Addressing stigma while moving a national campaign: Spotlight on Malawi

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In the weeks before, during and after May 28, the International Day of Action for Women’s Health, we are sharing from national campaigns, movements and coalitions for abortion rights from across the world, through the perspectives of inroads members who participate in and lead these movements. All of these inroads members are constantly working on addressing stigma within and outside movements, even as they work towards decriminalization and providing safe, legal and free access to abortion services. We have Spotlights on campaigns in Ireland, Argentina and here we present you a spotlight on Malawi.

The Coalition for the Prevention of Unsafe Abortion (COPUA), formed in 2008 with a  growing membership that is composed both of both civil society organization and individuals, is spearheading the advocacy efforts for legal change in Malawi.  COPUA has a board, a National Chairperson and a few voted who take roles of leadership while it is organized into taskforces such as the Religious Leaders taskforce, Community Mobilization taskforce, Legal taskforce and Youth taskforce.

In this Spotlight, Mackson Harawa, Francis Makiya, Boniface Mbewe and Andrew Mdala,  four inroads members, tell us more about the barriers or stigma that still need to be addressed in addition to fighting for legal reform in Malawi.

Members of COPUA gather for a cultural event

Although some liberal religious clerics and communities have given a nod to the need for a reform of the abortion law in Malawi, what are the many other socio-cultural obstacles that are yet to be combatted?

Boniface Mbewe (Chipembere Community Development Organization– CCDO): In Malawi there are still many socio-cultural obstacles hindering access to safe abortion services in health facilities. These obstacles include: condemnation emanating from cultural and religious beliefs as the person undergoing the abortion is perceived as sinner. For instance, some believe that abortion is an act carried out by non-believers, sex workers and promiscuous girls in the society; attitude, stigma and discrimination among health service providers towards the people seeking abortion or post-abortion care services also prevent women from seeking services; the legal implications associated with current laws around safe abortion do not necessitate the availability and accessibility of the services to those in need of them. The cost of abortion services and distance to get them (pre-and post-abortion services) are some of the challenge women are facing in Malawi.  

To what extent is reporting on abortion in Malawi changing, and do you believe that media is able to have a positively transformative effect on people’s minds as the movement for the legalisation of abortion gets stronger?

Mackson Harawa (Passion for Women & Children PAWOC): The fight to help reshape the abortion environment in the country might not have yielded anything if the media had been left out. The media has played a central and important role and continue to help in getting the message clear to the Malawian population on issues relating to abortion and how they affect the lives of individual women, girls, families, communities and as a country at large. The media has been able to spark debate around the issue, engaging and actively involving traditional leaders, religious leaders, civil society representatives and young people on radio programmes, TV programmes as well as newspapers. As it stands, there are still a great many miles to go in as far as the media is concerned in transforming the minds of people so as there is acceptance and internalisation of the bill shall it pass into a law. Malawians are still bound in the stigmatizing beliefs that we are a religious nation with sound, predetermined cultural beliefs and this continues to fuel stigma and discrimination when it comes to access to SRHR including abortion. There is need for more media programmes so that the message is relayed to the communities till they are able to support in creating demand and the implementation of the bill shall it pass into a law. The media can also help in breaking the resistance by other anti-abortion groups that are actively working against the passing of the bill in parliament. Limiting media programming is lack of funding; following the Global GAG Rule and having Malawi as one of the countries being funded by the US government, funding for other SRHR programmes including abortion has been a problem.

Malawi is making strides in improving availability and access to services for women and girls. This is greatly influenced by the political will and sound policies supporting implementation of SRHR programmes in the country. Deviating from the poor maternal indicators that the country has shown in the past few years, the country has managed to reduce its Maternal Mortality Rate (MMR) to 439 per 100 000 live births although a recent survey conducted by the National Statistics Office has shown a decline in contraceptive uptake especially among women. Regardless of the decline in MMR, unsafe abortion still remains one major contributing factor greatly affecting young women and girls as a result of restrictive laws that prohibit access to safe abortion and limit provision of abortion in hospitals in the country. With efforts by the civil society (Coalition on Prevention of Unsafe Abortion in Malawi, COPUA, and other member stakeholders), we have a draft bill we believe will help reshape access and availability of abortion services in the country. The draft bill has three main provisions: a pregnancy can be terminated where there a. is proof that the woman has been raped,b. is a victim of incest, and where c. the pregnancy poses threat to the woman’s life. The law has removed the ambiguity where previously the decision was solely on the medical practitioner to decide whether a pregnancy should be terminated or not depending on mere judgement.

Members of COPUA after a training with religious leaders

In addition to abortion law reform, what are the other steps needed to bust abortion stigma in service provider’s minds or to prevent conscientious objections from the medical community in Malawi? In what ways is the medical provider community still stigmatizing abortion?  

Frances Makiya (Medical Students for Choice): Malawi still has a long way to go as far as abortion law liberation is concerned. The current law only allows abortion when the life of a woman is in danger. There is a Drafted Termination of Pregnancy bill which is trying to expand on the current abortion law to also include abortion as a result of rape, incest or defilement, severe fetal malformation and abortion to prevent injury to the physical or mental health of a woman.

The status quo of the current laws has created a harsh working environment among health workers who may have pro-abortion ideas since it’s clearly illegal by the law of the nation irrespective of personal ideologies. There is therefore, need to take a diverse approach to tackle abortion stigma and conscientious objection in Malawi; one of the most fundamental starting points being reform of the abortion law.

Abortion Law reform will provide a legal framework for service providers to be able to provide abortion on a wide range of options. Malawi has one medical school. Targeting service providers from the early stages in Medical school will create a generation of service providers who are more willing to offer abortion services therefore there is need for curriculum reforms as well. Establishment specialized abortion clinics will help to ensure direct access to abortion services and at the same time create mechanisms or channels that are safe, private and confidential for dealing with backstreet abortions.

The medical community is still stigmatizing abortion for a number of reasons some of which have been discussed. Health providers often hold negative attitudes toward abortion for religious/moral reasons. This often results in health providers not wanting to do anything concerning abortion. The poor treatment of women by health providers in health facilities for seeking abortion especially young unmarried women is one of the most notable consequences of this stigma. Stigma by association is another way this affects health workers; health providers providing abortion services are seen as the worst sinners and they face stigma just because they provide abortion services. Consequently, this creates an environment in which health care providers are reluctant to offer abortion services. Many providers have also a tendency of talking women out of abortion instead of letting autonomy prevail. They cite complications of abortion such as the possibility of requiring blood transfusion after the procedure, uterine or cervical damage, infection, acute depression, and the risk of not falling pregnant again.

Since COPUA is a pan-Malawi network of more than hundred organizations, what steps have been taken within this movement to centre the voices of people who have had abortions in the struggle for legal reform? Secondly, how are youth led organizations taking part in these advocacy movements in Malawi?

Andrew Mdala (Coalition for the Prevention of Unsafe Abortion– COPUA): COPUA is spearheading efforts to promote law reform on abortion related laws in Malawi by, among other ways, engaging the opinion leaders in our erstwhile conservative society such as traditional leaders or religious leaders and sometimes political leaders. In the many face to face interaction with these opinion leaders, COPUA presents facts about the challenges that women encounter due to the current, rigid abortion legal framework. These facts, which demonstrate the magnitude of unsafe abortions in Malawi, show these leaders how the abortion law negatively affects the lives of Malawian women. In my view, this is how COPUA advocates for a change in abortion law in Malawi: by using examples of real people’s experiences when doing advocacy work with higher level leaders.

COPUA also centres youth experiences, in fact, the majority of the network members are youth led organizations thereby putting young people at the forefront of the legal reform campaign in Malawi. Furthermore, COPUA is split into task forces to streamline our advocacy and the youth task force is very vibrant in mobilising youths across the country to champion law reform on abortion related laws in Malawi.

We are sure that all of us inroads members across the world gain insight from Malawi’s abortion stigma busters and acknowledge that learning from one another #wemakeinroads.