Abortion laws and policies in Malawi and Zambia Dr Ernestina Coast Dr Emily Freeman London School of Economics Abortion Research to Policy Addis Ababa 30 th November 2016 Why compare countries ID: 535131
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Critical conjunctions: Abortion laws and policies in Malawi and Zambia
Dr Ernestina CoastDr Emily FreemanLondon School of EconomicsAbortion Research to Policy. Addis Ababa 30th November 2016Slide2
Why compare countries?Contrasts
SimilaritiesCommonalitiesPatternsStakeholdersArguments
EvidenceMotivationsProcessesOutcomes}Slide3
Current legal positionsMalawi
Abortions can be legally performed to save the life of the pregnant woman.
ZambiaContinuing a pregnancy involves a risk to the life of the pregnant woman, her physical or mental health or that of any of her existing children, greater than if the pregnancy were terminated; or a child born of the pregnancy would suffer from such physical or mental abnormalities as to be seriously handicapped. M
edical
practitioners may take account of the pregnant woman’s actual or foreseeable environment and her
age
E
xplicitly includes
rape or defilement of a female child as legal reason for inducing
abortion and to exempt
from prosecution female children who have attempted to self-abort in these circumstancesSlide4
Contexts todayMalawi
Draft Termination of Pregnancy BillNot yet before ParliamentLiberalisation of grounds on which abortion may be performed legally to include
Danger to lifePhysical + mental healthMalformation of the foetusRapeDefilementIncest
Zambia
2016 Referendum on changes to the Bill of Rights in the Constitution
Para 15(2) “The life of a person begins at conception”
Threshold of 50% of eligible voters not met (44% achieved)
Unclear next stepsSlide5
Contexts todayMalawi
Draft Termination of Pregnancy BillNot yet before ParliamentLiberalisation of grounds on which abortion may be performed legally to include
Danger to lifePhysical + mental healthMalformation of the foetusRapeDefilementIncestZambia
2016 Referendum on changes to the Bill of Rights in the Constitution
Para 15(2) “The life of a person begins at conception”
Threshold of 50% of eligible voters not met (44% achieved)
Unclear next stepsSlide6
Malawi
Highly restricted legal groundsLiberalisation?
ZambiaBroad range of legal grounds
Restriction?Slide7
Sources of evidencePrimary Media reports (print and social)Key informant interviews
Documents (including drafts)SecondaryResearch and evidenceSlide8
A PARTIAL HISTORYSlide9
TOP Act
TOP Act amended
Ratified Maputo Protocol
Ipas starts
working
Strategic assessment
unsafe
abortion
Post Abortion Task Force established
Standards &
Guidelines
ToP
Act amended
Planned Parenthood Association of Zambia
established
Ipas
establishes full country programme
International treaties
National instruments
Ministries
NGOs
Marie Stopes
Zambia: abortion
services
1972
2016
2000
1994
2005
2006
2008
2009
2011
2012
1st
Draft
of Constitution
“life begins at conception”
Referendum: inquorate
Ratified Maputo Protocol
1930
Penal Code
Communique signed by leaders of 11 political parties supporting law reform on abortion
Ipas starts
working
COPUA established
1987 BLM started
Strategic assessment
unsafe abortion
1987
Draft
Bill
2015
2007 PAC Strategy
Evidence
2007
2013
Law Commission review published
Health systems costs
Abortion incidence
2010
Standards &
GuidelinesSlide10
LEGAL LANDSCAPESlide11
TOP Act
TOP Act amended
Ratified Maputo Protocol
Ipas starts
working
Strategic assessment
unsafe
abortion
Post Abortion Task Force established
Standards &
Guidelines
ToP
Act amended
Planned Parenthood Association of Zambia
established
Ipas
establishes full country programme
International treaties
National instruments
Ministries
NGOs
Marie Stopes
Zambia: abortion
services
1972
2016
2000
1994
2005
2006
2008
2009
2011
2012
1st
Draft
of Constitution
“life begins at conception”
Referendum: inquorate
Ratified Maputo Protocol
1930
Penal Code
Communique signed by leaders of 11 political parties supporting law reform on abortion
Ipas starts
working
COPUA established
1987 BLM started
Strategic assessment
unsafe abortion
1987
Draft
Bill
2015
2007 PAC Strategy
Evidence
2007
2013
Law Commission review published
Health systems costs
Abortion incidence
2010
Standards &
GuidelinesSlide12
NGO presence/activitySlide13
TOP Act
TOP Act amended
Ratified Maputo Protocol
Ipas starts
working
Strategic assessment
unsafe
abortion
Post Abortion Task Force established
Standards &
Guidelines
ToP
Act amended
Planned Parenthood Association of Zambia
established
Ipas
establishes full country programme
International treaties
National instruments
Ministries
NGOs
Marie Stopes
Zambia: abortion
services
1972
2016
2000
1994
2005
2006
2008
2009
2011
2012
1st
Draft
of Constitution
“life begins at conception”
Referendum: inquorate
Ratified Maputo Protocol
1930
Penal Code
Communique signed by leaders of 11 political parties supporting law reform on abortion
Ipas starts
working
COPUA established
1987 BLM started
Strategic assessment
unsafe abortion
1987
Draft
Bill
2015
2007 PAC Strategy
Evidence
2007
2013
Law Commission review published
Health systems costs
Abortion incidence
2010
Standards &
GuidelinesSlide14
EVIDENCE PRODUCTION + CONSUMPTION“National policy change usually begins with documentable evidence of the problem and clear articulation of solutions.” IPAS,
2016Good reproductive health policy starts with credible research (Guttmacher
)Generating evidence for policy and practice (APHRC)Slide15
TOP Act
TOP Act amended
Ratified Maputo Protocol
Ipas starts
working
Strategic assessment
unsafe
abortion
Post Abortion Task Force established
Standards &
Guidelines
ToP
Act amended
Planned Parenthood Association of Zambia
established
Ipas
establishes full country programme
International treaties
National instruments
Ministries
NGOs
Marie Stopes
Zambia: abortion
services
1972
2016
2000
1994
2005
2006
2008
2009
2011
2012
1st
Draft
of Constitution
“life begins at conception”
Referendum: inquorate
Ratified Maputo Protocol
1930
Penal Code
Ipas starts
working
COPUA established
1987 BLM started
Strategic assessment
unsafe abortion
1987
Draft
Bill
2015
2007 PAC Strategy
Evidence
2007
2013
Law Commission review published
Health systems costs
Abortion incidence
2010
Regulatory Impact AssessmentSlide16
MalawiMaputo Protocol a “trigger”Abortion “did not fit with MDGs because no evidence”Series of studies
Strategic Assessment (2011)Incidence of Induced Abortion (2013)Health systems costs (2015)Slide17
“
Tonight, we’re going to let the statistics speak for themselves”Slide18
Letting the evidence speak for itself?Evidence/statistics a critical entry point
“Getting the conversation going”Evidence/statistics necessary but insufficientRole of “champions”“Don’t expect me to go to my constituents – they’ll kick me out” [MP]Private agreement but public distancingCoalitionsSlide19
Zambia: Standards & Guidelines do the talkingSlide20
CROSS-NATIONAL “LEARNING” (?)Slide21
On the one hand: Malawi Law Commission on abortion visitedEthiopiaZambia
MauritiusOn the other:“Stop cheating people that liberalized abortion was justifiable because of rising cases of maternal mortality rate….We have an example of Zambia and other countries, where abortion was liberalized, yet maternal death is still on the higher
side” Ethics, Peace and Justice Commission (Evangelical Association of Malawi)Slide22
On the one hand: Malawi Law Commission on abortion visitedEthiopia
ZambiaMauritiusOn the other hand:“Stop cheating people that liberalized abortion was justifiable because of rising cases of maternal mortality rate….We have an example of Zambia and other countries, where abortion was liberalized, yet maternal death is still on the higher side”
Ethics, Peace and Justice Commission (Evangelical Association of Malawi)Slide23
Religious/faith-based groupsMalawi
USA-based evangelic Christian groups lobbying MPs (2016)Concerns about abortion and gay rights articulated simultaneouslyEpiscopal Conference of Malawi (ECM)Zambia
Zambia officially a Christian countrySouth African-based “Doctors for Life”An aside about presenting evidence:
Women who have had abortions assumed to have no faithSlide24
Pastoral Statement (2016)“We, the Bishops of the Catholic Church in Malawi are aware of the pressure that
the Government has endured so far from foreign nations and agencies who attach their financial support to values and practices that are contrary to our culture. We applaud the efforts and the courage the Government has demonstrated so far to resist the pressure to adopt such foreign values and practices i.e. homosexuality and abortion. We wish to reaffirm that such practices are not only against our cultural values but
are also contrary to our laws and beliefs.”Slide25
Religious/faith-based groupsMalawi
USA-based evangelic Christian groups lobbying MPs (2016)Concerns about abortion and gay rights articulated simultaneouslyEpiscopal Conference of Malawi (ECM)ZambiaZambia officially a Christian
countrySouth African-based “Doctors for Life”An aside about presenting evidence:Women who have had abortions assumed to have no faithSlide26
Malawi
ZambiaCoalitionsCOPUA multi-interestMedical: Little evidence of activity ( beyond individual “champions”)
Legal: Highly activeNo broad coalitionMedical: Active participation and debateAdolescents
Adolescents as stakeholders
Abortion as an adolescent issue
Abortion as an adolescent issue
Social construction of abortion discourses
“not Malawian”
“not Zambian”
Ministry “sites”
Reproductive Health Unit (
MoH
)
-
MoH
- Technical Working GroupsSlide27
Law necessary but insufficientSlide28
ZambiaServices not widely availableUrban focus (public and private)
Low levels of knowledge about the lawPublicMedical professionalsServices inaccessible3 signaturesRegulatory Impact AssessmentNo broad-based coalition (yet)Opportunity for learning from Malawi?Slide29
Malawi
Highly restricted legal groundsLiberalisation?No change?
ZambiaBroad range of legal grounds
Restriction?
Increased access?Slide30
THANK YOUe.coast@lse.ac.uk