Yes. You read that right. Abortion is healthcare. Actually, it is a crucial component of maternal health. And I want you to take a breath first before you read another word because I know a lot of people like to tussle when it comes to this issue.

Thing is, the layman’s understanding of abortion is quite different from the actual definition of abortion in healthcare. In medical terms, abortion is defined as the termination of pregnancy before 28 weeks for Tanzania.

From there, it can be classified as whether safe or unsafe; induced or spontaneous; legal or illegal depending on the place. What is referred to as miscarriage is simply spontaneous abortion. In Tanzania, abortion is legal if it is conducted to save the mother’s life by certified health professionals.

On the morning of my birthday this year, I was at home lost in thoughts and I received a call from a new number; it was a patient that I could not even remember. She coincidentally called to thank me for the support I and the team of other health professionals provided when she had an abortion at the hospital.

Over a year had passed already, I had seen a number of patients, and moved to several other departments and I could barely recall but her call really cheered me up. It reminded me of the very importance of this practice in saving a mother’s life and reducing the maternal mortality ratio.

What do statistics say?

While most abortions are conducted illegally and in unsafe conditions, it is almost impossible to state exactly how many there are. This is not only because most of these unrecorded abortions are unsafe and illegal but also because of the stereotype that surrounds the loss of pregnancy.

According to the abortion health profile prepared by the World Health Organisation (WHO) in 2019, maternal abortions (miscarriages included) contributed to 13.8 per cent of maternal deaths in Tanzania in 2017.

Majority of cases the causes are unknown, but there are a number of known causes of abortions.

These include fetal malformations or abnormal development of the fetus; disorders in the uterus including fibroids; trauma including accidents and as a result of domestic violence; diseases such as malaria, viral infections, and sexually transmitted diseases; maternal chronic illnesses including hypertension, diabetes; and rhesus isoimmunization.

There is a stereotype surrounding the loss of pregnancy, whether spontaneous or induced for any reason. This has contributed largely to the morbidity and mortality of women as a result of abortion.

Many choose to not seek medical assistance for fear of being stereotyped by their families. This has resulted in complications including infection, severe bleeding, kidney failure, and shock that may result in death.

In hospital settings, women who are supposed to undergo abortion are provided with counselling before the procedure which helps them to deal with the traumatic loss of pregnancy.

Through proper history taking, physical examination and investigations not only can the cause of abortion be identified and therefore prevent a possible recurrence, but also complications can be prevented.

Post-abortion care includes ensuring that the womb is completely empty and no injuries have been inflicted as a result of the surgical procedure if done, infection control, counselling and contraceptive use are very important.

This also includes correcting the cause if it can be, such as control of hypertension, treatment of sexually transmitted infections and management of fibroids. Follow-up clinic visits can also be scheduled for further assessment of the mother’s health.

Unsafe abortions: a not-so-silent killer

The problem of unsafe abortions is a result of the failure of reproductive health education. Contraceptive use – natural or modern – and family planning counselling contribute to a better understanding of sexual health and thus prevent unintended pregnancies which usually result in unsafe abortions.

Furthermore, reproductive health awareness reduces the stereotype surrounding abortions and increases antenatal clinic visit compliance which in turn helps in the prevention, early detection and management of diseases such as hypertension, malaria and sexually transmitted diseases which when uncontrolled can cause abortions.

While to many the sight of the word abortion is equating to irresponsible, selfish women that choose to terminate pregnancies for the fun of it, to me it means so much more.

A lifesaving procedure

To me, it means a failure of reproductive health awareness and provision. A lifesaving procedure. A second chance at life to many women.

When I hear the word abortion I think of that young couple I spent extra hours of my shift with to ensure they are ready to face the reality of losing their first pregnancy which was twins.

I think of the woman who was brought in unconscious, in shock because she had a spontaneous abortion (miscarriage) at home almost a month prior and did not think of seeking medical care until she was in septic shock.

I think of the woman of my age whom we spent time talking about her life as I administered the drugs to control her hypertension and prevent convulsions before terminating her pregnancy; she cried, it was her third loss.

I think of the lady on the verge of losing her pregnancy who was dragged to take a trip of over 300 kilometres against the advice of medical professionals in order to cleanse her of the curse of abortion; I hope she made it.

I think of possibly so many unrecorded women who took matters into their own hands to terminate their pregnancies for whatever reason, instead of seeking medical assistance and counselling that could possibly save them and help them make more informed decisons.

Increased awareness

Thankful to the mass media campaign run by the health promotion sector of the Ministry of Health that has increased awareness about reproductive health and reduced the stereotype surrounding the topic that can save so many lives, especially for young women.

I wish someday there will be reproductive health clinics that can easily provide direct assistance to youths who need counselling and medical and social assistance with their reproductive issues, a safe haven that I believe will curb the problem of unsafe abortions.

Kuduishe Kisowile is a medical doctor and public health commentator based in Dar es Salaam, Tanzania. She is available through kuduzekudu@gmail.com or on Twitter as @Kudu_ze_Kudu. These are the writer’s own opinions and do not necessarily reflect the viewpoint of The Chanzo Initiative. Want to publish in this space? Contact our editors at editor@thechanzo.com for further inquiries.