countries like Malawi, where safe abortion is restricted or not
available, women often turn to clandestine and unsafe abortions when
faced with an unintended pregnancy. However, abortion isn’t
uncommon—roughly 67,300 induced abortions occur annually in Malawi.
Unfortunately, neither are the injuries and even deaths that occur
because of the law and other barriers—such as stigma and lack of access
to services— that leave women with few safe options.
Roughly one in five women seeking postabortion care in Malawi suffers from severe, often life-threatening complications, such as sepsis, according to a study published in the International Journal of Gynecology and Obstetrics.
In 2009, the Malawi College of Medicine, Ipas
and the Ministry of Health’s Reproductive Health Unit conducted a
nationally representative study to estimate the severity of abortion
complications in health facilities and to determine the risks for women.
Data on 2067 women seeking postabortion care was collected from a
total of 166 facilities—primarily public and some private and
NGO—throughout the country.
According to a related study
published in June 2013, about 18,700 women were treated in health
facilities for complications from unsafely performed induced abortions
in the community in 2009. “What we found in this work is that severe
complications are common, particularly for rural and vulnerable women,”
says Brooke Levandowski, one of this study’s authors and lead author of
the 2013 study.
Women most at risk: a profile
More than 27 percent of the women presented
with one or more signs of complications; most frequently sepsis.
Overall, more than one third of the women were in their second trimester
of pregnancy, when the risk of complications is much higher. Almost one
quarter said they were using some form of contraception to prevent the
Most were married and from rural areas. The
study results show that women categorized as having severe or moderate
complications were more likely to live in a rural area, be separated,
divorced or widowed, more likely to seek care after the first trimester,
and to have attempted to interfere with the pregnancy.
It’s important to note, say the researchers,
when women’s access to safe abortion is restricted, women will seek
unsafe services or use unsafe methods to end a pregnancy.
When paired with previous studies and data
about abortion in Malawi, this study paints a stark picture. Eighteen
percent of maternal deaths are attributable to unsafe abortion,
according to the World Health Organization. Young women, poor women,
rural women and otherwise marginalized women suffer the most—from lack
of contraception and youth-appropriate services to scarce access to safe
abortion and postabortion care.
“This research highlights the tremendous
impact that unsafe abortion plays in maternal mortality, underscoring
the need to invest in women and ensure their access to comprehensive
reproductive health care, including contraception and safe abortion,”
says Hailemichael Gebraselassie, Ipas senior research advisor and
“This research definitely highlights the
need for law reform and widespread expansion of safe abortion services,”
adds Chrispine Sibande, Ipas Malawi senior policy advisor.
This study was part of a larger body of research conducted in Africa and supported primarily by the Consortium for Research on Unsafe Abortion in Africa
and its principal donor, the UK Department for International
Development. Additional funding was provided by the United Nations
Population Fund Malawi. For more information, contact email@example.com