Abortion in one way is illegal but termination of pregnancy is legal -- but it goes with it some restrictive conditions, which deny women and girls liberty to abort unplanned pregnancies and they resort to still go ahead through clandestine and unsafe abortion.
This has created a huge crisis in Malawi and from surveys done, each year, over 141,000 women and girls have abortions -- almost all clandestine and the figure is likely to be higher because there are no records for those who successfully carried out the process.
The official figures are mostly obtained from government health facilities and from yet to be verified reports, there are many more women of affluent status, who have sought abortion services in private health facilities -- again clandestinely.
When the women's clandestine abortions goes awry, they rush to hospitals, especially the rural poor, who have to be treated for complications since the government allows for post-abortion health care.
This was enlightened by Centre for Solution Journalism (CSJ) during and interface meeting with senior media managers, to inspire the journalists on the need to amplify the abortion crisis in the country, yet a review of the Termination of Pregnancy (ToP) was completed and gazetted as a government Bill way back in 2016 and is gathering dust after it was submitted to the Ministry of Health in 2017.
CSJ Director, Brian Ligomeka observes that the first step to be done by Members of Parliament for the ToP Bill to be enacted into law, "is to have meaningful dialogue with their constituents on the Bill, which the Malawi Government through the Law Commission proposed".
"Members of Parliament should become the true representatives of their people," he said. "Most MPs in Malawi lose their seats because once they are elected they start representing their personal interest and political party interest.
"They completely ignore the interests of the women, the youth and the men who chose them. While their constituents are struggling with reproductive health challenges, the MPs act unconcerned."
He maintained that with the high maternal mortality rate in the country, the constituents will empower them to support the enactment of the bill, saying: "Let MPs represent the interest of their constituents including rape, incest victims, women who suffer from heart diseases and blood pressures who need good laws and policies on reproductive health that can benefit them when their lives are in danger."
According to surveys conducted by CSJ partners, data from various health facilities compiled by the Ministry of Health and non-state actors shows that the problem of unsafe abortion is big.
CSJ describes as encouraging development that the government has responded positively to the problem by setting up post-abortion care units and creating positions of its safe motherhood coordinators in all hospitals.
CSJ says: "Government has also effected the new marriage age, the ban on traditional birth attendants, the upscaling of family planning and the drafting of the proposed Termination of Pregnancy Bill -- all demonstrate how the government is addressing the problem from many angles.
"Data from health facilities justify government's response to the problem of maternal deaths some of which are caused by unsafe abortions.
"Magnitude-wise, data compiled by Ipas Malawi reveals that in 2022 alone, 3,395 women and girls induced unsafe abortions in Blantyre and sought treatment at post-abortion clinics in the district (Blantyre) health facilities.
"Trends show an increase in the number of women and girls seeking post abortion care after injuring themselves in unsafe abortion incidences. For example, health facilities in Blantyre provided post-abortion care to 665 women in 2020, the number rose to 1,144 in 2021 and further to 3,395 in 2022.
"The increase in the number of those seeking post-abortion treatment after suffering complications from backstreet abortions is not unique to Blantyre only -- as a similar trend is observed in Lilongwe, which recorded 1,098 post-abortion cases in 2020; 4,711 cases in 2021, and 7,851 in 2022.
"The trend is also present in rural districts such as Rumphi, which recorded 327 post-abortion cases in 2020, 448 cases in 2021, and 569 cases in 2022."
The pattern is the same countrywide as shown by a nationwide research by the Centre for Reproductive Health of the College of Medicine and Guttmacher Institute, which revealed in 2015 that over 141,000 women and girls in Malawi induce abortions every year.
The research report -- posted on https://www.guttmacher.org/news-release/2017/clandestine-and-unsafe-abortion-common-malawi -- reads "...research estimates 141,000 abortions occurred in Malawi in 2015, at an annual rate of 38 abortions per 1,000 women of reproductive age.
"...All indicate that abortion is common in the country. The majority of these procedures were performed under clandestine and unsafe conditions and often resulted in complications."
CSJ maintains that the research by the U.S.-based Guttmacher Institute and the College of Medicine, "comes as a national debate is underway in Malawi on whether to liberalise the country's abortion law by expanding the criteria under which an abortion can be legally obtained".
"Under the current law in Malawi, abortion is only permitted when it is necessary to save the life of the woman."
The surveys also indicate that treatment of unsafe abortion complications comes with a high cost from the services of food, clinicians time and bed as most such cases end up being admitted for some few days.
A past study tiltled 'Costs of post-abortion care in public sector health facilities in Malawi; 'A cross-sectional survey' published in 2015 (https://www.researchgate.net/publication/291010728_Costs_of_postabortion_care_in_public_sector_health_facilities_in_Malawi_A_cross-sectional_survey#pf5) indicates that "the median cost of treating one post-abortion care (PAC) case in public facilities is US$40".
Part of the research reads: "The median cost per D&C case (US$63) was 29% higher than MVA treatment (US$49). Costs to treat severe non-surgical complications (US$63) were almost five times higher than those of a simple PAC case (US$13).
"Severe surgical complications were especially costly to treat at US$128. PAC treatment in public facilities cost an estimated US$314,000 annually.
"Transition to safe, legal abortion would yield an estimated cost reduction of 20%-30%, thus CSJ believes the the figures of post-abortion care cases are rising, and so is the cost of their procedures.
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Ligomeka says the big lesson that "Malawi can learn is that countries which reduce maternal deaths take bold steps in addressing the major causes of maternal deaths which include hemorrhage, sepsis, obstructed labour, hypertensive disorders and unsafe abortions".
"Much as the other causes of maternal deaths are quickly addressed as they do not trigger controversies as the issue of abortion, but is is time the problem is addressed so that no single woman of girl should be dying from backstreet procedures.
"Our neighbouring countries such as Mozambique, Zambia, Zimbabwe and South Africa have changed their pregnancy termination laws and in the process reduced maternal deaths. We can do the same -- we are in the same region with these countries."
In his last words, Ligomeka said: "We are in the country where changing laws that benefit women is a huge problem as the patriarchal system and the champions of male chauvinism fight tooth and nail in the name of tradition, culture and religion.
"The enactment and setting up policies on Gender Equality Act, Marriage and Divorce legislation, Marriage Age and even Prevention of Domestic Violence Act faced serious challenges from the gurus of patriarchy.
"The sad part is that this type of resistance has fertile ground in poor countries like Malawi. In prosperous countries laws that uplift lives of women are prioritised.
"We need to do the same so that rape and incest victims can access good services. The enactment of Termination of Pregnancy law, which the government formulated, will bring huge relief to victims of sexual assaults and help in reducing maternal deaths while improving safe motherhood."
