Access to safe abortion care in Malawi is difficult. Women seeking abortion are challenged by a complex legal landscape and medical facilities that are not prepared to provide abortion services. These conditions sometimes drive women to resort to unsafe abortion methods to terminate unwanted pregnancies; a proportion of these women die from their complications.

A recent High Court judgment in Malawi has created an opportunity to improve access to abortion services by clarifying that a risk to life includes both physical and mental health. This fact sheet summarizes the current legal situation, service provision landscape and social attitudes toward abortion access in Malawi and outlines actions to continue improving access to safe abortion care in the country.

Abortion Law in Malawi

Malawi’s abortion law (based on the 1930 Penal Code) has been highly restrictive, allowing termination of pregnancy only where it is necessary to save the life of the woman.¹ The adoption of a democratic constitution in 1995 introduced a comprehensive Bill of Rights, including specific rights accorded to women and children.

This framework was strengthened with passage of the Gender Equality Act in 2013 (implemented in 2014), which recognizes sexual and reproductive health and rights. However, lack of guidance on how protections should be operationalized has resulted in health providers relying almost exclusively on the Penal Code. This has led to widespread uncertainty and restrictive interpretations of abortion provision within the health system. As a result, even women and girls whose pregnancies posed serious risks to their life were often denied services.

In October 2025, the High Court of Malawi delivered a pivotal judgment in AC (a Minor) v. Solomon and Others, a case about a 14-year-old survivor of sexual violence who was denied access to safe abortion.² The Court held that denying her abortion services violated her sexual and reproductive health and rights under the Gender Equality Act.

• The Court clarified that a risk to life includes both physical and mental health risks, particularly in the context of pregnancy resulting from sexual violence.
• The Court affirmed that health providers have a duty to provide accurate information and respectful care, enabling informed decision-making about sexual and reproductive health services.
• The Court directed the Ministry of Health to review and amend the national postabortion care (PAC) guidelines within 180 days to explicitly recognize that child survivors of sexual violence have a right to seek an abortion if they choose to do so. It also underscored the need for provider training and institutional accountability to ensure compliance.

This judgment confirmed that legal abortion in Malawi is not limited to immediate physical harm to a pregnant woman; the circumstances extend to serious mental health risks, especially for minors whose pregnancy results from rape or incest.

Guidelines on Provision of Postabortion Care

Malawi's National Post Abortion Care Standards and Guidelines (2020–2025) continue to guide PAC provision.³ The guidelines’ goals included integrating PAC into broader sexual and reproductive health care, increasing accessibility of PAC services, and ensuring quality care through training and equipment provision.

Other aspects of the guidelines:

• Allowed mid-level providers to offer PAC services in order to expand service delivery.
• Emphasized that providers can use their clinical judgment to determine whether circumstances are life threatening for a patient before performing an abortion.
• Endorsed the use of misoprostol and manual vacuum aspiration to manage incomplete abortion, and recommended that all PAC patients receive family planning counseling and a contraceptive method of choice.

This guidance was intended to reduce unsafe abortion complications. However, challenges such as inadequate dissemination of the guidelines, insufficient provider training, limited medication availability and sociocultural stigma have undermined full implementation, and 65% of providers stated in 2025 that they declined to provide PAC for fear of breaking the law.⁴ The next national PAC guidelines (2026–2030) are under review.

Abortion Incidence

Data on abortion incidence in Malawi are extremely hard to gather as provision of abortion services is severely restricted. Official statistics provided by the Ministry of Health indicate 260 induced abortions were provided in the country in 2024, and there were 1,310 PAC cases.⁵ More accurate data come from health facility studies, the most recent of which was conducted in 2015. Since then, statistical modeling has generated more recent estimates. While the available data and estimates show that abortion incidence may be decreasing, they indicate that women in Malawi are likely to have one abortion, on average, by the end of their reproductive years.

• The 2015 study referenced above estimated that 141,000 abortions occurred annually, which is a national rate of 38 abortions per 1,000 women aged 15–49.⁶
• Estimates of abortions using statistical modeling found that for 2015–2019, the abortion rate in Malawi was 31 abortions per 1,000 women aged 15–49.⁷ This is slightly lower than the subregional average for Eastern Africa of 35 abortions per 1,000 women aged 15–49 in the same time period.⁸
• An estimated 30% of unintended pregnancies in 2015 ended in abortion;⁶ in 2015–2019, 27% were estimated to end in abortion.⁷ The subregional average for Eastern Africa was 35% in the same time period (2015-2019).⁸

Availability and Safety of Abortion Care

Availability of legal abortion services in Malawi is scarce and unsafe abortion remains one of the most persistent, while also addressable, causes of maternal mortality.

• Only 40% of health facilities—most of them located in urban areas—offer abortion services within the provisions of the law and individuals frequently rely on unsafe abortion methods.⁴
• Even minors who are victims of rape, and therefore are entitled to abortion under the current law, lack access to safe abortion and effective legal recourse. In this 2023 study, One-Stop Centers—integrated facilities providing medical, legal, social and psychological support for survivors of sexual and gender-based violence and child abuse—were not able to meet the abortion-related health care needs of respondents.⁹
• Adolescents in Malawi have higher rates of attempts to end a pregnancy before coming to a clinic compared with adolescents in Ethiopia and Zambia, which have less restrictive abortion laws.¹⁰
• A reliance on unsafe abortion methods was visible in a 2015 study that found 60% of women who had an abortion needed care for complications; 38% were estimated to have received care and 22% to have untreated complications.⁶
• The best estimate of the proportion of maternal deaths due to unsafe abortions in Malawi is 7%, and this is considered to be an underestimate.¹¹

While there remains a high use of unsafe abortion methods, maternal mortality in Malawi has improved dramatically over the last few decades.

• The most recent estimate was 225 maternal deaths per 100,000 live births in 2023, which translates into 1,500 deaths annually.¹²
• Reasons for maternal mortality include barriers to seeking health care due to lack of funds to obtain services, long distances to a health care facility, women’s lack of autonomy and lack of knowledge of danger signs, and negative past experiences and expectations of poor quality of care that can lead to delays in seeking care.¹³ In addition, a recent report also highlighted avoidable factors related to health care worker actions and training as one of the leading preventable causes of maternal deaths.¹¹
• Malawi’s rate of reduction in maternal mortality was estimated at 55% between 2000 and 2023, and 5% annually between 2016 and 2023.¹²
• The reduction is due to a number of factors: increased skilled birth attendance (now 97%),¹⁴ improved access to emergency obstetric and newborn care, and improved antenatal care. Other factors include community-based health initiatives, increased contraceptive use and decreased HIV infections.^15,16

Quality of abortion care

There is limited research measuring quality of care for abortion services in Malawi. The use of misoprostol for abortion, instead of unsafe and invasive procedures, is known to save lives. While misoprostol was endorsed in the National Post Abortion Care Standards and Guidelines (2020–2025) for treatment of first-trimester incomplete abortion, its uptake had been low. Recent studies indicate growing but uneven use of misoprostol for PAC, and targeted training interventions have been shown to significantly increase its use in health facilities.

• A study across five hospitals in 2020 found misoprostol use for PAC treatment rose from 23% to 36% after provider training, while reliance on sharp curettage declined.¹⁷
• In a 2021 study, health workers reported advantages of misoprostol—such as reduced workload for staff, and fewer infections and shorter hospital stays for patients—though challenges remained regarding eligibility criteria and drug availability.¹⁸
• In a 2020 study, most patients who received misoprostol to treat incomplete abortion indicated that they preferred it to surgical treatment and would recommend use of misoprostol to others.¹⁹
• Malawi’s National Essential Medicines List does not include the mifepristone–misoprostol combination pack, widely recognized as the gold standard for medical abortion.²⁰ This omission constrains access to safe abortion services because the combination pack is a more effective regimen than misoprostol alone.

Social Attitudes Toward Abortion

Survey responses were gathered in Malawi in 2024, including questions on pregnancy and abortion.²⁵ While the results are limited in what they capture, they provide some insight into social perceptions regarding abortion in the country. In particular, the responses reflect a situation in which there is high perceived incidence of abortion coupled with high social disapproval when the procedure is delinked from health issues.

• In the survey, 85% of Malawians supported women’s autonomy in decisions about childbearing (which may or may not be interpreted to include abortion); this is one of the highest response proportions in Africa.
• Malawi had the highest proportion of respondents across Africa (50%) stating that pregnancy termination happens “often.”
• Reflecting perceptions of when termination of pregnancy is justified, 87% felt economic hardship never justified abortion.

Conclusions and Future Directions

The recent High Court decision in Malawi provides a critical opportunity to strengthen abortion care and improve Malawians’ ability to achieve their family building goals, while also reducing maternal morbidity and mortality from unsafe abortion. The challenge will be for the Ministry of Health to fully implement the judgment.

Efforts continue for passage of stand-alone abortion legislation, including proposals arising from the Malawi Law Commission’s draft Termination of Pregnancy Bill 2015. The bill proposes liberalization of abortion under specific circumstances, including risk to the woman’s physical and mental health, severe fetal malformation incompatible with life and pregnancies resulting from sexual violence. Legislative reform remains stalled, perpetuating continued constraints on access to safe abortion services.²⁶

Drafting the next national PAC guidelines (2026–2030) “provides an opportunity to incorporate [World Health Organization] 2022 recommendations, expand provider roles, address legal and policy barriers, improve supply chains, enhance mentorship, and invest in high-quality data systems.”⁴ Effective implementation of existing law—through policy reform, provider training and service delivery guidance—remains critical to reducing unintended pregnancy and unsafe abortion in Malawi.

Meeting women’s reproductive health needs, as well as protecting their rights, requires increased investment. It is cost-effective to invest in contraception to help women prevent unintended pregnancies.

• Meeting those needs would require an additional per capita investment of US$17.34 in addition to the currently covered cost of $7.80, as of 2024.²⁷ Most of the total cost to fully meet the need for these services (79%) would be applied to strengthen health systems and support programs necessary to ensure that services can be provided.
• Every dollar spent on contraceptive services beyond the current level would save $2.38 in the cost of maternal, newborn and abortion care in Malawi.²⁷