Former chairperson for sexual and reproductive health champions Patricia Manyengo recalls how her friend was defiled while they were in Form Two at Bangwe Private Secondary School in Blantyre.

Her memory takes her back to a sexual violation that ended, sadly, in her death.

Manyengo: Rape is no bragging matter

“The rapist was not known. She went to a herbalist to get an abortion. It was botched. She died from the complications,” she refreshes.

Manyengo believes Malawi’s dragging feet on the Termination of Pregnancy Bill is putting minors who are raped at high risk of unsafe abortions leading to death or raptured wombs.

Affirms Manyengo: “Rape is something we can’t brag about. By denying girls who are defiled access to safe abortion, you submit them to trauma all their lives. What will they think when they see the child? It is very different from a situation where a girl has a pregnancy from a boyfriend where they were not ready.”

Another youth rights activist, Tisungane Sitima, says of the many cases she has encountered, she recalls of one girl in Mwanza who was defiled and was made pregnant. Although the family agreed to terminate the pregnancy, they could not afford the service at a private clinic.

“They opted to go to a herbalist. It was an unsafe abortion so she had to be taken to the hospital for post-abortion care [PCA]. The cost of such assistance is higher than the cost of having a safe abortion. When we talked to a herbalist in the district, he told us out of the 10 cases he works on, six end up going for care,” she said.

While the rapists in both cases remained unknown, another Chiradzulu-based youth, Gladys Kandunji, believes even where the rapist is known, the trauma on the pregnant girl or woman will live with victim for the rest of her life.

“The rapist may serve a jail term for their crime, but what about the girl?” she said.

A 15-year-old girl in Nsanje explained how she went for PAC at the district hospital following a back alley abortion at the herbalist’s went awry.

“I got the pregnancy during a kusasafumbi ritual. I don’t even know the man who did this to me but my mother told me to take some drugs to end it,” said the girl.

Gender Coordination Network chairperson Emma Kaliya says with the youth speaking out on the issues on rape, pregnancy and abortion, there is hope the proposed new law may see light of the day in future.

Observes Kaliya: “There is hope that one day, Parliament with the youth in the majority will pass the Bill. They will care more about their people. MPs know women and girls are going for backstreet abortions but they fear losing votes if the bill is passed.”

At times, the Bill has attracted demonstrations. For Kaliya, that is hypocrisy.

“Some have demonstrated against the Bill, yet they have never demonstrated against rapists. Most of the rapists have a religion they belong to,” says Kaliya.

Sexual and reproductive health expert who is also a lawyer and human rights actovist Dr Godfrey Kangaude says that since legal reforms take long, the grey area in the law where women and girls made pregnant from rape and defilement are denied access to abortion in public health facilities requires an ‘authoritative intepretation’.

He said since clinicians interpret the law as prohibiting abortions unless there is a threat to life, they deny the service.

“However, when we met with health practitioners, including obstericians and gynaecologists, they affirmed that the pregnancy of a minor, especially a traumatic one like defilement is risky. So, the minor should be offered a termination,” he says.

According to him, while legal reforms are taking long, the matter can be challenged in court. “One way is for a girl or woman who believes that her rights have been infringed upon when she was denied an abortion, she can sue,” says Kangaude.

Yet, there are some problems. “Abortion is a controversial issue. So, girls and women fear exposure to the public if they initiate legal proceedings. Another thing is that those who can do so can afford discreet services at a private clinic are not interested in litigation,” he observes.

Referring to a case in 2021 where a girl aged below 15 sued a One Stop Centre of a public hospital refused her an abortion of a pregnancy resulting from defilement. The matter, however, did not proceed to a judicial review.

After nation-wide consultations, in July 2015, the Malawi’s Special Law Commission on the Review of the Law on Abortion released a draft Termination of Pregnancy Bill, which, if Parliament approved, would have liberalised abortion.

Under the Bill, conditions for abortion would have been broadened to include where termination would prevent injury to the physical or mental health of the woman, there is severe malformation of a foetus, and where pregnancy is a result of rape, incest, or defilement.

The proposed law provides that where health workers feel it is against their conscience to terminate a pregnancy , they would refer it to fellow practitioners.

Parliament blocked a motion to introduce the Bill in the National Assembly. In June 2021, the motion was withdrawn.

As the Bill gathers dust, spot checks in labour wards of a number of hospitals in the country showed a number of women being treated for back alley abortions.

Hospitals in Salima, Nsanje and Rumphi affirmed some girls and women use cassava vines, bicycle wheel spokes, labour-inducing pills and other herbs to terminate pregnancies.

A clinical officer in one of the hospitals, opting for anonymity, said: “Some women use prescription drugs like misopostrol, a drug often sold under the brand name Cytotec, which is normally used to induce labour and control bleeding when taken under a doctor’s direction. But some insert the pills through their private parts when they want to abort. We discover the pills while treating women of unsafe abortion complications.”

In a separate interview, Chiradzulu post-abortal care coordinator Blessings Kadzuwa said from July to September last year, 247 women were treated. He said as a district, one of the problems they face is lack of resources for the PCA, pressures which could have been easier if access to safe abortion was upheld.

“The figures could be higher since most of those seeking PAC go to private clinics. Unsafe abortion ranks third in cases of maternal deaths after excessive bleeding and sepsis [body’s reaction to severe infection] during labour,” he said.

In 2015, the BioMed Central Health Services Research conducted an in-depth survey on treatment categories of PAC conducted in the country. It also dwelt on three uterine evacuation procedures of manual vacuum aspiration (MVA), dilation and curettage (D&C) and miscropostol-alone in 15 public hospitals. These are means to pump out residues after a botched abortion.

It showed that the cost of D&C, at $63 (about K64 000), was 29 percent higher than an MVA at $49 (about K50 764). A severe operation is as high as K132 480. A spot check in private clinics conducting safe abortions, the cost was no more than K30 000.

The research showed that Malawi uses about K325 million annually to provide PAC, which could be reduced by 20 to 30 percent if the laws were flexed.

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