In Malawi, abortion is legal only to save a woman’s life. Yet despite this restrictive law, women in Malawi seek abortion for a variety of reasons, including poverty, unplanned pregnancy or fear of being forced out of school. In a study published in International Perspectives on Sexual and Reproductive Health, researchers report that more than 67,000 abortions were performed in 2009. The abortion rate in the country (23 abortions per 1,000 women of reproductive age) is comparable to the estimated abortion rate for the African continent (28 abortions per 1,000 women of reproductive age); however, is slightly lower than estimates for the Eastern Africa region (rate of 36 abortions per 1,000 women of reproductive age).
Lead author Dr. Brooke Levandowski, formerly senior research advisor for Ipas, and co-author Dr. Hailemichael Gebreselassie, Ipas senior research advisor, note that this study attempted to fill a gap in critical information: “Only a few studies on abortion and related morbidity and mortality had been conducted in the past decade in Malawi.” Co-author Dr. Chisale Mhango, who at the time of the study was director of Reproductive Health Services for the Malawi Ministry of Health, adds that the study aimed to gather evidence to inform policymakers about the health impact of unsafe abortion.
Unsafe abortion, according to the study, is common in Malawi. Roughly 18,700 women were treated in health facilities for complications from unsafely perfomed induced abortions in the community in 2009. To determine this, researchers primarily examined data from a nationally representative sample of health facilities—166 total. Of those 93 were public, 65 were run by nongovernmental organizations and eight were private. They also interviewed 56 health professionals from various health facilities and backgrounds.
The Northern region of the country experienced the highest abortion rate. In this region, married women appear to have greater access to contraception than in other parts of the country. Yet use of traditional methods which have higher failure rates are more likely to be used, likely accounting for the higher abortion rate. Related, women in the North seem to have completed more schooling than in other regions—particularly compared with those in the Central region, where women tend to have their first birth six years earlier. The Central region also has little exposure to media messages about contraception and reproductive health.
Overall, the study found a high unintended pregnancy rate of 139 per 1,000 women aged 15-44, illustrating that women need better access to contraceptive services. Young women in particular need the services; “Half of all women in Malawi seeking postabortion care are under age 24 and many young women ages 12-19 report having one or more close friends who have tried to end a pregnancy,” says Levandowski.
Unsafe abortion is a significant contributor to high maternal mortality in Malawi, with nearly 20 percent of maternal deaths occurring from complications of unsafe abortion. The time is now, urge the authors, to reduce these preventable deaths, through legal reform of the abortion law and expanded availability of safe services, and increased information about and access to contraception.
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