interview with the largest faith-based health NGO in Malawi, I was told that facilities run by the Catholic church promoted ‘selected methods’ such as abstinence or the natural method.

Even where contraceptives are available, other factors further hinder access.

During a visit to the Dowa District Health Facility, where Save the Children runs a maternal and newborn health programme, I visited a twice-weekly ‘centre’ for young people. The nurse on duty acknowledged that the fact that the youth centre is run from the STI clinic was not ideal as young people were reluctant to for fear of being seen ‘going through that door’, and the resulting stigma for them and their families.

Nchanda ni Nchanda

Save the Children’s Nchanda ni Nchanda (Youth to Youth) project, which works to improve the health and well-being of young people aged 10-24, is a good example of the kind of non-judgmental, confidential, adolescent-friendly services that Malawi needs.

The project has created 30 Youth Resource Centres which offer community-based sexual and reproductive health services for hard-to-reach young people. They use trained agents to provide counselling and contraceptive services to young people and help organise Teen Mother Clubs to support young mothers with information, life skills development and employment training.

More than half of Malawi’s people are under 18.  If the country is to achieve Millennium Development Goal 5, to reduce maternal mortality and provide universal access to reproductive health by 2015, there has to be sustained global effort to support Malawi’s young people to realise their sexual and reproductive health rights.