The COVID-19 pandemic which brought about lockdown restrictions has further restricted women and girls’ access to safe abortion services in traditionally marginalized communities in Zimbabwe.
With COVID-19 restrictions, obtaining the necessary appointments and documents to access health facilities has become a nightmare, especially for women in poor areas and this has aided the need for most women and girls who fell pregnant, unintentionally or otherwise, to Nicodemusly seek the termination of pregnancies.
Under Zimbabwe’s 1977 Termination of Pregnancy Act, abortion is only legally permitted under certain circumstances which include cases of rape and incest, when the mother’s health is at risk or foetal abnormality.
If conducted illegally, it carries a penalty of up to five years in jail and or a fine.
Before the COVID-19 pandemic women and girls would sometimes travel to neighbouring countries to access abortion services.
Without this option women and girls are resorting to potentially life-threatening unsafe abortions.
In Shamva, a mining community North East of Harare, Illegal backyard abortion clinics are using assorted concoctions to terminate pregnancies of desperate girls and women, putting them at a higher risk of death.
Investigations by 263Chat led to a quack doctor Chenesai Hombarume from the Shamva town, who revealed how she conducts abortions.
“I make use of herbs such as gavakava (aloe vera) and also pills such as mifepristone and misoprostol commonly known as Cytotec,” said Hombarume.
Prior to the lockdown, a ministry of health official reported that teenagers accounted for nearly a third of Zimbabwe’s abortion-related maternal deaths.
The backyard clinics are endangering the lives of young women and girls with many succumbing to the post-abortion effects due to lack of professional care.
Hombarume says stigma associated with an unwanted pregnancy leads young girls to take extreme measures.
“Most of my clients are young girls who for fear of family backlash after being dumped by their boyfriends they resort to abortion. Infidelity is also a major contributor with married women coming to get rid of pregnancy after conceiving outside their marriage,” she said.
There has been a decrease in the uptake of contraception, with new clients on combined birth control pills dropping by 90% in Zimbabwe according to the WHO Regional Office for Africa, 2020, largely due to restricted movements to access SRHR services.
A recent Plan International survey found that respondents in Zimbabwe were not active in seeking SRHR information, with only 17.1% saying they had tried to access SRHR information.
50.1% of respondents indicated that they did not have information on where, how and when to access SHRH information during the lockdown.
The COVID-19 pandemic has had a range of negative impacts on women’s and girls’ access to maternity services in Zimbabwe, including staff shortages, resource stock-outs, the closure of antenatal clinics and disruption of public transport.
Women and girls are avoiding attending healthcare facilities for fear of contracting the virus, our investigations revealed.
Furthermore, access to maternity services in Zimbabwe was already reduced due to a doctors’ and nurses’ strike, which continued through the lockdown.
When Sixteen-year-old Evelyn Mashanda fell pregnant during the COVID-19 induced lockdown she decided to get rid of the pregnancy after her boyfriend denied responsibility.
“After realising that I am pregnant, I told my boyfriend but he told me to get rid of the pregnancy because he was not ready to be a father because I did not want to embarrass my parents I secretly sought the help of aunt Chipo who administered traditional herbs to me. I was three months pregnant then.
“A few minutes after I took the concoction I started feeling severe pains and bleeding. It was a horrendous experience. I regretted why I had embarked on aborting because it almost took my life,” Mashanda said.
The stigma around abortion is compounded by socio-cultural beliefs that have seen many women resorting to backdoor unsafe abortions due to fear of stigmatization and labelling.
Abortion is an issue that is not largely and openly discussed in the community because of the beliefs that abortion is murder and with different values and norms.
However, avoiding open discussion around the issue has seen a rise in maternal deaths attributed to unsafe abortion hence the need to hold dialogues to get issues from people within the community and their voices will inform our advocacy.
Despite complaining of pains after the procedure Mashanda has not sought medical assistance.
“There are times that I have stomach pains to the extent that I can’t move or sit until the pain goes. I cannot go to the hospital. My fear is it will expose what I did,” she added.
Another abortionist based in Mazowe’s highly populated Jumbo suburb who asked to remain anonymous said it costs US$200 to terminate a pregnancy without side effects.
“You pay your USD200 via Mukuru and I will send you the medication, just send me your address. I will give you pills and it will come like a miscarriage. The pills are effective and have no side effects.” said the abortionist who identified as Vicky.
Pretending to be a potential client we were directed to another abortionist in Mazowe who gave showed us a traditional concoction upon payment of US$25.
The clandestine activity involves health professionals from the country’s hospitals and traditional healers with charges pegged at a sliding scale, usually a minimum of US$20 depending on the stages of the pregnancy.
The most common pill that the abortionist use is Cytotec which medical experts say is an over the counter pill and is used to induce labour or cause an abortion as well as treat stomach ulcer.
At times some abortionists use extreme ways to terminate the pregnancy by using coat hangers and fire tongs to remove the foetus.
Harare based gynaecologist, Dr Stanley Ngwaru said complications from backyard abortions vary.
“Such unsafe methods are associated with complications that range from infections (pelvic inflammatory diseases, pelvic abscesses septicaemia and septic shock), haemorrhage, uterine damage (perforations), in extreme complications death. Most delay seeking medical help and present late when nothing much can be done to change. Most are faced with failure to conceive in future as a result of these complications,” said Dr Ngwaru
Obstetrician and gynaecologist Dr Joyce Mukweva said an overdose of Cytotec has many side effects due to non-compliance with protocols.
“Cytotec is a prescription drug so no one should access it without a prescription. It is illegal to terminate a pregnancy without approved court papers or reasons stated in the laws of this country such as rape. Drug overdose has many side effects including excessive bleeding diarrhoea shivering stomach cramps.
“Disadvantages of administering without following the protocols include the side effects and lack of follow up. The woman may remain with products of conception which will later cause sepsis or even death. Follow up scans and medical care as well as antibiotics will need to be given. The drugs can cause heavy bleeding and death from shock.
“If abortion is effected, a woman is given antibiotics and contraception to prevent another unwanted pregnancy. A review after a week or two to check for complications such as infection. Effects of late post-abortive care are severe sepsis which may result in death. The chronic pelvic infection could result in future subfertility from blocked tubes. General ill health from complications such as anaemia,” said Dr Mukweva.
Dr Ruth Labode, the chairperson of the Parliamentary Portfolio Committee on Health and Child Care, recently told Parliament that as much as 80,000 illegal abortions take place in Zimbabwe annually.
“Illegal abortions in Zimbabwe have increased from 60 000 to 80 000 per annum – which is very unsustainable,” Dr Labode said, as she argued to a review of Zimbabwe’s Termination of Pregnancy Act, which was passed in 1977.
With the worrying data, activists have called for a comprehensive evaluation of the Termination of Pregnancy Act in order to save lives.
Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative.
As with other more visible global health issues, this scourge threatens women throughout the developing world
