Calls to legalise abortion as unsafe methods take toll on Rwandan women
The EastAfrican - 8 hours ago
By EDMUND KAGIRE Rwanda Today
Posted Saturday, June 21 2014 at 12:43
Women with their babies in a ward in Rwanda. Experts say family
planning services must be expanded to ensure all women can plan their
pregnancies and hence reduce abortions. Photo/Cyril Ndegeya
IN SUMMARY
Government spends $1.7 million (Rwf1.1 billion) annually on treatment
for complications resulting from unsafe abortion.
It is estimated that about 60,000 abortions are carried out in Rwanda annually.
A new report that shows that about 18,000 women and girls in Rwanda
require treatment annually from the effects of unsafe abortion has
prompted advocacy groups to push the government further to
decriminalise the act in a bid to save lives and resources.
The report, released at the end of May by the New York-based
Guttmacher Institute in partnership with the University of Rwanda's
School of Public Health and the Ministry of Health, showed that the
government spends $1.7 million (Rwf1.1 billion) annually on treatment
for complications resulting from unsafe abortion.
It is estimated that about 60,000 abortions are carried out in Rwanda
annually, according to the report.
Advocacy groups said the research -- which was conducted in 39 public
and private healthcare facilities across the country and sampled
18,000 women who reported to health facilities with abortion defects
in 2012 -- was proof that there is a need for the government to
decriminalise abortion.
READ: When girls risk their lives to secure an abortion
Dr Aflodis Kagaba, the executive director of Health Development
Initiative-Rwanda (HDI), described the report as a good step in
creating awareness that abortion is real in Rwanda and that the issue
needs to be addressed in order to save lives and resources.
"The country spends significant resources in addressing its
complications and this indicates that some effort needs to be invested
in preventing unwanted pregnancies and fighting unsafe abortion," Dr
Kagaba said.
"However, the report only gives highlights on the costs at the
healthcare system level and there is a need for another study that
would help us to understand the costs that are directly incurred by
the beneficiaries as we believe there are much higher."
Dr Kagaba and other advocates of safe abortion believe that policy and
decision makers should use the evidence generated by the study and
previous ones on the prevalence of abortion to put in place more
effective measures to address unwanted pregnancies and ensure access
to safe abortion services.
"Our argument is based mainly on the evidence generated from different
researchers that restrictive abortion laws contribute to higher
maternal mortality and morbidity rates due to unsafe abortion," Dr
Kagaba said.
"Countries that have decriminalised abortion, such as South Africa,
have seen a dramatic drop in maternal mortality."
In 2012, parliament legalised abortion but only "in cases of sexual
assault, rape, incest and where the continued pregnancy endangers the
mental and physical health of the mother or the life of the mother or
the foetus."
Activists say that while this was a step in the right direction, there
are some barriers that need to be addressed if the potential victims
are to benefit from the new provisions.
"For example, requiring a competent court to certify that a woman has
become pregnant as a result of rape, incest or forced marriage will be
a serious barrier for women who would qualify for the services," added
Dr Kagaba.
"This is mainly because of stigma, fear and family pressure that may
prevent many women from reporting incest or sexual violence and
engaging with the justice system."
The post-abortion care report indicates that the cost per client
across five types of abortion complications was $93 (Rwf60,000).
The report shows that 49 per cent oftotal amount of money spent on
post-abortion care in the country was expended on direct non-medical
costs. It adds that up to $2.5 million (Rwf1.6 billion) was most
likely to be spent to address all the demands of post-abortion
complications annually.
The report further says that 75 per cent of women who reported to
health facilities with post-abortion complication were treated for
incomplete abortion and smaller proportions for serious complications
such as sepsis, which covers 13 per cent, and shock, which accounts
for nine per cent.
A bigger amount of the money is spent on direct costs such as drugs,
supplies, tests, medical personnel and hospitalisation fees, as well
as indirect costs for overhead and capital expenses.
Lead author Michael Vlassoff said abortion poses a significant and
unnecessary burden on Rwanda's healthcare system.
"The vast majority of these abortions could be avoided by preventing
unintended pregnancy, which is the root cause of most abortions.
Family planning services must be expanded to ensure all women are able
to plan their pregnancies," says Ms Vlassoff.
The Ministry of Health says the government is making some progress in
addressing this problem but most of these measures do not address the
problem directly but rather focus on preventing unwanted pregnancies.
"We want to increase access to contraceptives for everyone who is at
the threat of getting unwanted pregnancies; early prevention is key,"
said Dr Fidele Ngabo, the director of Maternal and Child Health in the
Ministry of Health.
He added that the progress Rwanda has made, which includes legalising
abortion to a certain extent, should be taken note of.
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