Talking about abortion in Namibia.
It has enlightened me and was de-stigmatising in terms of the way that I look at abortion.
The session was very factually based and there was a lot of personalising and sharing of real life experiences.
The structure in which information was handed out was very open and participatory, which allowed me to share and make use of scenarios from my own community and formulate solutions that would suit problems where I come from.
We really want you all to come with us here again.
Keep on giving us relevant information like this; keep it up!
Is it possible to talk openly about abortion or is it too stigmatised an issue in Namibia? Three workshops organised by The International Community of Women Living with HIV/AIDS Namibia (ICW Namibia) and Ipas in January 2009 with members of civil society organisations, student leaders, parliamentarians, and community members took on this challenge in Windhoek.
The comments above came from participants, who showed that such discussions are indeed possible in Namibia and that more such dialogues are needed and wanted. After the first workshop, Sheena Magenya hosted Sister Namibia's radio call-in show on the topic "Should the law on abortion be liberalised in Namibia?" Callers' comments and SMS messages confirmed what was seen in the workshops--Namibians want and need to learn more about what abortion means to the health and wellbeing of women throughout the country.
ICW Namibia was formed in 2005 to call attention to the situation of an estimated 130,000 women aged 15 and older who are living with HIV, in a total population of approximately 2 million people.
Breaking the silence
While some adolescent and adult women living with HIV want to bear children, or are pressurised into motherhood, others are confronted with social and economic pressures to have an abortion because of their HIV status, even if they want to continue with pregnancies. However, HIV-positive women also deal with unwanted pregnancies and face the decision of risking an unsafe abortion. Sexuality, pregnancy and abortion are all important--yet silenced--issues for women living with HIV and Aids. Opening up discussion about unwanted pregnancies and abortion was one of the main goals of the three workshops held by ICW Namibia and Ipas.
According to Namibia's Abortion and Sterilisation Act (1975), as amended through Act 48 of 1982, abortion is legal in Namibia when the pregnancy endangers the life or physical or mental health of the woman, when there is foetal malformation, and when the pregnancy is the result of rape or incest. Yet this law is rarely put into practice, meaning that women who fulfill these conditions are not able to access safe abortion services in Namibia.
One reason for this is the current requirement that three medical practitioners (which could be physicians or nurses) must authorise a woman's safe abortion in writing. In addition, health facilities do not provide women with information about their right to have a safe legal abortion under the circumstances listed above.
Another problem lies in the fact that many women who might think about having an abortion do so for reasons not accommodated in the current law, including the stigma of being a single or young mother, lack of support from their partners, or because they cannot afford to support a(nother) child. Many abortions are performed by people who are not trained to do the procedure well or they are done in unhygienic conditions, meaning that they are potentially dangerous to the woman's life or health.
One workshop participant noted that "some people use sticks, bleach, boiling washing powder, boiled water and brandy" to induce an abortion. For this reason, the Consolidated National Reproductive and Child Health Policy (draft) April 2008 states that "unsafe abortion is one of the main causes of maternal mortality and morbidity, particularly amongst adolescents." Baby dumping, all too prevalent in Namibia, was raised as an important issue throughout the workshops. Participants noted that, "It's (abortion is) better than dumping babies, especially when it is done in unexpected conditions, like rape," and "it (abortion) can reduce death rates and baby dumping."
Dialoguing for change
Maria de Bruyn, Senior Policy Advisor at Ipas and a long-standing collaborator of ICW, helped prepare the participatory workshops through the production of a curriculum, Expanding reproductive rights knowledge among, and advocacy by, HIV-positive women and their allies in Namibia: Community discussions on sensitive reproductive health issues. Using this material, ICW Namibia director, Jennifer Gatsi Mallet, ICW facilitators, and Ipas consultant Deborah Billings conducted three one-day workshops dedicated to discussing the issues of unwanted pregnancy, abortion and baby dumping with a wide range of people, including students, academics, physicians, grassroots community members, and representatives of civil society and government.
A participatory approach was taken so that everyone who attended had the opportunity to voice their opinions and draw on their own life experiences to better understand how the current legal and policy setting in Namibia affects women when they are faced with the need to have an abortion. Opinions about abortion held by participants ranged from "it denies someone the opportunity to life" to "it should not be used as a family planning method" to "it should be legalised without conditions or provisions". The workshop setting encouraged participants to express the full range of perspectives.
Participants were also asked to think about circumstances related to unwanted pregnancy and abortion and to recognise how decisions are influenced by multiple factors in women's lives. Lastly, the facilitators wanted the participants to have accurate information about abortion--that when performed by trained providers and under hygienic conditions, abortion procedures are very safe, that Manual Vacuum Aspiration (MVA) is a safe and effective technology that is not currently available in Namibia, and that unsafe abortion can be prevented when laws and policies allow health care providers to be trained in safe abortion provision and enable women to access safe services.
ICW Namibia's commitment to incorporating information about unwanted pregnancy, emergency contraception and abortion (as well as Post Exposure Prophylaxis for survivors of sexual violence) into their work is empowering in important ways. It enables members to make connections between HIV and other important reproductive health and rights issues and helps them to reach out to both HIV-positive and -negative women to talk about the full range of their sexual and reproductive health needs. More organisations should work to include basic information about abortion in their projects so that Namibian women no longer have to resort to baby dumping or unsafe abortion when they face an unwanted pregnancy, or the expensive trip to South Africa to access safe and legal abortion services there.
Go to www.icw.org and www.ipas.org for more information on the two organisations leading the workshops.