Safer abortions in Zambia

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Warning: This story includes disturbing sounds and descriptions.

Hoban: The waiting room in the gynecologic emergency ward of Lusaka's University Teaching Hospital is always full. Dozens of women sit on wooden benches along the wall, leaning on one another. Others lie on the floor.

Patient treatment room in the gynecologic emergency wardPatient treatment room in the gynecologic emergency ward

Midwife Iness Kabamba is the lead nurse here. She says she sees every kind of gynecologic problem come through the door. But what she sees most are pregnant women who've been bleeding for days or have infections. Kabamba often finds foreign objects in their vaginas. Many of the women first went to a traditional healer in an attempt to end their pregnancies. But the women don't come out and say that.

Kabamba: � When they come to the hospital they don't disclose until maybe if you probe more further, that's when they disclose. But most of the time, they don't, and even if sometimes� we do find them with you know tablets, or maybe sticks, they will refuse to say I haven't done anything. �
Hoban: �When you say stick... are we talking about, like, a piece of a tree?�
Kabamba: �Yes.�
Hoban: �So, literally a stick of wood��
Kabamba: "Um hmm."

Hoban: Kabamba says she's also seen women who've tried to use ground glass� or battery acid� or who've taken overdoses of drugs to induce an abortion.

Kabamba: �They do it at home, but then when they come here they don't disclose because they feel maybe... they don't feel free.�

Nurse Kabamba preparing a procedureNurse Kabamba preparing a procedure

Hoban: Abortion is legal in Zambia as long as it's provided in a medical setting by a medical practitioner. But the procedure is so stigmatized, women don't talk about it. Many women don't know that it's legal � or how or where to get an abortion done safely. Stephen Mupeta is one of the few gynecologists at University Teaching Hospital.

Mupeta: �All of the studies that have been done on the contribution of abortion to maternal mortality was that abortion was found to be among the top five causes of maternal mortality.�

Hoban: He says one study done in Zambia found about 30 percent of pregnant women who die, do so because of an unsafe abortion.

Mupeta wants to change that. He received training from a U.S.-based organization called Ipas that teaches safe abortion techniques. Ipas also manufactures a manual vacuum aspirator. It's a low-tech instrument to do abortions safely in places with few resources. It's the instrument Mupeta uses.

The hospital charges women a dollar for the procedure. The price and the opportunity for a safe procedure bring women to the emergency clinic by the dozens. These women arrive first thing in the morning, and they sit for hours � on the other side of a flimsy wall that separates the waiting room from the procedure room.

This rusted gurney is typical of the equipment used hereThis rusted gurney is typical of the equipment used here

They can hear procedures that take place without any anesthesia or even pain medication� because those drugs are too expensive. But they stay and wait their turn

One of the women waiting asked to be known only by her first initial - G. G's husband died eight years ago, and left her with three children. One is developmentally disabled and at ten, can't yet walk or feed herself. G lost her job last year and is desperate about money. She and her boyfriend of three years were using birth control�

G: �I think I am missed one or two days but then I took two in advance, thinking it will cover up... and then I tried also to use condoms to prevent it. So I thought it was safe enough until I realized that it was not the case.�

Hoban: She and her boyfriend agreed there was no way they could afford another mouth.

G: �Of course, I know abortion is not a good thing, it's not the right thing��

Hoban: Tears stream down her face.

G: �But circumstances in which we are found in really make us do this thing�. like, I'm Catholic� staunch Catholic� and in the Catholic Church this is not allowed. But I'm doing it, you know� I'm breaking so many rules, and of course I know God does not allow this, God doesn't want this, but I just have to do it.

Hoban: She says she couldn't give away a child. Even if she wanted to, the country is already flooded with AIDS orphans.

Medical professionals in this ward have no access to running hot waterMedical professionals in this ward have no access to running hot water

Many women who come seeking abortions already have families, says Doctor Ameck Kamanga, another obstetrician at University Teaching Hospital. Kamanga says before he trained in his specialty, he thought women who sought out abortions must be immoral, or careless. But now he understands their desperation. And he began to believe that by performing abortions, he's saving lives.

Kamanga: �Whether you provide the service or not, that women will still go and have the abortion somewhere. There is nobody that you are saving by sending that woman away. Actually you're just creating a bigger health problem, and probably risking a life doing that.�

Hoban: Kamanga and all of the doctors and midwives counsel women after their abortions to use contraception to prevent further pregnancies. Doctor Stephen Mupeta says that kind of counseling is needed throughout Zambia. Recently he's begun traveling around the country and interviewing community leaders on the best way to reduce the number of unsafe abortions. He hears the same thing over and over.

Mupeta: �It's only when we provide contraceptives and we have adequate sex education that we are going to prevent unprotected sex, prevent un-wanted pregnancy and eventually prevent unsafe abortion.�

Hoban: But Zambia's got a long way to go. Country-wide surveys show more than a quarter of married Zambian women want to use birth control but can't get it. Others can get birth control, but their husbands forbid it.

Until attitudes towards contraception and abortion change in Zambia, Doctor Mupeta fears his hospital's waiting room will continue to overflow with women who've risked their lives to end their pregnancies.

For The World, I'm Rose Hoban, Lusaka, Zambia.