Feature: Unsafe abortions still rife in Tanzania

40-year-old Vailet Mollel is an Arusha-based successful business woman, married with only one daughter.

Unlike most well-heeled women who choose to have smaller families, Vailet would have wanted to have more than one child, but circumstances have not allowed her to do so.

The story behind all this dates back to 1994 when she had just qualified to join University of Dar es Salaam (UDSM) after good performance she achieved from one of the Moshi-based high schools.

In those days, getting a chance at UDSM was a source of pride for her family, especially her father, who used to be one of the best coffee growers in one of the villages on the slopes of Mount Meru, the fifth highest mountain in Africa.

However, her celebrations were short-lived after she discovered she was three months pregnant a few weeks before the scheduled date to report at UDSM.

For fear of disappointing her parents, she decided that an abortion was her only way out of this mess, and consulting some of her peers, she finally settled on the idea of using a sharp knitting wire inserted through her vagina to pierce the foetus.

"I thought I followed the instructions to the letter, especially after noticing some blood stained discharge," says Vailet.

A few days later, when she was convinced she had successfully executed the secret abortion, she began to experience some excruciating lower pelvic pains.

When all home remedies failed, and the pain worsened, she was later rushed to a health centre where her parents were informed that she was almost 16 weeks pregnant.

She was later referred to the Mount Meru Regional Hospital, where she was thoroughly observed and it was discovered that she had sustained severe injuries to her cervix and uterus, making her vulnerable and almost unfit to carry the pregnancy to full term.

"It was bad news to me as I was advised to stay on bed rest, and close monitoring by health workers, because I was too weak to carry the pregnancy to full term," she narrated.

At that juncture, her joy and long-time of joining university were shattered, as she had to take care of her pregnancy and then she delivered her daughter, though her uterus was removed due to permanent damage. Vailet named her daughter Tumaini.

When Tumaini fell pregnant in 2014, when she was in Form Five her mother strongly advised her against terminating the pregnancy, owing to her personal experience.

Prof Andrea Pembe is a senior lecturer at the Muhimbili University of Health and Allied Sciences (MUHAS) who defines abortion as termination of pregnancy by the removal or expulsion of a foetus or embryo from the womb before viability.

He explains that abortion could either be spontaneously, usually called a miscarriage or it can be purposely induced.

"The term abortion most commonly refers to induced abortion (termination of pregnancy)," stresses Pembe who is also a gynaecologist and obstetrician.

According to World Health Organisation, unsafe abortion is defined as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both.

Out of the estimated 205 million pregnancies occurring each year worldwide, about 42 million abortions are performed, 20 million of which are classified as unsafe.

Women obtained about 405,000 induced abortions in Tanzania in 2013, according to a study conducted by researchers at the US-based Guttmacher Institute and Tanzania's National Institute for Medical Research (NIMR) and the MUHAS.

"Zanzibar has the lowest abortion rate at 10.7 per 1,000 women. The Lake zone has by far the highest abortion rate of 51 abortions per 1,000 women," said part of the study titled: "Incidence of Induced Abortion and Post-Abortion Care in Tanzania."

"In the Lake zone, the high abortion rate is most likely a consequence of low contraceptive use (lowest in the country) and high unmet need, which are also responsible for the highest unintended pregnancy rate in the country."

Women with unmet needs are described as those capable of producing offspring and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the next child.

The concept of unmet need points to the gap between women's reproductive intentions and their contraceptive behaviour.

The pregnancy rate for Tanzania is 245 per 1,000 women of reproductive age while the unintended pregnancy rate is somewhat lower at 92.7 per 1,000 women of reproductive age.

The study uncovered that the majority of abortions in the country are clandestine rules that put women's well-being at risk because of an abortion law that is both highly restrictive and ambiguous.

Dr Pasiens Mapunda is the Deputy Country Representative of a Pathfinder International, who says: "Unsafe abortion is increasing because of the law; as people do abortion in unhygienic environment."

"Reviewing the law will help in reducing the number of women died due to unsafe abortion," he suggests.

In Tanzania, the penal code explicitly states that termination of pregnancy is legally permitted if it is performed to save a woman's life.

According to Dr Mapunda, restricting abortion doesn't deter women from carrying it out.

He adds: "When a woman decides to terminate her pregnancy, she will get access to whatever method that is available to her regardless of legality (and generally regardless of safety)."

"Unsafe abortions occur in countries with restrictive abortion laws or practice regimes."

Dr Mapunda further says African abortion laws came with colonization and have continued to have a significant influence on restrictive features of abortion laws.

"Abortion then was looked at as private not a public concerns resolved within family confines or community. But recent days, trends have changed as colonialists have started regulating abortion through replicas of laws in penal codes of those colonial powers such as Italy, France, Portugal and Spain." Endit