By Duncan Mlanjira
Having read the Termination of Pregnancy (TOP) Bill and having listened to arguments and comments from the general public with various and different backgrounds, pathologist and senior lecturer at College of Medicine, Dr. Tamiwe Tomoka has come up with an analysis of this Bill.
She feels that arguments and comments, many people seem not to have read the bill as most people are worried that if the Bill passes, it’s like publicizing abortion and that some will bend the rules and take advantage of the proposed Bill to procure abortions.
“There are provisions for offences and those who will take advantage will be committing a crime by law,” she wrote on Facebook.
“Abortions are not a secret though we want to treat them as such. They are happening and will continue to happen. Women with resources are doing them safely.”
She said it is the poor who cannot afford proper TOP services and end up soliciting unsafe backstreet services.
She said when she was practising as a doctor in the public health service in 2004-05, she used to experience about 20-30 women per day being referred to Queen Elizabeth Central Hospital with complications of backstreet abortion for post-abortal care.
She said the majority of them were poor women who used things like rods, sticks, perforations and some had very bad complications when they tried to terminate their pregnancies.
“In light of the provisions in the Bill, I need to be balanced where all this talk from some people blaming women for unwanted pregnancies and why they want to terminate is coming from,” she said.
Her understanding of the TOP Bill in summary include:
a. the continued pregnancy will endanger the life of a pregnant woman;
b. the termination of pregnancy is necessary to prevent injury to the physical or mental health of a pregnant woman;
c. there is severe malformation of the foetus which will affect its viability or compatibility with life, or;
d. the pregnancy is a result of rape, incest or defilement
“In the Bill ground (d) can only be carried out at 16 weeks below while the rest (a,b,c) any gestational age as long as other conditions in the Bill are met.
“Counselling shall be provided and consent obtained. Counselling shall include:
(a) information on options of continuing or terminating the pregnancy,
(b) available methods for termination of pregnancy,
(c) possible short and long-term effects associated with each method of termination of pregnancy,
(d) emotional and psychological responses following termination of pregnancy, and information about family planning.
“Consent shall be obtained. In case of the child if consent by parents is being unreasonably withheld practitioner may decide to go ahead with termination.
“Medical personnel will not be forced to perform terminations if their conscious does not allow except in emergency or saving the life of the mother,” she quotes the Bill.
Furthermore, a woman can lodge a complaint if she feels she is being denied access to termination as provided for under the Act and that complaints handling committee to be set up at every facility.
“Then there is the offences section which deals with unauthorized termination, false declaration of rape, incest or defilement, obstructing a person from accessing TOP and general offenses.
“This section covers all forms of TOPs that are not provided for in the Act.
“My opinion on the bill: TOPs where there is threat to a woman’s life, are already being done in the hospitals (eg in eclampsia = high BP in pregnancy associated with convulsions and other life threatening illness). Now in the Bill we have 3 additional grounds.
“As the Bill stands now, it is not absolutely pro-choice as some people are making us believe. There are 4 indications/grounds for TOP in the Bill — it does not have provisions for TOP on demand or any other reason apart from the 4 above.”
She added that TOP due to rape, incest and defilement are only limited to 16 weeks and below while the other indications are not limited in time.
Health facility for the TOP is defined as community hospitals, district hospitals and central hospital and Tomoka wondered if private hospitals are excluded or which category do they fall in.
“The bill falls short in addressing the autonomy of women regarding the choice to keep or not keep a pregnancy. A pregnant woman will be committing an offence if she procures TOP for grounds not provided for in the Act.”
Dr. Tomoka, a graduate of University of Malawi’s College of Medicine, studied anatomical pathology at University of Cape Town in South Africa and also studied epidemiology at London School of Hygiene and Tropical Medicine and did her MSc Epidemiology at University of London.
In his reaction to the explanation, Joseph Nkhoma the TOP Bill is otherwise as important as any other necessary law in a country while Burnett Chila Chiona, while applauding Tomoka for her good analysis says there need for civic education.
“I see that many arguments that are coming are biased towards religious beliefs rather than analyzing the actual Act,” he said.
Ivor Mbengo also applauded Tomoka for her “insightful” analysis, saying one can make an informed decision just based on the information she provided.
Ausbert Thoko Msusa said the TOP lessens the grey areas in the current Act, saying it is some progress as far as the Law is concerned.
“And it has to be understood the line Ministry had seen lots of maternal deaths from post abortal complications of unsafe abortions, thus it had to relook at this matter.
“When those and such that meet criteria for TOP, they should be done in a safe way with good guidelines,” he said.