Abortion in Lesotho

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In Lesotho, abortion is illegal unless the pregnancy poses a risk to life or health.

Contents

In 2010, Lesotho listed grounds for legal abortion in its penal code. In 2021, the Parliament of Lesotho and church leaders debated legalisation.

Unsafe abortions cause about one-fifth of maternal deaths in the country. Few hospitals provide abortion. Government guidelines provide for post-abortion care, but few facilities exist. The government has recommended that women seeking abortion travel to South Africa, where it is safe and legal. Clandestine abortions are available in Lesotho from foreign physicians. Women who are likely to have abortions are those who have an unmet need for contraception, are young, or get pregnant outside of marriage.

Legislation

Section 45 of the Penal Code Act 2010 criminalises abortion unless there is a legal defence: [1]

  1. A person who does any act bringing about the premature termination of pregnancy in a female person with the intention of procuring a miscarriage, commits the offence of abortion.
  2. It shall be a defence to a charge under this section that the act intended to terminate pregnancy was performed by a registered medical practitioner –
    1. in order to prevent significant harm to the health of the pregnant female person, and the person performing the act has obtained a written opinion from another registered medical practitioner to the effect that the termination of pregnancy is necessary to avoid significant harm to the health of the pregnant female person;
    2. in order to prevent the birth of a child who will be seriously physically or mentally handicapped, and the person performing the act has obtained in advance from another registered medical practitioner a certificate to the effect that the termination of the pregnancy is necessary to avoid the birth of a seriously physically or mentally handicapped child; or
    3. in order to terminate the pregnancy of a female person who is pregnant as a result of incestuous relationship or victim of rape.
— Penal Code Act of 2010, Section 45 [2]

Lesotho does not have national guidelines on safe abortion or post-abortion care (PAC). [2] Lesotho's abortion law is one of the most restrictive in the region. [3]

Legislative history

Lesotho had a total ban on abortion before legalising abortions to save the life or health of the pregnant woman. [4]

In its 2018 review of the Addis Ababa Declaration on Population and Development, the government of Lesotho listed management of unsafe abortion as a priority. [2]

The chair of the Social Cluster Committee, Fako Moshoeshoe, suggested the legalisation of abortion. He cited the high rate of abortion complications and the need for increased public health education. [5] On 30 March 2021, 26 members of parliament met with a group of church leaders who opposed abortion. The meeting was led by the Southern Africa HIV and AIDS Information Dissemination Service, along with the SADC Parliamentary Forum. Moshoeshoe proposed a referendum on abortion. Church leaders agreed. [6]

Prevalence

In 2015–2019, 67% of pregnancies were unintended and 24% of these resulted in abortion. Between 1990–1994 to 2015–2019, the unintended pregnancy rate remained constant and the abortion rate increased 28%. [7] According to the 2022 State of the World Population Report, 60% of unintended pregnancies in the country result in abortion, and the unintended pregnancy rate is rising. [8] Abortion data collection in the country is sparse. [1] [2]

As of 2015, about one-fifth of maternal deaths in Lesotho are caused by spontaneous or induced abortion. Lesotho has a high maternal mortality rate, especially in rural areas. [2] In some hospitals, unsafe abortion may cause up to 50% of deaths of women aged 13 and up. [9]

Women are regularly reported to the police for suspected abortions. Some do not seek medical attention for unsafe abortions due to fear of prosecution. [10]

Access

According to the Ministry of Health, as of 2015 only 10% of hospitals provide safe abortion, and medical abortion is available in 18% of hospitals and 14% of health centres. Lesotho's guidelines for healthcare providers deal with referral for legal abortion. [2]

Foreign medical professionals often perform illegal procedures for high prices. They often avoid prosecution as they can flee the country and women are afraid to report them. Many women search for abortion services on Facebook. Dozens of Facebook pages advertise safe abortion pills and services. Women who receive these pills experience bleeding and faintness. Some receive procedures that do not work. Local newspapers advertise abortions. [10]

The Ministry of Health recommends that women travel outside the country to receive abortions. In neighbouring South Africa, safe and legal abortions are available. Critics say it is hypocritical that the government suggests getting abortions abroad instead of legalising abortion. [10] Few women in Lesotho can afford the cost of travel. [11]

In the 1990s, most abortions were conducted unsafely by unqualified providers. They used chemicals, herbs, or physical methods to induce abortions. Some girls sought abortions from traditional healers. [12]

Post-abortion care

The government's National Health Strategic Plan 2017–2022 noted that abortion is the number one cause of hospital admissions among women. [2] According to the Ministry of Health, the rate of hospital admissions due to spontaneous or induced abortion is 13%, as of 2018. [10] In 2021, gynaecological treatment due to abortion was received by 35.7% of girls aged 10 to 15, 8.2% aged 15 to 19, and 10.6% aged 20 to 24. [8] The Queen Mamohato Memorial Hospital, the only referral hospital in Lesotho, receives a PAC patient every day, as of 2020. [5]

Few PAC facilities exist. Training for health providers is poor. [1] As of 2015, only 15% of hospitals and health centres provide PAC. [2]

The Essential Service Package lists manual vacuum aspiration (MVA) for PAC. [1] As of 2015, 4–7% of facilities provide MVA, and misoprostol is available in 86% of hospitals and 6% of health centres. Most providers do not want to perform MVA. [2] In 2010, at Queen Elizabeth II Hospital in the capital Maseru, 73.7% of PAC patients received post-abortion family planning, but only 25.9% were briefed about it. [13]

Societal factors

Sexual and reproductive healthcare in Lesotho is limited by lack of personnel and training. Services rely heavily on donors, which can cause loss of funding. The U.S. government's Mexico City policy, in effect under Donald Trump, prohibited foreign organisations receiving U.S. funding from performing or distributing information about legal abortion, which limited information about Lesotho's law allowing abortion to preserve health. [2] The policy's instatement in 2001 cut off funding for Planned Parenthood's distribution of condoms in the country. [14]

Lesotho has a high unmet need for contraception, which leads to unintended pregnancies and unsafe abortions. [15] Many women are aware of family planning services, but many do not use them or disapprove of them. [13]

Pregnancies and abortions are common among adolescents. They often face judgement or refusal from providers. The Ministry of Health's National Quality Standards for Young People Friendly Health Services in Lesotho suggested the expansion of youth-friendly health services including safe therapeutic abortions, screening for abortion complications, and PAC. [2] The Ministry of Health holds sensitisation programs to educate young people about abortion, supported by the United Nations Population Fund. [5]

Many women receive abortions after getting pregnant outside of marriage. Some face financial issues and have relationships with married men who support them, who abandon them after the pregnancy. [5]

See also

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons women give for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

<span class="mw-page-title-main">Self-induced abortion</span> Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

<span class="mw-page-title-main">Unsafe abortion</span> Termination of a pregnancy by using unsafe methods

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention. About 25 million unsafe abortions occur a year, of which most occur in the developing world.

<span class="mw-page-title-main">Abortion in South Africa</span>

Abortion in South Africa is legal by request when the pregnancy is under 13 weeks. It is also legal to terminate a pregnancy between weeks 13 and 20 if the continued pregnancy would significantly affect the pregnant person's social or economic circumstances, poses a risk of injury to the pregnant person's physical or mental health, there is a substantial risk that the foetus would suffer from a severe physical or mental abnormality, or the pregnancy resulted from rape or incest. If the pregnancy is more than 20 weeks, a termination is legal if the foetus' life is in danger, or there is a likelihood of serious birth defects.

Abortion has been legal in India under various circumstances with the introduction of the Medical Termination of Pregnancy (MTP) Act, 1971. The Medical Termination of Pregnancy Regulations, 2003 were issued under the Act to enable women to access safe and legal abortion services.

Unintended pregnancies are pregnancies that are mistimed or unwanted at the time of conception, also known as unplanned pregnancies.

<span class="mw-page-title-main">Ipas (organization)</span> International non-governmental organization

Ipas is an international, non-governmental organization that seeks to increase access to safe abortions and contraception. To this end the organization informs women how to obtain safe and legal abortions and trains relevant partners in Africa, Asia, and Latin America on how to provide and advocate for these.

Abortion is illegal in Bangladesh under most situations, but menstrual regulation is often used as a substitute. Bangladesh is still governed by the penal code from 1860, where induced abortion is illegal unless the woman is in danger.

Abortion in Uganda is illegal unless performed by a licensed medical doctor in a situation where the woman's life is deemed to be at risk.

In Benin, abortion is legal on broad socioeconomic grounds up to twelve weeks of pregnancy.

Abortion is a controversial topic in Nigeria. Abortion in Nigeria is governed by the two laws that differs greatly depending on geographical location. Northern Nigeria is governed by The Penal Code and Southern Nigeria is governed by The Criminal Code. The only legal way to have an abortion in Nigeria is if having the child is going to put the mother's life in danger. However, sex-selective abortion has long had acceptance in Nigeria.

Nepal legalised abortion in March 2002, under the 11th Amendment to the Civil Code. The legal services were successfully implemented on December 25, 2003. The high maternal mortality rates in Nepal led to the government legalising it. More than 500,000 women sought abortion between 2004–2014. In 2014, 323,100 women in Nepal had the abortion; among this, only 42% of abortions were legal and 19% were treated for abortion complications. Similar study had found the rate of unintended pregnancy as 50%.

<span class="mw-page-title-main">Abortion in Kenya</span>

Abortion in Kenya is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for women in Kenya.

In 2005, the Ethiopian Parliament liberalised the abortion law to grant safe abortions to women in specific circumstances.

In Zambia, abortion is legal if the pregnancy would threaten the mother's life or physical or mental health or those of existing children, or if it would cause a birth defect. Zambia has one of the most permissive abortion laws in Africa, though its restrictions limit access.

In Malawi, abortion is only legal to save the life of the mother. Abortion is a felony punishable by prison. Malawi's abortion law is one of the strictest in the world.

In Senegal, abortion is illegal unless the life of the mother is in danger. A medical exception requires a medical certificate. Senegal is one of the only countries whose criminal code completely bans abortion. Receiving an abortion is punishable by fines and prison.

In Togo, abortion is only legal in the cases of pregnancy from rape or incest, risk to the mother's health or life, or risk of birth defects. The law requires abortion to be performed by a doctor.

<span class="mw-page-title-main">Abortion in Africa</span>

In Africa, abortion is subject to various national abortion laws. Most women in Africa live in countries with restrictive laws. Most countries in Africa are parties to the African Union's Maputo Protocol, the only international treaty that defines a right to abortion.

In Guinea, abortion is illegal unless the pregnancy poses a threat to the life or health of the pregnant woman or fetus, if it resulted from rape, or if the pregnant woman is a minor. Illegal abortions are punishable by fines and prison. Legal abortions require approval from doctors in the case of therapeutic abortion or ethics committees in the case of abortion from rape. Women's rights activists and journalists have advocated for reform.

References

  1. 1 2 3 4 Macleod, Catriona Ida; Reuvers, Megan; Reynolds, John Hunter; Lavelanet, Antonella; Delate, Richard (5 June 2023). "Comparative situational analysis of comprehensive abortion care in four Southern African countries". Global Public Health . 18 (1): 2217442. doi: 10.1080/17441692.2023.2217442 . PMID   37272354.
  2. 1 2 3 4 5 6 7 8 9 10 11 Macleod, Catriona Ida; Reynolds, John Hunter (1 June 2022). "Reproductive health systems analyses and the reparative reproductive justice approach: a case study of unsafe abortion in Lesotho". Global Public Health . 17 (6): 801–814. doi:10.1080/17441692.2021.1887317. PMID   33600739.
  3. ↑ MacPherson, Eleanor E.; Richards, Esther; Namakhoma, Ireen; Theobald, Sally (26 June 2014). "Gender equity and sexual and reproductive health in Eastern and Southern Africa: a critical overview of the literature". Global Health Action . 7: 23717. doi: 10.3402/gha.v7.23717 . PMC   4074359 . PMID   24972916.
  4. ↑ Remez, Lisa; Mayall, Katherine; Singh, Susheela (2 December 2020). "Global Developments in Laws on Induced Abortion: 2008–2019". International Perspectives on Sexual and Reproductive Health . 46 (Suppl 1): 58. doi:10.1363/46e0920. PMID   33326400.
  5. 1 2 3 4 Molupe, Majara (8 December 2020). "Unsafe abortions: A growing concern in Lesotho". Gender Links. Retrieved 7 August 2024.
  6. ↑ Molupe, Majara (30 March 2021). ""Let the people decide"". The Post. Archived from the original on 30 March 2021.
  7. ↑ "Lesotho country profile". Guttmacher Institute . 2022. Retrieved 7 August 2024.
  8. 1 2 Sello, Limpho (17 March 2022). "Legalise abortion: Vox Pop". Lesotho Times. Retrieved 7 August 2024.
  9. ↑ Avetin, Áine; Rabie, Stephan; Skeen, Sarah; Tomlinson, Mark; Makhetha, Moroesi; Siqabatiso, Zanele; Lohan, Maria; Clarke, Mike; Lohfeld, Lynne; Thurston, Allen; Stewart, Jackie (9 June 2021). "Adaptation of a gender-transformative sexual and reproductive health intervention for adolescent boys in South Africa and Lesotho using intervention mapping". Global Public Health . 14 (1): 1927329. doi: 10.1080/16549716.2021.1927329 . PMC   8205055 . PMID   34106036.
  10. 1 2 3 4 Warren, Rossalyn (7 March 2018). "In Lesotho, women say they're finding their abortions on Facebook". CNN . Retrieved 7 August 2024.
  11. ↑ Lowe Morna, Colleen (28 September 2018). "Abortion: SA must speak up". Mail & Guardian. Retrieved 7 August 2024.
  12. ↑ Mturi, Akim J.; Moerane, William (June 2001). "Premarital Childbearing among Adolescents in Lesotho". Journal of Southern African Studies . 27 (2): 270. Bibcode:2001JSAfS..27..259M. doi:10.1080/03057070120049967.
  13. 1 2 Oyebola, Oyebanji G.; Pengpid, Supa (June 2010). "Knowledge, attitudes and practice of family planning following termination of pregnancy among Basotho women at Queen Elizabeth II hospital, Maseru, Lesotho". Gender & Behaviour. 8 (1): 2857–2870. doi: 10.4314/gab.v8i1.54702 .
  14. ↑ Sherwood, Jennifer; Sharp, Alana; Honermann, Brian; Horrigan, Caitlin; Chatterjee, Meghna; Jones, Austin; Cooney, Chloe; Millett, Greg (12 September 2018). "Mapping the impact of the expanded Mexico City Policy for HIV/ family planning service integration in PEPFAR-supported countries: a risk index". BMC Public Health . 18 (1): 1116. doi: 10.1186/s12889-018-6008-2 . PMC   6134602 . PMID   30208876.
  15. ↑ "In climate change-affected Lesotho, self-injected contraceptives empower women to choose their own future". United Nations Population Fund . 12 March 2020. Retrieved 7 August 2024.
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