Lack of Safe and complications that result from unsafe can be prevented by “the provision of safe, legal induced abortions and Services care for complications of abortion.”2 According to the World Health Organization (WHO), abortion is a very safe medical procedure “when performed by skilled providers using the correct medical procedure”3 or when self-managed with medication and access to accurate information.4 A Result of Restrictive Laws However, Tanzanian women and girls’ lives and health continue to and Stigma be at risk on a daily basis due to lack of access to safe options to terminate pregnancies. This also has a larger impact on their fami- lies, society, and the country, including by creating a great burden June, 2020. on the public health care system due to the considerable cost of treating the resulting complications.5 This factsheet discusses the legal and health system challenges that force women and girls in to resort to unsafe methods and untrained providers to terminate pregnancies. It also highlights the challenges to accessing post-abortion care.

1. WOMEN AND GIRLS HAVE Rape or incest;9 DIVERSE REASONS FOR SEEKING ABORTION SERVICES Lack of financial means to care for the child, particularly when women and girls already Unlike the common misconception that have other children to take care of, making it only young or adolescent girls, or women difficult to continue with the unplanned preg- and girls who are not married, procure nancy.10 This issue is further compounded 6 abortions, the interviewees for this re- when the man responsible for the pregnancy 7 search indicated that, in Tanzania, women denies responsibility or indicates that he will and girls from all walks of life — married not provide any financial support to raise the and unmarried, young and old, educated 11 and uneducated, low-income and wealthy child; — seek abortion services for varying The desire to continue with their education.12 reasons. For some, a single reason can be a In Tanzania, adolescent girls are often decisive factor; for others, it is a combina- tion of reasons that lead to their decision. expelled from school when found to be preg- nant and are denied re-entry after delivery;13 The reasons for terminating pregnancies are as diverse as the women and girls them- Becoming pregnant within a short time after selves, but the common denominator is that giving birth. When this happens, a woman can they are carrying an unplanned and decide to terminate the pregnancy due to the unwanted pregnancy. “There is no talking about unsafe associated health risk or because she doesn’t Some of the reasons cited by interviewees 14 abortion, and it’s just those things have the capacity to care for another child; include: that happen in the background and Stigma against those who engage in sexual everybody knows about it and you Lack of education and 1 services, which lead to limited contra- relations out of wedlock and get pregnant as just keep quiet about it.” 15 ceptive usage;8 a result.

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 1

2. LAWS AND POLICIES ON ABORTION AND POST- ABORTION CARE ARE UNCLEAR SOCIO-ECONOMIC PROFILE OF TANZANIA AND CONTRADICTORY With an estimated population of 58 million,1 Tanzania is one of the lowest- Creating an enabling legal environment is 2 income countries in the world. According the Development critical for reducing maternal mortality and Programme’s Human Development Report (HDR), nearly half (47%) of the morbidity resulting from unsafe abortions population is living in multidimensional poverty and 18% in extreme pov- and ensuring that women and girls can 3 4 erty, with some regions experiencing a poverty rate as high as 66%. exercise their right to access a full range of 5 Ninety percent of the population lives on under $2 per day. The percentage sexual and reproductive health services. of the population with formal education is also low. According to the HDR, However, an assessment conducted by the 24% of females and 15% of males have no formal education and less than Center for Reproductive Rights found the 6 one in 10 Tanzanians have completed secondary education. In addition, law and policies governing termination of the working-age population — those 15 years and older — is 25 million, with pregnancy in Tanzania to be inconsistent, 7 young people making up 55% of this group. The low education rate and unclear, and often contradictory.16 There large working-age population in turn affect the employment rate. are also no comprehensive guidelines on the provision of abortion and post-abortion The latest available data indicates that the unemployment rate stands at 8 care services. As a result, women and girls 10%. Seventy-five percent of the population are engaged in informal em- often lack comprehensive information ployment, and eight out of 10 young people are engaged in vulnerable 9 about the content of the law and the proce- employment. This, according to the HDR, indicates that many are engaged dure for seeking health care professionals in an employment sector with “various activities that involved insecure and for providing abortion services. precarious forms of wage employment, where the distinction between being employed or being underemployed is not clear-cut.”10 Legal Framework on Abortion The situation is even more dire when it comes to women and girls because The penal code of Tanzania criminalizes they are “more likely to experience lower levels of human development due abortion with a punishment of up to 14 to inequalities in access to education, health services, and economic oppor- 11 years’ imprisonment17 and the crime of tunities.” Only 7.4% of women in mainland Tanzania have attained at least 12 “child destruction”18 with life imprison- secondary education. This significantly reduces their chances of gaining 13 ment.19 However, a person will not be paid employment and senior positions. Only 69% participate in the labor liable for abortion or “child destruction” if market, as opposed to 81% of men, and the majority are engaged in the in- 14 the procedure is performed in good faith formal sector. They also spend a large portion of their time on unpaid 15 and with reasonable care and skill to pre- housework, which affects their level of income. 20 serve the pregnant woman’s life. Further, while there are no domestic decisions that have interpreted these penal code provi- sions, there are pre-independence when asked if they will provide an abor- framework on abortion has not changed jurisprudences from England and from the tion to a woman who became pregnant from 2013, the 2017 updated guidelines do East African Court of Appeal, which re- as a result of rape, many providers have not make any reference to induced abor- 21 main binding, that have interpreted the said that they will not.23 In addition, tions, even when performed to save the life life exception under the penal code to also some government policies previously of the pregnant woman, and defines abor- permit abortions on the grounds of mental outlined additional grounds for legal tion only as being “the spontaneous loss of and physical health of the pregnant woman abortions. For instance, the 2013 version a fetus before it is viable.”25 It also defines and for pregnancies resulting from sexual of the Standard Treatment Guidelines viability as starting approximately at 24 22 violence. and Essential Medicines List recognizes weeks of gestation,26 in contradiction to the rape and fetal malformation as legal Comprehensive Post Abortion Care Guide- However, many, including health care pro- 24 viders and legal professionals, are not grounds for abortion. line Trainees Manual and the penal code, both of which put viability at 28 weeks.27 aware of these jurisprudences. As a result, Conspicuously, even though the legal

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In 2016, the Ministry of Health of Tan- Post-Abortion Care 3. WOMEN AND GIRLS zania issued the latest edition of the ENCOUNTER MULTIPLE The government of Tanzania, in many Comprehensive Post Abortion Care BARRIERS TO ACCESSING policies and documents, acknowledges the Guideline Trainees Manual, which is SAFE ABORTION SERVICES negative effect of unsafe abortion and meant to be used primarily by post- 30 affirms post-abortion care as an integral abortion care trainees and trainers. The research revealed that Tanzanian component of maternal health care ser- The manual recognizes comprehensive women and girls encounter numerous 28 vices. The National Road Map Strategic post-abortion care as “interventions obstacles to accessing safe abortion Plan to Improve Reproductive, Maternal, which reduce maternal morbidity and services, compelling them to resort to Newborn, Child & Adolescent Health in mortality through providing care to unsafe methods. Additionally, post- Tanzania (2016-2020) aims to improve young girls/women who suffer compli- abortion care — critical medical interven- access to Basic Emergency Obstetric and cation” from induced abortions and tion to treat complications from unsafe 31 Neonatal Care, which includes post- miscarriages. It further acknowledges abortion — is not easily available or ac- abortion services, from 20% to 70% in that there are many factors that hinder cessible, putting many women and girls’ dispensaries and from 39% to 100% in access to post-abortion care, including a lives and health at increased risk. health centers.29 stigma on induced abortions, providers’ negative attitudes, and inadequate i. Limited Knowledge of Laws and 32 equipment and supplies. Policies on Abortion The manual further emphasizes quality of care by providing that “[h]ealth care Due to the absence of a clear policy or providers should respect women’s in- guidelines, and limited dissemination of formed decision-making, autonomy, information regarding the current legal confidentiality and privacy at all times.” framework on abortion, women and girls 33 It also says special attention should be lack knowledge of when and how to legal- given to vulnerable groups, such as ly terminate pregnancies. As a result, adolescents and youths, women with many believe the law to be more restric- disabilities, low-income women, and tive than it is. That discourages them from survivors of sexual violence.34 seeking abortions at public health care facilities and compels them to resort to While this training manual provides unsafe methods. useful information and is important for Almost all the women interviewed for the equipping health care professionals with research said they are not aware of the the essential skills needed to provide legal grounds for abortion.39 Many of the comprehensive post-abortion care, it is women have limited avenues to access not a policy document.35 Regardless, information and mostly refer to newspa- health care providers and advocates pers, radio, and TV,40 which, for the most interviewed for this research wrongly part, do not provide accurate information assumed that such guidelines exist and when it comes to abortions.41 As a result, often referred to the training manual they fear being reported and arrested, and when asked about the guidelines.36 While the post-abortion training prefer not to seek abortion services from manual provides useful infor- However, as one advocate correctly put health facilities even in situations where mation and is important for it, “the manual is for teaching and [for] they might have qualified for a legal equipping health care profession- facilitators to follow when giving a abortion.42 als with the essential skills training but is not legally binding. Similarly, lack of clarity leads to the needed to provide comprehensive [There is a need for] a guideline that is a restrictive interpretation of the law by post-abortion care, it is not a policy document which is going to be health care providers and the denial of policy document legally binding, and if someone does services to women and girls who would not provide the service as provided, you have qualified for legal abortions. can follow up and take action.”37

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Almost all the providers interviewed for this research agreed that the law allows abortions when performed to save the life METHODS OF UNSAFE ABORTION of the pregnant woman. However, their When women and girls do not have access to safe abortion services, they understanding of the law varied when it often resort to unsafe and crude methods that put their lives and health at came to the additional exceptions, such as grave risk. Some of the methods include:38 the health of the pregnant woman, particu- larly mental health, and in cases of serious > Boiling and drinking Coca-Cola. fetal abnormalities and rape. For instance, when assessing whether to perform an > Inserting cassava sticks in the uterus. abortion on health grounds, many provid- > Drinking traditional (local) herbs. ers take into account only physical health and not, as recommended by the WHO, > Drinking boiled tea leaves. mental health and social well-being.43 Further, many of the health care providers > Drinking boiled aloe-vera. do not provide abortions for pregnancies 44 > Inserting roots of different trees in the uterus. that result from sexual violence. Additionally, the lack of clear policy guidelines creates inconsistent understand- ing of the procedure health care providers must follow when determining the need to as an important component of quality abor- guidance, guidelines are crucial to inter- terminate a pregnancy. Even though it is tion services.49 In addition, while some pret and provide clarity on the not a legal requirement, as confirmed by government guidelines make passing refer- implementation of the laws regulating health care providers interviewed for this ences to the legality of abortion and the service. However, while many gov- research, many providers believe that, circumstances under which abortion is per- ernment documents recognize the high when presented with a case, one doctor mitted,50 there is no official comprehensive level of unsafe abortion and its contribu- cannot make the determination to terminate government policy or guidelines on safe tion to maternal mortality in Tanzania, a pregnancy and needs to consult other abortion services.51 “no government policy or guideline 45 doctors or specialists. However, they appears to comprehensively address the According to the WHO, standards and guide- disagree about the number of doctors who provision of safe abortion services in lines on abortion are important to “eliminate need to be consulted — while some think Tanzania or to clarify when providers barriers to obtaining the highest attainable the number is three, others think as many may offer these services or who may 46 standard of sexual and reproductive health” as five doctors are needed. provide them.”55 as they can “refer to the underlying princi- In addition, doctors erroneously believe ples and essential requirements for providing Government officials and documents that this is a legal or policy requirement equitable access to, and adequate quality of, further contribute to this confusion by but were not able to identify a document lawful abortion services.”52 Guidelines are providing incomplete or inaccurate in- 47 describing the requirement. Some further important to improve the quality or process formation. For instance, the National believe that consent from a partner is need- of care as well as patient outcomes.53 They Adolescent Reproductive Health Strate- ed before providing an abortion, even in further “offer explicit recommendations for gy 2011-2015 states that ‘[i]nduced situations where the pregnancy is risking clinicians who are uncertain about how to abortion is illegal in Tanzania hence the 48 the health of the pregnant woman. proceed, overturn the beliefs of doctors ac- actual magnitude of the problem is not 56 Health care providers have a limited un- customed to outdated practices, improve known” without clarifying that there derstanding of the laws and policies on consistency of care, and provide authoritative are grounds under which termination of abortion in part because they generally do recommendations that reassure practitioners pregnancy is legally permitted. not receive training on the issue, either about the appropriateness of their treatment In 2016, the Tanzanian prime minister, 54 while they are in medical school or after polcies.” When it comes to the provisions while visiting a regional government leaving, even though they see such training of abortion services, beyond the clinical hospital, threatened doctors, telling them

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 4

to “stop performing abortions on girls ii. The Restrictive Law Fuels This, however, could be addressed with and women or they will be sacked and Unsafe Abortions and Resulting a comprehensive guideline on safe charged according to the law.”57 Accord- abortion services that clearly articulates that health care providers can legally ing to a news report, he stated, “[t]hese “Women who have financial means provide post-abortion care irrespective unlawful acts are totally unacceptable, do safe abortion. Women who are of whether the abortion was legal. doctors who entertain this behavior will poor do unsafe abortion.”60 not be spared. I don’t want to hear labor rooms are being used for terminating The restrictive abortion law is a major iii. Limited Availability of Safe pregnancies.”58 As a reproductive rights contributor to the high level of unsafe Abortion and Post-Abortion advocate interviewed for this research abortions in Tanzania, and it dispropor- Services explained, these kinds of public state- tionally affects women and girls who ments made by political leaders promote are not able to afford the high cost of Beyond the restrictive legal framework, misinformation about the legality of obtaining an abortion from a private interviewees shared several health- abortions. The advocate stated: facility. Most of the interviewees said system challenges that further impede women and girls’ access to safe abor- “There is a need for knowledge that women who have the means to pay tion and post-abortion care. For about the law on abortion. … Gov- can access safe abortion services in a instance, there is lack of basic equip- ernment officials should send private facility with trained health care 61 ment, such as ultrasound equipment accurate messages because once professionals. By contrast, low- and manual vacuum aspirators, needed they say something, people take it income women who, due to the restric- for diagnosis and treatment.65 The as it is. For example, when the tive law, cannot go to public facilities government has made some effort to prime minister said that abortion is where the services are provided free or improve the availability and quality of not allowed, then people just know at low cost, are compelled to resort to post-abortion services but the inter- that it’s not allowed under any cir- unsafe methods to terminate their preg- viewees for this research said that there cumstances. People do not go back nancies as the cost at a private health is a need to scale up these efforts to to read, and I don’t blame them facility can be as high as 90,000 Tan- ensure that the service is available, because they don’t have access to zanian shillings (Tsh), approximately 62 particularly in primary level facilities— [the information] anyway. They 40 dollars. dispensaries and health centers—which really take words spoken by our Fear of Arrest and Prosecution are closer and more accessible to the leaders to heart, so our leaders Impede Access to Post-Abortion community. As one reproductive health should be more of the champions Care advocate explained, contrary to the on this and strive for the people to information in The National Road Map have the right information.”59 Even though post-abortion care is legal, due to the restrictive law that allows Strategic Plan to Improve Reproduc- abortion only on limited grounds, many tive, Maternal, Newborn, Child & women and girls who suffer complica- Adolescent Health in Tanzania (2016- tions avoid seeking treatment for fear 2020), dispensaries refer women to of being arrested and prosecuted.63 Fear higher-level facilities—health centers of prosecution also hinders health care and hospitals—because the dispensa- professionals from providing post- ries lack the necessary equipment and 66 abortion care because some are not training to provide post-abortion care. aware that they are legally allowed to Even at higher-level facilities, howev- provide treatment and that women have er, limited and outdated equipment is an issue.67 The lack of clear policy guidelines the right to the service. As such, when creates inconsistent understanding a woman experiencing complications Shortage of trained health professionals of the procedure health care pro- goes to a facility, health care providers is an additional major obstacle that 68 viders must follow when might refuse to treat her because they hinders access to post-abortion care. determining the need to terminate a fear negative legal consequences if they While obstetricians and gynecologists pregnancy. provide treatment, but the woman ends receive training on the services when up dying.64 undergoing their medical education,

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 5

training of general practitioners is not drug properly, misoprostol is useful in for administrative costs; for various universal. In addition, the in-service reducing unsafe abortions and the tests, such as ultrasound; and for medi- 84 training provided to midlevel providers, resulting complications. The complication cation. Another woman, from Mwanza, such as nurses, midwives, and clinical rate is very low when misoprostol is used explained that the cost can be much 85 officers, does not reach all those who with proper information, according to higher—Tsh 70,000 to Tsh 100,000. work in public health facilities.69 research conducted by the Department of This was confirmed by multiple health care practitioners, who indicated that the Refresher training to ensure that provid- Obstetrics and Gynaecology at Muhimbili cost can increase if there are complica- ers are up to date with the current University of Health and Allied Sciences tions.86 Some referral facilities even technology is also very limited.70 This to “investigate the feasibility of providing charge these fees to discourage women means women and girls will have to bear harm-reduction services to reduce unsafe 78 from coming to the facility without a the additional burden of traveling long abortion in Tanzania.” In this research, referral from a primary-level facili- distances and incur additional costs to study subjects were given information ty.87Additionally, because many women access higher-level facilities — mainly about the “appropriate dosage, adverse and girls are not aware that it is legal to hospitals — to find trained providers.71 effects, and cautions” of misoprostol, and “no maternal deaths or severe complica- access post-abortion care, some provid- The shortage of equipment and personnel tions owing to induced abortion were ers use this opportunity to ask for further results in poor-quality service 88 reported” among those who chose to use payment as a bribe. because women have to wait long hours 79 the drug to induce abortion. — sometimes an entire day — and go v. Stigma and Negative Attitude of through lengthy administrative proce- iv. Lack of Knowledge of and High Providers dures before receiving treatment.72 Cost of Post-Abortion Care The government of Tanzania recognizes Access to Medication Abortion Interviewees indicated that women and that the stigma surrounding abortion is According to the WHO, the use of medi- girls have limited knowledge regarding an additional major barrier to post- 89 cations, usually a combination of where and how to access post-abortion abortion services. Indeed, many wom- mifepristone and misoprostol, and some- service. Many of the women interviewed en and other stakeholders interviewed times misoprostol alone where did not know that treatment is provided in for this research said that stigma from mifepristone is not available, “have been public health care facilities and believed the community and health care providers proved to be safe and effective” for early that such services were available only in can force women to delay seeking post- 80 termination of pregnancies.73 However, private facilities. This discourages abortion care or to stay away from pub- misoprostol is registered in Tanzania women from seeking the service, even lic health facilities. Some refrain from only for postpartum hemorrhage and when they suffer complications, or causes going to health facilities because they management of post-abortion complica- them to incur unnecessary expenses by fear that they will be seen by people they 81 90 tions—not for abortions.74 Regardless, as going to private facilities. In addition, know, while others fear a negative 91 confirmed by many of those interviewed despite the government’s policy to pro- reaction from health care providers. for this research,75 misoprostol is widely vide all maternal, newborn, and child This concern is not unfounded: A wom- available without a prescription at phar- health services — which includes post- an who went to a public hospital seeking 82 macies and drug dispensaries. It can cost abortion care, free of charge — many treatment for a miscarriage recounted the anywhere from Tsh10,000 to Tsh70,000, are not aware of this policy and are asked harsh treatment she received when the depending on the brand and where it is to pay when seeking treatment at a public health care providers initially thought 83 92 sold, and many women rely on the drug facility. Further, because the prices that she’d had an abortion. An Ob/Gyn to self-induce abortions.76 However, be- facilities charge are not based on govern- working in a public facility reported: cause they are not always given accurate ment guidelines, the cost varies from one “Some health providers can judge before information on how to safely administer facility to another. listening to the reasons why the woman induced [an abortion]. They will ask her, the drug, using it can sometimes lead to For instance, a woman from Arusha who 77 ‘Why did you do that?’ Like she is a complications. went to a public hospital seeking treat- criminal. Some even tell women that ment for complications from a Nevertheless, when women and girls what they did is criminal and threaten to miscarriage was made to pay Tsh 35,000 have the right information and use the report them. I have witnessed that. They

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 6

abortions “as well as integrating the do not report to the police but threaten 4. TANZANIA’S HUMAN RIGHTS provisions of the [Maputo Protocol] into to do it and make the women feel un- OBLIGATIONS TO ENSURE 97 93 domestic law.” comfortable.” ACCESS TO ABORTION AND Further, Tanzania has the obligation to The negative attitude of health care pro- POST-ABORTION CARE guarantee the implementation of these viders can be attributed to personal and Tanzania has ratified a multitude of legal protections, including by ensuring religious beliefs, lack of training and 94 international and regional human rights that “health services and health care resources, or, as discussed previously, treaties that obligate the government to providers do not deny women access to fear of arrest and prosecution. respect, protect, and fulfill human rights …safe abortion information and Beyond religious and personal beliefs, standards concerning the sexual and services because of, for example, the restrictive law on abortion can fuel reproductive rights of women and girls, requirement of third parties or for rea- the stigma related to abortion. When including their right to access safe and sons of conscientious objections.”98 This access to a health service is criminalized legal abortion and post-abortion services. includes removing any requirement for or highly restricted, it conveys the mes- These human rights instruments require multiple medical doctors to provide sage that those who access the service that the government take legal and authorization for an abortion before a should be condemned. The practice of programmatic measures to ensure that woman can access the service.99 doctors consulting multiple other doc- safe abortion services are accessible, both The sensitization of legal practitioners tors before women or girls are able to in law and in practice, to all women and and law enforcement bodies is further legally access abortion services also girls who might need the service. required to prevent the arrest and prose- “implies that abortion is a suspect pro- 95 cution of women and girls who have cedure that demands extra scrutiny.” Reform Laws and Policies on “sought safe abortion services or post- Abortion Services abortion care to which they are One critical measure that Tanzania must entitled.”100 take to protect the right of women and Development of implementation stand- girls to access safe abortion services is to ards and guidelines, establishment of ensure that the domestic legal framework accountability mechanisms, and effec- regulating abortion service is harmonized tive redress mechanisms for women and with international and regional human girls whose reproductive rights are rights standards. For instance, Article 14 violated are additional requirements for of the Maputo Protocol, which Tanzania fulfilling the right recognized under has ratified without any reservation, pro- Article 14 of the Maputo Protocol.101 vides that states are required to: In addition, treaty-monitoring bodies protect the reproductive rights of have held that restrictive abortion laws women by authorising medical abor- violate a compendium of rights of wom- tion in cases of sexual assault, rape, en and girls, including the right to incest and where the continued health, life, privacy, equality, and non- pregnancy endangers the mental discrimination, and freedom from ill- and physical health of the [preg- treatment.102 These rights are further nant woman] or the life the affirmed under the Constitution of Tan- Despite the government’s policy to 96 [pregnant woman] or the foetus. zania.103 To protect these rights, provide all maternal, newborn, and therefore, states are required to remove child health services — which in- As the African Commission on Human punitive measures in all circumstances cludes post- abortion care, free of and Peoples’ Rights has elaborated, in for women who access abortion charge — many are not aware of order to comply with the obligation services.104 this policy and are asked to pay under this provision, Tanzania must when seeking treatment at a public provide a conducive legal environment, For instance, the United Nations Com- facility. including by “revisiting… policies and mittee on Economic, Social and Cultural administrative procedures” relating to safe Rights has found that states violate their

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 7

obligation to respect the reproductive Abortion and post-abortion services rights of women and girls when they should be accessible to all women and criminalize them for undergoing abor- girls without discrimination, including tions and has held that states have the without any procedural, practical, or core obligation to repeal or eliminate social barriers.110 The obligation to laws and policies that criminalize safe ensure accessible sexual and reproductive abortion services.105 health services entails health facilities The Committee on Elimination of that are within safe physical reach for all, Discrimination against Women, holding including for vulnerable groups, such as that criminalization of reproductive women living in rural areas, those with health services constitutes a form of disabilities, and adolescents, to ensure 111 discrimination, has called on states to timely access to services. eliminate punitive measures for women Affordability of health services is also an who undergo abortions and for health integral component of accessibility, and care providers who deliver abortion as such, governments should take steps to services.106 ensure that cost is not a barrier to access- 112 Likewise, the U.N. Committee on the ing abortion and post-abortion care. Rights of the Child has urged states to Tanzania also has the obligation to en- “decriminalize abortion to ensure that sure access to comprehensive, accurate, girls have access to safe abortion and and evidence-based information on abor- post-abortion services” and to review tion services, including on the legal 113 their legislation to guarantee the best framework, and to dispel any miscon- interest of the girl child and ensure that ceptions against those who seek the girls’ “views are always heard and re- service. spected in abortion-related decisions.”107 Additionally, safe abortion services should be acceptable: Facility personnel Availability, Accessibility, Acceptabil- should be “respectful of the culture of ity, and Quality of Safe Abortion individuals, minorities, peoples and Services communities and sensitive to gender, age, disability, sexual diversity and life- Tanzania has the obligation to Tanzania has the obligation to ensure 114 cycle requirements.” Acceptability of ensure accessible, available, and accessible, available, and quality safe services, therefore, entails ensuring pri- quality safe abortion services and abortion services and post-abortion care vacy and confidentiality to women and post-abortion care to all women to all women and girls without any 115 adolescents seeking abortion services and girls without any barriers. barriers. and providing medically accurate and Availability necessitates putting in non-stigmatizing information on place an adequate number of function- abortion.116 ing health care facilities and services Quality, another major component of with trained medical and professional abortion and post-abortion services, re- personnel and skilled providers who are quires that these services be evidence- trained to perform the full range of sex- based and scientifically and medically ual and reproductive health services, 108 appropriate, that they be provided by Abortion and post-abortion services including abortion services. It also adequately trained health care providers, should be accessible to all women requires that states provide post-abortion and that required equipment and drugs and girls without discrimination, care to women, regardless of whether 117 109 are current and scientifically approved. including without any procedural, abortion is legal. practical, or social barriers.

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ENDNOTES pregnancy-testing-expulsion?_ga=2. there is “evidence that a woman had at 256528331. 1965979050.1591276157- any material time been pregnant for a 1 period of twenty-eight weeks or more.”: Interview with a reproductive rights advo- 1223613524.1547846277 [hereinafter See Penal Code, Cap. 16, sec. 219. cate, Dar es Salaam (Sep. 25, 2017). Center for Reproductive Right, Forced 19 2 Out]. Penal Code, Cap. 16, sec. 219. World Health Organization, Safe Abortion: 14 20 Technical and Policy Guidance for Health Interview with a woman, age 40, Dar es Penal Code, Cap. 16, sec. 230; See Systems 1, 2nd ed. (2012) [hereinafter, Salaam (Sep. 26, 2017) (“I discovered that also Center for Reproductive Rights, WHO, Technical Guideline on Abortion]. I was pregnant [while] I was still nursing. Legal and Policy Framework, supra 3 After consultation with my doctors, they note 16, at 18. Id., at 21. agreed to perform [the abortion]” ); Focus 21 4 Center for Reproductive Rights, Legal World Health Organization, Medical man- group participant, Mwanza (Nov. 7,2017) and Policy Framework, supra note 16, agement of abortion 29 (2018) [hereinafter (“It was an unplanned pregnancy and I at 22. WHO, Medical Management of Abortion]. already had a 3 months old baby when I 22 5 Id., at 20. WHO, Factsheet: Preventing unsafe abor- discovered that I was pregnant again. I 23 tion (2019) available at asked myself how I could afford to raise See interview with Head Nurse work- http://www.who.int/mediacentre/factsheets the child and the pregnancy. I could not af- ing in a public dispensary, Dar es /fs388/en/.. ford to care for two children and decided to Salaam (Sep. 25, 2017); interview with 6 an ob/gyn working in a facility that is See, for instance, interview with a woman, have an abortion”). 15 partly public, Mwanza (Nov. 8, 2017); age 43, Arusha (November 21, 2017). Interview with a woman, age 37, Arusha Interview with a nurse, Muhimbili hos- 7 See the introductory factsheet for back- (November 21, 2017); Government Offi- cial, Gender and Youth Department, pital, Dar es Salaam (Sep. 20, 2017): ground information about the research, Interview with an ob/gyn, Sekou Toure including methodology and profile of inter- Mwanza (Nov. 15, 2017); Focus group discussion with women, Arusha (Nov. 20, hospital, Mwanza (Nov. 8, 2017) (He viewees. Due to the sensitivity and stigma explained: “I will consider the policy surrounding abortion in Tanzania, identify- 2017) (One woman shared the experience of a friend who was widowed: “I guess the [which does not] allow to induce abor- ing information of the people interviewed tions unless the pregnancy is in danger for this research is not included in this re- pregnancy made her fear the perception society will have of her after knowing that or is threatening her life. I am working port. according to the national policies. I 8 she was pregnant as a widow. It is a tradi- Interview with a woman, Mwanza (Nov.13, tion that you have to tell [people] how you cannot induce [abortion] unless there 2017); See also Interview with woman, became pregnant while being a widow. is a medical ground…Although I think age 37, Arusha (November 21, 2017). She would have been excluded from her it’s important, we do not deal with psy- 9 Interview with a woman, age 26, Dar es family and community [if they have found chological issues”). Salaam (Dec. 6, 2017). out that she is pregnant]. Therefore, she 24 United Republic of Tanzania, Ministry 10 Interview with a woman, age 22, Mwanza decided to have an abortion. She took tra- of Health and Social Welfare, Standard (Nov. 13, 2017). ditional medicines and over-bled and Treatment Guidelines and Essential died”). Medicines List, 96 (4th ed 2013) [here- 11 Interview with a woman, age 34, Arusha 16 inafter 2013 Tanzania Essential (Nov. 20, 2017); interview with a woman, Center for Reproductive Rights, Briefing Medicines list]. age 21, Dar es Salaam (Sep. 26, 2017); Paper: A Technical Guide to Understand- 25 Interview with a woman, Dar es Salaam, ing the Legal and Policy Framework on Standard Treatment Guidelines & Na- age 40 (Dec.6, 2017); interview with a Termination of Pregnancy in Mainland tional Essential Medicines List th woman, age 36, Mwanza, interview date, Tanzania 6 (2012) [hereinafter Center for Tanzania Mainland, 122 (5 ed 2017) (Nov. 13, 2017). Reproductive Rights, Legal and Policy [hereinafter 2017 Essential Medicines Framework]. List]. 12 Focus group discussion with young girls, 17 26 Mwanza (Nov.13, 2017) ( “For school rea- Penal Code, Cap. 16, sec. 150; Penal Id. sons, [adolescent girls] tend to [have an Code, Cap. 16, sec.151; Penal Code, Cap. 27 Penal Code, Cap. 16, sec. 219; Minis- abortion] in order to continue with their 16, sec.152 (attempts to cause a miscar- try of Health, Community studies, because if you are pregnant, you riage by a third party with a punishment of Development, Gender, Elderly and are not allowed to continue with [your] 14 years imprisonment; attempts by the Children, Comprehensive Post Abor- studies.”) woman herself to procure a miscarriage tion Care Guideline Trainees Manual, with a punishment of 7 years; and anyone 13 See, in general, Center for Reproductive 12 (2nd ed. 2016) [hereinafter MOH, who supplies materials that is intended to Rights, Forced Out: Mandatory Pregnancy Post Abortion Care Trainees Manual]. be used to procure a miscarriage is guilty Testing and the Expulsion of Pregnant 28 See Ministry of health and social wel- of a criminal offense and liable to a prison Students in Tanzanian Schools (2012) fare, national Policy guidelines for term of 3 years). available at reproductive and Child health services, 18 https://www.reproductiverights.org/docum Under the Penal Code, a child is consid- 20 (2003); Ministry of Health and So- ent/tanzania-report-forced-out-mandatory- ered to be capable of being born alive if cial Welfare, National Essential Health

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 9

Care Interventions Package-Tanzania have an abortion… I also fear that if I al, supra note 27, at 12. (NEHCIP-Tz) 22 (2015). share my experience, I might be reported 51 Center for Reproductive Rights, Legal 29 Ministry of Health and Social Welfare, The to the police and be arrested”); interview and Policy Framework, supra note 16, National Road Map Strategic Plan to Im- with a woman, age 32, Arusha (Nov. 21, at 33. 2017) (“I know from the media that women prove Reproductive, Maternal, Newborn, 52 WHO, Technical Guideline on Abortion, who had abortions may be reported to Child & Adolescent Health in Tanzania supra note 2, at 65. (2016-2020) 22 (2016) [hereinafter MOH, police and arrested.”). 53 Steven H Woolf et.al., Potential bene- National Road Map on MNCAH 2016- 43 The definition of health provided by the fits, limitation, and harms of clinical 2020). WHO, as adopted by the government of guidelines 527 BMJ VOL.318: 527-30 30 Tanzania, states that “[h]ealth is a state of MOH, Post Abortion Care Trainees Man- (1999). complete physical, mental and social well- ual, supra note 27, at 2. 54 being and not a merely the absence of Id. 31 Id., at 10. disease or infirmity”: Constitution of the 55 Center for Reproductive Rights, Legal 32 Id., at 14. World Health Organization, Adopted by and Policy Framework, supra note 16, 33 Id., at 15. the International Health Conference in at 33. 34 New York (1946). 56 Id. Ministry of Health and Social Welfare, 44 35 See, for instance, interview with an ob/gyn Interview with a reproductive rights advo- The National Adolescent Reproductive working in a public hospital, Dar es Sa- cate, Dar es Salaam (Sep. 29, 2017). Health Strategy 2011-2015, 7 (2011). laam (Sep. 30, 2017); general practitioner 57 36 Interviewed Doctors in Arusha, Dar es Kizito Makoye, Tanzania's new PM working in a public hospital, Dar es Sa- threatens to sack doctors for illegal Salaam and Mwanza in public and private laam (Oct. 4, 2017). facilities all refer to the curriculum as a abortions, The Citizen (January 8, 2016) 45 Interview with an ob/gyn working in public post abortion care guideline. available at hospital, Mwanza (Nov. 8, 2017); interview 37 http://www.thecitizen.co.tz/News/18403 Interview with a reproductive rights advo- with a general practitioner working in a 40-3025462-ltw6d2z/index.html (last cate, Dar es Salaam (Sep. 29, 2017). public hospital, Dar es Salaam (Oct. 4, visited June 7, 2020). 38 Participants of FGDs Women and Ado- 58 2017). Id. lescents Girls in Arusha, Dar es Salaam 46 Interview with an ob/gyn working in a pub- 59 and Mwanza Regions; Health care pro- Interview with a reproductive health lic hospital in Mwanza (Nov. 9, 2017) advocate, Dar es Salaam (Sep. 25, viders (Gynecologists, Obstetricians, (“The decision to terminate a pregnancy General Practitioners and Nurses) work- 2017). must be taken by 3 doctors with good rep- 60 ing in public and private facilities at utations [because] that’s is the law”); Interview with a woman, age 21 Arusha different levels (from dispensary to health interview with a general practitioner work- (Nov. 17, 2017). center to hospitals) in Arusha, Dar es Sa- ing in a private facility, Arusha (Oct. 11, 61 See, for instance, interview with a laam Regions; Reproductive health 2017) (“Even if abortion is necessary to member of parliament, Dar es Salaam advocates implementing programs in dif- save her life, the government policy re- (Oct. 4, 2017); Government Official, ferent regions in Tanzania. quires that we first conduct some tests, Gender and Youth Department, 39 Focus group discussion, Arusha (Nov. 20, ultrasound, and seek advice from other Mwanza (Nov. 15, 2017); focus group 2013); See also interview with a woman, doctors before performing the abortion. discussion with health care providers Mwanza (Nov. 9, 2011); Focus Group One doctor alone cannot decide on abor- working at a local NGO, Dar es Salaam discussion, Mwanza (Nov. 7, 2011); inter- tion, 3 to 5 doctors must be involved in the (Sep. 21, 2017): interview with a young view with a woman, Mwanza (Nov. 9, decision making). woman, age 19 years, Mwanza (Nov. 2017). 47 Interview with an ob/gyn working in a pub- 16, 2017); focus group discussion with 40 Interview with woman, age 21, Mwanza lic hospital, Mwanza (Nov. 8, 2017). police officers, Mwanza (Oct. 11, 2017). 62 (Nov. 17, 2017). 48 Interview with a nurse working in public See Guttmacher Institute, In brief: Un- 41 Interview with a legal practitioner, Dar es hospital, Dar es Salaam (Sep. 20, 2017). safe Abortion in Tanzania: Review of Evidence. 2 (2013) available at Salaam (Sep. 21, 2017) (“The media has 49 Interview with a nurse working in public a big role to educate, inform and com- https://www.guttmacher.org/sites/default hospital, Dar es Salaam (Sep. 20, 2017); /files/pdfs/pubs/IB_unsafe-abortion- municate to the society. The problem right See also interview with an ob/ gyn working now is that they sensationalize the infor- tanzania.pdf; interview with a woman, in a public hospital, Dar es Salaam (Oct. 4, age 24, Mwanza (Nov. 9, 2017); also in- mation which waters down the magnitude 2017). of the problem. They also have a limited terview with a reproductive health 50 For example, the Comprehensive Post understanding of the issue”). advocate, Dar es Salaam (Nov. 9, Abortion Care Guideline Trainees Manual 2017). 42 Interview with a woman, age 36, Mwanza, provides that per the Penal Code, abortion 63 interview date, (Nov. 13, 2017) (“I learned Interview with a woman, age 24, can legally be performed when “it is nec- Mwanza (Nov. 9, 2017) (She used mul- from TV and radio that it is a criminal of- essary to save the woman’s life”: See fence, but I had no other option than to MOH, Post Abortion Care Trainees Manu-

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 10

tiple unsafe methods to terminate her preg- and Youth Department, Mwanza (Nov. 15, 81 Interview with a woman, age 34, Arusha nancy, including drinking soaked ashes, 2017); See also interview with an obs/gyn (Nov. 20, 2017) (She experienced se- boiled blue detergent together with coca co- working at public and faith based hospital, vere pain and bleeding for two weeks la, black tea and pills, and suffered Mwanza (Nov. 9, 2017); interview with a after an unsafe abortion but did not complication. She recounted: “I did not go to reproductive rights advocate, Dar es Sa- know that public facilities provided post public hospital for the bleeding and stomach laam (Sep. 29, 2017); interview with a abortion care, and did not go to a pri- pain, because I was afraid of being arrested general practitioner working in a public vate facility because of cost); See also when they found out that I had an abortion. hospital, Dar es Salaam (Sep. 20, 2017) interview with a woman, age 21, Dar es And I did not go to the private clinic/hospital (The doctor explained: “What happens at Salaam (Sep. 26, 2017). because of the cost”); See also interview the national reference hospital is very dif- 82 MOH, National Road Map on MNCAH with a reproductive health advocate, Dar es ferent from what happens in other 2016-2020, supra note 29, at 8. Salaam (Nov. 9, 2017). facilities. In other facilities, management of 83 See e.g. interview with a young woman, 64 Interview with a reproductive health advo- complications is very poor. We receive age 19 years, Mwanza (Nov. 16, 2017); cates, Kigoma (Sep. 28, 2017). patients with very bad conditions at the interview with a woman, age 24, 65 national hospital…health workers at lower Interview with a general practitioner working facilities do not have enough knowledge to Mwanza (Nov. 9, 2011). in public and private facilities, Mwanza (Nov. deal with complications from abortions”). 84 Interview with a woman, age 24, 8, 2017); interview with an ob/gyn working in 72 Arusha, Rec. 74 (Nov. 20, 2017). a public hospital, Dar es Salaam (Oct. 4, Interview with a woman, Mwanza (Nov. 85 2017). 13, 2017); interview with a general practi- Interview with a woman, (age withheld) 66 tioner working in a private facility, Arusha (Nov. 7, 2017). Interview with a head nurse working in a (Oct. 11, 2017). 86 public dispensary, Dar es Salaam (Sep. 25, Interview with an ob/gyn working in a 73 2017); See also interviews with a reproduc- WHO, Technical Guideline on Abortion, public hospital in Mwanza (Nov. 9, tive rights advocates, Dar es Salaam (Sep. supra note 2, at 42. 2017); Interview with a general practi- 29, 2017 & Dec. 7, 2017). 74 2017 Essential Medicines List, supra note tioner working a public referral hospital, Dar es Salaam (Nov. 28, 2017). 67 Interview with a general practitioner working 25, at 124 & 130. 87 in public and private facilities, Mwanza (Nov. 75 Many people interviewed for this research Interview with a midwife and nurse 8, 2017) (“In private facility, we have enough indicated that the number of women and working in a regional hospital, Arusha trained staff, equipment and supplies. In the adolescent girls using misoprostol to self- (Nov. 21, 2017). public dispensary we are still using old induce an abortion has increased in the 88 Focus group discussion with health care equipment. For example, we only have one past few years: See, e.g. interview with a providers working at a local NGO, Dar MVA kit [in the public facility] and it has only general practitioner working in public and es Salaam (Sep. 21, 2017): See also in- few tubes so if we have 5 [post abortion] pa- private facilities, Mwanza (Nov. 8, 2017). terview with a woman, age 22, Mwanza, tients, we cannot accommodate them”). 76 Syriacus Buguzi, The unsafe practice of (Nov. 13, 2017). 68 89 Interview with a reproductive health advo- intended abortion fueled by drug-stores, MOH, Post Abortion Care Trainees cate working in an international non- The Citizen (February 27, 2017) available Manual, supra note 27, at 14. governmental organization, Dar es Salaam at 90 Focus group discussion with health care (Dec. 7, 2017) (“In a remote area, women https://www.thecitizen.co.tz/magazine/The providers working at a local NGO, Dar have to go a very long way to get these ser- -unsafe-practice-of-intended-abortion- es Salaam (Sep. 21, 2017) vices. In these areas, we train providers, fuelled-by-drug-stores/1840564-3829544- 91 Interview with a general practitioner bring the supplies and equipment and reno- format-xhtml-nfwkat/index.htm (last ac- working in public and private facilities, vate the facility. It is ready to be used but cessed June 7, 2020). Mwanza (Nov. 8, 2017). when the trained provider is moved to an- 77 Interview with a nurse working at a private other facility in a different area, it means we 92 Interview with a young woman, age 25, facility, Mwanza (Dec. 15, 2017) lose their skills and women lose the access Arusha (Nov. 20, 2017). (“[m]isoprostol that is under dosed results to quality reproductive health services”). 93 in incomplete abortions. [Women and girls] interview with an ob/gyn working in a 69 Interview with a maternal health and family get it from pharmacies, it is sold secretly. facility that is partly public, Mwanza planning program analyst, Dar es Salaam Nowadays, most of the pharmacies have (Nov. 8, 2017). (Oct. 5, 2017) (“Government facilities are in misoprostol but they fail to give the proper 94 Interview with a nurse working at a pri- all regions, but you may find that in some dosage.”) vate facility, Mwanza (Dec. 15, 2017). places the providers working in government 78 Catherine Kahabuka et al., Provision of 95 Center for Reproductive Rights, Legal facility may not have knowledge of [post harm-reduction services to limit unsafe and Policy Framework, supra note 16, abortion services]”). abortion in Tanzania, 211, Int. Journal of at 29. 70 Interview with a general practitioner working Gynecology & Obstetrics 136: 2 (2016). 96 African Commission on Human and in a public referral hospital, Dar es Salaam 79 Id. Peoples’ Rights, General Comment No. (Nov. 28, 2017). 80 Focus group discussion with women, 2 on Article 14.1 (a), (b), (c) and (f) and 71 Interview with a government official, Gender Mwanza (Nov. 11, 2017). article 14.2 (a) and (c) of the Protocol to

Lack of Safe Abortion Services: A Result of Restrictive Laws and Stigma . 11

the African Charter on Human and Peoples’ Human Rights Treaty Bodies, at 14, pa- ENDNOTES: SOCIO-ECONOMIC Rights on the Rights of Women in , ra. 18, U.N. Doc.HRI/GEN/1/Rev.9 (Vol. PROFILE OF TANZANIA para 46 (2014) [hereinafter ACHPR, Gen- II) (2008) [hereinafter CEDAW Commit- tee, Gen. Recommendation No. 24]; eral Comment 2]. 1 CRC Committee, Concluding Observa- World Population Review, Tanzania Popu- 97 Id. tions: Nicaragua, para. 59, U.N. Doc. lation 2020 available at http://worldpop- 98 Id., para 48. CRC/C/NIC/CO/4 (2010); CAT Commit- ulationreview.com/countries/tanzania- 99 CEDAW Committee, Concluding Observa- tee, Concluding Observations: population/ (last visited June 16, 2020). tions: Timor-Leste, para. 31(a), U.N. Doc. Nicaragua, para. 16, U.N. Doc. 2 World Population Review, Low Income CEDAW/C/TLS/CO/2-3 (2015). CAT/C/NIC/CO/1 (2009); ESCR Com- Countries 2020 available at https://world- 100 mittee: Concluding Observations: ACHPR, General Comment 2, supra note populationreview.com/countries/lowincom Pakistan, paras. 77, 78, U.N. Doc. 96, para 49. ecountries/ (last visited June 16, 2020). CESCR/C/PAK/CO/1 (2017). 3 101 UNDP AND GOVERNMENT OF TANZANIA, Id., para 46. 107 Committee on the Rights of the Child, TANZANIA HUMAN DEVELOPMENT REPORT 102 See, e.g., K.L. v. Peru, Human Rights General Comment No. 20 (2016) on the 2017: SOCIAL POLICY IN THE CONTEXT OF Committee, Commc’n No. 1153/2003, U.N. implementation of the rights of the child ECONOMIC TRANSFORMATION XII (2018) Doc. CCPR/ C/85/D/1153/2003 (2005); L.C. during adolescence, para. 60 U.N. doc [hereinafter UNDP, TANZANIA HUMAN DE- v. Peru, CEDAW Committee, Commc’n No. CRC/c/GC/20 (2016). VELOPMENT REPORT 2017]: 22/2009, para. 8.15, U.N. Doc. 108 ESCR Committee, General Comment Multidimensional poverty refers to “the ex- CEDAW/C/50/D/22/2009 (2011) tent of deprivation that individuals face 103 No. 22 (2016) on the right to sexual and The Constitution of the United Republic of reproductive health (article 12 of the In- with respect to their standard of living, ed- Tanzania (1977) see Part III. ternational Covenant on Economic, ucation and health” and extreme poverty 104 See CRC, Concluding Observations: Bhu- Social, and Cultural Rights), para. 13, refers to “the proportion of people below tan, para. 35(c), U.N. Doc. U.N. Doc. E/C.12/GC/22 (2016) [herein- the food poverty line”: See UNDP, CRC/C/BTN/CO/3-5 (2017); Cameroon, pa- after ESCR Committee, Gen. Comment TANZANIA HUMAN DEVELOPMENT REPORT ra. 35(c), CRC/C/CMR/CO/3-5 (2017); No. 22]. 2017, at 7 & 11. Sierra Leone, para. 32 (c), U.N. Doc. 109 4 CAT Committee, Concluding Observa- UNDP, TANZANIA HUMAN DEVELOPMENT CRC/C/SLE/CO/3-5 (2016); Benin, para. tions: Paraguay, para. 22, U.N. Doc. REPORT 2017, at xii & xiii. 57(c), U.N. Doc. CRC/C/BEN/CO/3-5 CAT/C/PRY/CO/4-6(2011). 5 (2016); CEDAW Committee, Concluding Ministry of Foreign Affairs of Denmark, 110 ESCR Committee, Gen. Comment No. Observations: Micronesia, para. 37(b), U.N. Current and future challenges and oppor- 22, supra note 109, para 2, 15, and 24. Doc. CEDAW/C/FSM/ CO/1-3 (2017); Niger, tunities in Tanzania (2014) available at 111 para. 33(c), U.N. Doc. Id., para 16. http://um.dk/en/danida- en/strategies%20and%20priorities/country CEDAW/C/NER/CO/3-4 (2017); Costa Rica, 112 Id., para 17. para. 31(a), U.N. Doc. CEDAW/C/CRI/CO/7 -policies/tanzania/current-and-future- 113 Id., para. 18: ACHPR, General Com- (2017). See also Human Rights Committee, challenges-and-opportunities-in-tanzania/ ment 2, supra note 96, para. 51. Concluding Observations: Honduras, para. (last visited June 16, 2020). 114 ESCR Committee, Gen. Comment No. 6 17, U.N. Doc. CCPR/C/HND/CO/2 (2017). UNDP, TANZANIA HUMAN DEVELOPMENT 22, supra note 109, para. 20. 105 Committee on Economic, Social and Cultur- REPORT 2017, supra note 3, at xii & xiv. 115 CEDAW Committee, Gen. Recommen- 7 al Rights, General Comment No. 22 (2016) Id. on the right to sexual and reproductive dation No. 24, supra note 107, para. 8 Trading Economics, Tanzania Unemploy- health (article 12 of the International Cove- 31(e); Committee on the Rights of the ment Rate 2001-2018 available at nant on Economic, Social and Cultural Child, Concluding Observation: Slo- https://tradingeconomics.com/tanzania/un Rights) para. 35 & 49 U.N. Doc. vakia, para 41(e), U.N. Doc. employment-rate. E/c.12/GC/22 (2016). CRC/C/SVK/CO/3-5 116 9 106 CEDAW Committee, General Recommen- Committee on the Rights of the Child, UNDP, TANZANIA HUMAN DEVELOPMENT dation No. 24: Article 12 of the Convention Concluding Observation: Slovakia, para REPORT 2017, at 45. (women and health) (20th Sess., 1999), in 41(e), U.N. Doc. CRC/C/SVK/CO/3-5. 10 Id. 117 Compilation of General Comments and ESCR Committee, Gen. Comment No. 11 Id., at 13. General Recommendations Adopted by 22, supra note 109, para. 21. 12 Id.

13 Id., at 73.

14 Id., at 15 & 45. 15 Id., 15-16.

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