FACT SHEET

Induced and Postabortion Care in

Revised July 16, 2019

■■ Zimbabwe has one of the highest Zimbabwe, the regional abortion rate is maternal mortality ratios in the world, nearly double, at 34 per 1,000 women estimated at 651 maternal deaths per aged 15–44. 100,000 live births. In contrast to a worldwide trend of declines, maternal ■■ Abortion rates in Zimbabwe vary mortality has increased in Zimbabwe greatly across the country. The highest Delays and gaps in service over the past 25 years. rates are in the Mashonaland provinces provision and (21 per 1,000 women aged ■■ Many women experiencing complica- ■■ Abortion is legally permitted in the 15–49) and lowest in the Manicaland tions from or miscar- country only under limited circum- and Masvingo provinces (12 per 1,000 riage in 2016 faced delays in obtaining stances, including if the pregnant wom- women). postabortion care. On average, nearly an’s life is in danger or in cases of , two full days elapsed between expe- or fetal impairment. In practice, Provision of postabortion care riencing complications and receiving it is extremely difficult to obtain a legal ■■ Of the estimated 25,200 women completed treatment. Common rea- abortion; as a result, most receiving facility-based postabortion sons for treatment delays included lack are clandestine and potentially unsafe. care in 2016, about half were treated of money, lack of transportation and for complications related to abortions distance to a health facility. ■■ The Zimbabwe Ministry of Health and (many of which were unsafe), and half Child Care has made efforts to increase were treated for complications related ■■ Postabortion care is not offered at the access to and improve postabortion care to late miscarriage. majority of primary health centers, in order to reduce maternal mortality. which are the facilities most accessible However, ongoing economic insecurity ■■ The vast majority (85%) of postabortion to rural women. Overall, nearly half of has limited the health system’s capacity care was provided in public health facil- postabortion care patients in 2016 had to provide these services. ities. Half of these cases were treated to seek care at more than one facility at district hospitals and one-third at to get complete treatment. Incidence of abortion larger, central hospitals. ■■ In 2016, an estimated 65,300 induced ■■ One-fifth of public facilities asked abortions occurred in Zimbabwe. This ■■ Among women treated for postabor- women to pay for postabortion care translates to a rate of 17 abortions for tion complications in 2016, 78% had prior to treatment—which caused every 1,000 women aged 15–49. mild or moderate complications and delays in treatment—even though 19% had severe complications. Three these facilities are supposed to provide ■■ Zimbabwe has one of the lowest percent died or nearly died from the service at no cost. abortion rates in Sub-Saharan Africa. complications. In Eastern Africa, which includes ■■ A substantial proportion of first- trimester postabortion cases were OUTCOMES treated using surgical procedures not recommended by the World Health One in 10 end in abortion. Organization (WHO) or national guide- lines for this type of care. These pro- 10% cedures are more expensive and carry greater risk for further complications Unintended pregnancy ending in abortion than medically recommended methods such as manual and 60% 30% Unintended pregnancy ending in miscarrage or birth (a type of medication).

Intended pregnancy ending in miscarriage or birth ■■ More than half of health facilities reported shortages of misoprostol—an

677,300 pregnancies, 2016 JULY 2019

5%

Intended pregnancy ending in miscarriage or birth

Unintended pregnancy ending in miscarriage or birth 69% Unintended pregnancy ending in abortion POSTABORTION CARE SUPPLY SHORTAGES of postabortion care and Cooperation Agency, UK Aid disparities in access to treat- from the UK Government, and Many health facilities reported running out ment, contribute to maternal the Dutch Ministry of Foreign of essential supplies for postabortion care injury and likely to death. Affairs. The views expressed in a three-month period in 2016. are those of the authors and do not necessarily reflect the ■■ Increase the availability and official positions or policies of 100 use of WHO-recommended the donors. postabortion care meth- 90 ods by ensuring facilities NOTE 80 have adequate training, This fact sheet has been corrected to reflect small 70 supplies Misoprand equipment.ostol 60 Specifically, primary health changes in the numbers of centers should be stocked abortions and pregnancies, 50 which resulted from correcting with adequate supplies of 40 an error in an underlying data misoprostol. A wide range of input. These corrections do 30 55 providers, including nurses, 20 not change the study’s main 35 34 should be trained and sup- findings or conclusions. 10 ported to provide both miso- 0 prostol and manual vacuum Misoprostol Blood for Intravenous (IV) aspiration. transfusions antibiotics

% of health facilities designated to provide postabortion care ■■ Increase funding to ensure public health facilities essential medicine for Two-thirds (66%) of mar- have the resources they postabortion care—in the ried women and sexually need to provide postabor- three months preceding active unmarried women in tion care free of charge College of Health Sciences Clinical Trials Research Centre the survey. Half of facilities Zimbabwe used a modern and fully implement the 15 Phillips Ave, Belgravia designated under national contraceptive method in National Guidelines for Com- Harare, Zimbabwe guidelines to provide man- 2015. Nevertheless, one in prehensive Postabortion [email protected] ual vacuum aspiration did 10 married women and two Care in Zimbabwe. www.uzchs-ctu.org not have the equipment to in 10 sexually active unmar- do so. Many other facilities ried women reported want- ■■ Meet women’s and couples’ had equipment but were not ing to avoid a pregnancy but needs for contraception to using it. were not using any contra- help them avoid unintended ceptive method. pregnancies and the unsafe ■■ Forty percent of women abortions that often follow. who had an abortion in Recommendations Family planning programs Zimbabwe experienced ■■ Broaden the circumstances should include targeted complications that required under which abortion is efforts to reach unmarried Zimbabwe Ministry of Health and Child Care medical treatment. However, legally permitted, and young women, poor women Kaguvi Building, 4th Floor, only half of women with educate health care pro- and women in rural areas. Central Avenue complications received the fessionals and the public Harare, Zimbabwe treatment they needed. about legal provision in SOURCES [email protected] order to reduce the number Information in this fact sheet www.mohcc.gov.zw can be found in the following Contraception and of clandestine and unsafe sources: Sully EA et al., procedures. unintended pregnancy The incidence of induced ■■ Most women who have an abortion in Zimbabwe, PLOS abortion do so because they ■■ Ensure the availability of ONE, 2018, doi: 10.1371/ become pregnant when safe, legal abortion services journal.pone.0205239; and they do not intend to. In and postabortion care in Madziyire MG et al., Severity 2016, 40% of pregnancies order to reduce ill health and and management of post- in Zimbabwe were unin- death from unsafe abortion. abortion complications tended and one-quarter of Unsafe abortion can result among women in Zimbabwe, Good reproductive unintended pregnancies in severe complications, as 2016: a cross-sectional BMJ Open health policy starts with ended in abortion. well as high social and eco- study, , 2018, 8(2):e019658, doi:10.1136/ credible research nomic costs to women, their bmjopen-2017-019658. ■■ Zimbabwe has the highest families and the health care 125 Maiden Lane New York, NY 10038 rate of modern contracep- system. Despite the low ACKNOWLEDGMENTS 212.248.1111 tive use in Sub-Saharan national abortion rate, com- The study on which this fact [email protected] Africa, likely due to the plications from unsafe abor- sheet is based was made government’s robust tion in Zimbabwe, along with possible by the Swedish www.guttmacher.org family planning program. critical gaps in the provision International Development JULY 2019