A new report that shows that about 18,000 women and girls in Rwanda require treatment annually from the effects of unsafe abortion has prompted advocacy groups to push the government further to decriminalise the act in a bid to save lives and resources.
The report, released at the end of May by the New York-based Guttmacher Institute in partnership with the University of Rwanda’s School of Public Health and the Ministry of Health, showed that the government spends $1.7 million (Rwf1.1 billion) annually on treatment for complications resulting from unsafe abortion.
It is estimated that about 60,000 abortions are carried out in Rwanda annually, according to the report.
Advocacy groups said the research — which was conducted in 39 public and private healthcare facilities across the country and sampled 18,000 women who reported to health facilities with abortion defects in 2012 — was proof that there is a need for the government to decriminalise abortion.
Dr Aflodis Kagaba, the executive director of Health Development Initiative-Rwanda (HDI), described the report as a good step in creating awareness that abortion is real in Rwanda and that the issue needs to be addressed in order to save lives and resources.
“The country spends significant resources in addressing its complications and this indicates that some effort needs to be invested in preventing unwanted pregnancies and fighting unsafe abortion,” Dr Kagaba said.
“However, the report only gives highlights on the costs at the healthcare system level and there is a need for another study that would help us to understand the costs that are directly incurred by the beneficiaries as we believe there are much higher.”
Dr Kagaba and other advocates of safe abortion believe that policy and decision makers should use the evidence generated by the study and previous ones on the prevalence of abortion to put in place more effective measures to address unwanted pregnancies and ensure access to safe abortion services.
“Our argument is based mainly on the evidence generated from different researchers that restrictive abortion laws contribute to higher maternal mortality and morbidity rates due to unsafe abortion,” Dr Kagaba said.
“Countries that have decriminalised abortion, such as South Africa, have seen a dramatic drop in maternal mortality.”
In 2012, parliament legalised abortion but only “in cases of sexual assault, rape, incest and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus.”
Activists say that while this was a step in the right direction, there are some barriers that need to be addressed if the potential victims are to benefit from the new provisions.
“For example, requiring a competent court to certify that a woman has become pregnant as a result of rape, incest or forced marriage will be a serious barrier for women who would qualify for the services,” added Dr Kagaba.
“This is mainly because of stigma, fear and family pressure that may prevent many women from reporting incest or sexual violence and engaging with the justice system.”
The post-abortion care report indicates that the cost per client across five types of abortion complications was $93 (Rwf60,000).
The report shows that 49 per cent oftotal amount of money spent on post-abortion care in the country was expended on direct non-medical costs. It adds that up to $2.5 million (Rwf1.6 billion) was most likely to be spent to address all the demands of post-abortion complications annually.
The report further says that 75 per cent of women who reported to health facilities with post-abortion complication were treated for incomplete abortion and smaller proportions for serious complications such as sepsis, which covers 13 per cent, and shock, which accounts for nine per cent.
A bigger amount of the money is spent on direct costs such as drugs, supplies, tests, medical personnel and hospitalisation fees, as well as indirect costs for overhead and capital expenses.
Lead author Michael Vlassoff said abortion poses a significant and unnecessary burden on Rwanda’s healthcare system.
“The vast majority of these abortions could be avoided by preventing unintended pregnancy, which is the root cause of most abortions. Family planning services must be expanded to ensure all women are able to plan their pregnancies,” says Ms Vlassoff.
The Ministry of Health says the government is making some progress in addressing this problem but most of these measures do not address the problem directly but rather focus on preventing unwanted pregnancies.
“We want to increase access to contraceptives for everyone who is at the threat of getting unwanted pregnancies; early prevention is key,” said Dr Fidele Ngabo, the director of Maternal and Child Health in the Ministry of Health.
He added that the progress Rwanda has made, which includes legalising abortion to a certain extent, should be taken note of.