Brenda Zulu
8 June 2009
ACCORDING to a recent Press report, a male nurse in Samfya is on the run after conducting a failed abortion which resulted in the death of a female teacher.
Both the district health authorities and the police confirmed the incident which is just one of the many such deaths caused by backstreet abortions.
Like many other women, the teacher sought a backstreet abortion because she did not know that she could get help from a Government health facility to carry out a safe abortion.
It is also not unlikely that the run-away nurse could be one not well versed in the programme just introduced by the Government- Comprehensive Abortion Care (CAC).
Backstreet abortions are the reason why the Government is still far from achieving the Millennium Development Goal (MDG) number five, aimed at reducing maternal mortality by three quarters by 2015.
Unsafe abortions are one of the top five causes of maternal mortality in Zambia. In 1998, the Ministry of Health introduced post-abortion care (PAC), a service currently available in all the provinces.
While the scale up of PAC continues, it has been realised that the programme needs to be expanded to CAC, which is a continuum of care and will involve prevention of unplanned pregnancies through intensified information, education and communication, expanded family planning services and management of unsafe abortion.
Following the successful development and validation of the CAC standards and guidelines in Zambia, the Ministry of Health, in collaboration with IPAS Africa Alliance, has planned to launch this document.
It is in the quest to improve maternal health care and reduce maternal mortality in Zambia that the Government has introduced several interventions in reproductive health to address the main cause of maternal mortality, including obstetric hemorrhage, obstructed labour, hypertensive disorders, sepsis and unsafe abortion.
In this endeavour, the Government is encouraging integrated packages including CAC, which is an integration that seems to have scored some gains, especially as the country has managed to reduce maternal mortality so far.
At the moment, Zambia's maternal mortality rate stands at 591 for every 100, 000 live births and it is estimated that up to 30 per cent of these result from unsafe abortion.
The Ministry of Health also estimates that about 23 per cent of incomplete abortions occur among women younger than 20 years while 25 per cent of maternal deaths are due to induced abortions in girls younger than 18 years.
Hospital-based studies show that 30 to 50 per cent of acute gynaecological admissions are currently as a result of abortion complications, a big proportion being from unsafe abortion.
It is in this context that the Ministry of Health is yet again introducing CAC which, if adequately implemented, will significantly reduce unnecessary deaths from unsafe abortion, a cause that is totally preventable.
Evidence points to many women, many of whom are girls, resorting to unsafe methods to terminate pregnancies, thus endangering their lives.
It is hoped that the standards and guidelines for reducing unsafe abortion morbidity and mortality in Zambia will reduce unnecessary deaths from unsafe abortion.
The Government, through its Reproductive Health Policy, advises that reproductive health needs should be addressed in an integrated manner rather than in parallel compartments, more so that reproductive ill-health results from complications of pregnancy including unsafe abortion, reproductive tract infections, cancers, STIs. HIV/AIDS, infertility and violence against women, which are all inter-related.
The purpose of the standards and guidelines document is to ensure that women prevent unwanted pregnancies and those with unwanted, unintended, or risky pregnancies get appropriate services to prevent the occurrence of unsafe abortion and associated morbidity and mortality.
The document, which will be launched next month, is based on sound current scientific evidence of safe medical practice and, therefore, provides a basis for the provision of equitable and quality comprehensive abortion services as close to the people as possible.
The standards and guidelines document is directed at health providers, managers and policy makers involved in the provision of abortion related services.
It is hoped that women who have been victims of unsafe abortion will no longer suffer preventable morbidity and mortality irrespective of their social status or the part of the country they come from because the guidance will be institutional in both public and private health facilities.
The document has been developed within the tenets of the international human rights framework. The Zambian Government has ratified a number of legally binding international agreements that protect human rights, in particular the right to life, liberty and security of a person, the right to the highest attainment standards of health, the right to non-discrimination, the right to be free from inhuman and degrading treatment and the right to education and information.
In the foregoing, global consensus on the international human rights framework for reproductive health has been reached at various levels including the International Conference on Population Development (ICPD), the Tehran Proclamation, the 1995 Fourth World Conference on Women and the 2000 United Nations Summit.
Further, the document seeks to operationalise provisions of the Maputo Plan of Action and the protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa that are concerned with reproductive health and abortion.
The document also seeks to enhance the implementation of ICPD and ICPD + 5 plans of action, International Covenant on Economic, Social and Cultural Rights, International Covenant on Civil and Political Rights, Committee on the Elimination of Discrimination against Women and Convention on the Rights of Children.
A needs assessment for PAC was conducted in 1998 and the findings indicated that abortion complications were predominant.
Family planning use was very low and access to safe abortion services was restricted due to ignorance by policy makers, providers and society of the law on abortion.
PAC, an integrated package consisting of emergency abortion care, family planning and linkage to other RH services, was thus introduced.
Many successes have been noted with the PAC programme and many providers, have been trained in the use of manual vacuum aspiration and, because these services have been decentralised to lower level, many women do not have to travel long distances to access services.
Contraceptive prevalence rates have also continued to increase as indicated by the Zambian Demographic Health Survey.
However, the maternal mortality ratio has not correspondingly come down as many women continue dying from complications of unsafe abortion.
Owing to the foregoing, the Ministry of Health, in collaboration with the World Health Organisation and IPAS Africa Alliance, commissioned a strategic assessment into problems of unsafe abortion in 2008.
The exercise had the following three strategic objectives:
The assessment had pertinent findings that spanned across programmatic issues manifest through socio-cultural barriers and policy shortcomings.
One of the main findings was that abortion services are being provided in a vacuum.
It was noted that while the law exists, it does so on a stand-alone basis with no clear policy framework for standards and guidelines in implementing the services.
This led to the Ministry of Health taking steps to develop the document and it is hoped that it can fully attend to the challenges of unsafe abortion by introducing a holistic approach of PAC.
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