Nearly all abortions in Zimbabwe are clandestine, with many resulting in complications that require medical treatment. However, half of women who experience complications from unsafe abortion in Zimbabwe never receive the care they need. These findings come from a new study conducted by researchers from the University of Zimbabwe College of Health Sciences Clinical Trials Research Centre (UZCHS-CTRC), the Zimbabwe Ministry of Health and Child Care and the U.S.-based Guttmacher Institute. The study, which provides the first comprehensive estimates of the incidence of abortion and postabortion care in Zimbabwe, was conducted in an effort to understand the potential impact of unsafe abortion on maternal injury and death in a country that has among the highest maternal mortality ratios in the world. The findings are based on surveys of all health facilities in the country, as well as experts on abortion and women seeking postabortion care—which includes treatment for complications from unsafe abortion and miscarriage—and were published in the journals PLOS ONE and BMJ Open.
Abortion in Zimbabwe is only legally permitted to save the life of the pregnant woman or in cases of rape, incest or fetal impairment. Even under these circumstances, it is extremely difficult for women to obtain legal abortions at a health facility. In 2016, there were an estimated 66,800 abortions in Zimbabwe. This translates to one of the lowest abortion rates in Sub-Saharan Africa—18 abortions per 1,000 women of reproductive age—or roughly half the regional abortion rate for Eastern Africa, which is 34 per 1,000 women. However, virtually all abortions in Zimbabwe are clandestine and likely unsafe. Some women travel outside of Zimbabwe to obtain an abortion, such as to neighboring South Africa, where abortion is legal.
"Zimbabwe’s low abortion rate is likely a result of successful family planning programs and the high rate of modern contraceptive use," says Dr. Tsungai Chipato, researcher at UZCHS-CTRC and a lead investigator of the study. "Effective contraception helps women and couples avoid unintended pregnancy, which is the most common reason for abortion."
Four in 10 women in Zimbabwe who had clandestine abortions in 2016 experienced complications—such as haemorrhage and infections—that required medical treatment. However, only half of women who needed treatment received it.
"Women in Zimbabwe who experience complications from unsafe abortion face many obstacles to receiving the treatment they need," says Dr. Elizabeth Sully, senior research scientist at the Guttmacher Institute and a lead investigator of the study. "Our research finds that many health facilities lack the equipment, supplies and trained staff necessary to provide postabortion care."
In the study, many women seeking postabortion care reported experiencing substantial delays between being seen at a health facility and receiving complete treatment, often due to lack of money, wait times, staffing shortages or inability to get complete treatment at a single facility. In the three months prior to the study, more than half of all public and private facilities designated to provide postabortion care reported they had shortages of misoprostol, an essential medication for postabortion care, and over one-third reported running out of essential supplies including blood for transfusions and intravenous antibiotics.
The vast majority of postabortion care in Zimbabwe (85%) is provided at public health facilities. The Ministry of Health and Child Care has made efforts to expand and improve postabortion care services in order to reduce maternal mortality, such as revising national guidelines in 2014 to make these services available at a broader range of facilities. However, ongoing economic difficulties in Zimbabwe have limited the capacity of the health system to provide postabortion care services.
The researchers found disparities in the severity of postabortion complications among women depending on place of residence, marital status and age. Rural women seeking postabortion care in 2016 had twice the odds of experiencing severe complications as their urban counterparts. And adolescent women, who have the highest unmet need for contraception in Zimbabwe—which increases their risk of experiencing unintended pregnancy and, in turn, clandestine abortion—were more likely than women older than 30 to experience severe complications.
Given these findings, the researchers recommend loosening legal restrictions on abortion in Zimbabwe, and increasing awareness among health providers and the public about when it is legal to obtain an abortion under the current law, so that more women can access safe procedures. Efforts to ensure the availability of postabortion care must be expanded in order to reduce injury and death from unsafe abortion. This includes ensuring that public health facilities have the supplies, equipment and trained providers they need in order to offer this critically needed service.
Ultimately, continued investment in family planning is critical to help women—particularly women who are young, unmarried, poor or living in rural areas—avoid unintended pregnancy.
This study was made possible by the Swedish International Development Cooperation Agency, UK Aid from the UK Government and the Dutch Ministry of Foreign Affairs. The views expressed are those of the authors and do not necessarily reflect the official positions or policies of the donors.
For more information, see the full articles:
"Abortion in Zimbabwe: A National Study of the Incidence of Induced Abortion, Unintended Pregnancy and Post-Abortion Care in 2016," by Elizabeth A. Sully, Mugove Gerald Madziyire, Taylor Riley, Ann M. Moore, Marjorie Crowell, Margaret Tambudzai Nyandoro, Bernard Madzima and Tsungai Chipato, is available online in PLOS ONE.
"Severity and Management of Postabortion Complications Among Women in Zimbabwe, 2016: A Cross-Sectional Study," by Mugove Gerald Madziyire, Chelsea B. Polis, Taylor Riley, Elizabeth A. Sully, Onikepe Owolabi and Tsungai Chipato, is available online in BMJ Open.