A strategic assessment of unsafe abortion in Malawi

As part of efforts to achieve Millennium Development Goal 5 – to reduce maternal mortality by 75% and achieve universal access to reproductive health by 2015 – the Malawi Ministry of Health conducted a strategic assessment of unsafe abortion in Malawi. This paper describes the findings of the assessment, including a human rights-based review of Malawi's laws, policies and international agreements relating to sexual and reproductive health and data from 485 in-depth interviews about sexual and reproductive health, maternal mortality and unsafe abortion, conducted with Malawians from all parts of the country and social strata.

The study notes that consensus recommendations to address the issue of unsafe abortion were developed by a broad base of local and international stakeholders during a national dissemination meeting. Malawi's restrictive abortion law, inaccessibility of safe abortion services, particularly for poor and young women, and lack of adequate family planning, youth-friendly and post-abortion care services were the most important barriers. The consensus reached was that to make abortion safe in Malawi, there were four areas for urgent action:

• abortion law reform
• sexuality education and family planning
• adolescent sexual and reproductive health services
• and post-abortion care services.

The authors further conclude that:

• there is growing recognition in Malawi that reaching the MDG 5 targets by 2015 will be impossible without addressing unsafe abortion
• Malawi's policymakers have demonstrated their understanding of the need to tackle unsafe abortion through the regional treaties and consensus documents they have signed and their own national policies, and by requesting external assistance to help them combat the public health tragedy of unsafe abortion
• following the strategic assessment, a group of national women's health and human rights advocates have mobilised to help generate the political will required for bolder actions.
• further progress is unlikely without reform of Malawi's restrictive abortion law and subsequent provision of safe abortion services – essential not only for Malawi but also most other African countries.