Safeguarding the sexual reproductive rights of young women

By Sindiso V. Moyo, Policy and Legal Consultant

Namibia has one of the highest rates of teenage pregnancy in eastern and southern Africa. Family planning services have had limited success in preventing teenage pregnancy in Namibia. The United Nations Population Fund (UNFPA) Namibia found that by the age of 17 half of Namibian adolescents have had their first sexual experience. Meanwhile, Namibia’s Ministry of Education, Arts and Culture records no fewer than 1 500 pregnancy cases among school-going adolescent girls every year. According to the United Nations, early unplanned pregnancy has a major negative impact on the educational outcomes of adolescents, in particular adolescent girls. Adolescent girls who fall pregnant face a myriad of challenges to remain in school and achieve educational milestones.

Sexual reproductive health rights in Namibia

In February 2018, UNFPA Namibia donated reproductive health commodities worth N$7 million to the Ministry of Health and Social Services. The donation was made through the Preventing Maternal Deaths in East and Southern Africa project and with an intended target of 70 000 beneficiaries. The donation further intended to prevent 22 000 unplanned pregnancies, 4 000 unsafe abortions and 40 maternal deaths, through providing adolescent girls and young women with access to modern contraceptives.

Although Namibia has made tremendous progress in the area of reproductive health over the past 30 years, there are still barriers impeding the use of modern contraceptives. As many as 12% of women still need contraception, while 19% of adolescent girls (age 15 to 19) have started bearing children, with some regions of the country reporting incidences of more than 36%. This indicates that more vigorous efforts have to be made to understand and meet the needs of adolescents and young people in Namibia (www., News, 8 February 2018, UNFPA hands over N$7.4m contraceptives to Health Ministry).

A woman’s ability to access abortion services is not only a matter of a woman’s right to choose. If women have autonomy over their bodies and are able to access safe abortion services, we have a safer, better and stronger society than one where women have to resort to illegal and unsafe abortion methods. A shift in the attitude of people in society is required in order for women to be able to exercise autonomy over their own bodies.

Abortion in Namibia

In Namibia, the conditions under which women have legal access to abortion are stipulated under the Abortion and Sterilisation Act 2 of 1975, which is based on the former South African Abortion Act. Induced abortion is restricted to circumstances where a continued pregnancy endangers the life of the woman or poses a serious threat to her physical health, mental health, or both. A woman may also request an abortion if the pregnancy is a result of rape or incest or if there is a serious risk that the child will have physical or mental defects that will be an irreparable handicap to the child. In cases of rape or incest, the woman needs a police report and permission from a magistrate to abort the foetus (HEARD, Unsafe abortion in Namibia: country fact sheet, 2016.)

Furthermore, section 24.7 of the Namibia Standard Treatment Guidelines (2011) states that a woman with HIV has the right to terminate the pregnancy as a medical condition. However, according to legal practitioners, this stipulation has no legal force (HEARD, 2016). It could be argued that the enforcement of legal abortion for HIV-positive mothers is lower because Namibia has achieved tremendous results with preventing mother-to-child transmission of HIV. Coverage of anti-retrovirals for mothers and infants has reached 93% and 88% respectively  (UNICEF Namibia , 2010).

The impact of the Global Gag Rule

Apart from restrictive abortion legislation, access to family planning services and the fight to liberalise the abortion laws have been heavily affected by the Global Gag Rule. The United States government previously provided donor funding for sexual reproductive health rights programmes through the United States President Emergency Plan for Aids Relief and with the support of the Centers for Disease Control and Prevention. However, the US government’s Protecting Life in Global Health Assistance policy, also known as the Mexico City Policy or the Global Gag Rule, has silenced civil society organisations that seek to provide quality health care and abortion care services (International Planned Parenthood Federation, 2018). The Rule has directly affected the International Planned Parenthood Federation (IPPF) and its member associations, such as the Namibia Planned Parenthood Association (NAPPA), which was established in 1996. The IPPF and its member associations have decided not to accept US funding that detracts from their commitment to provide the highest quality of healthcare for all people. This decision has affected the finances NAPPA requires to operate its three service points and three clinics. As a result, NAPPA has ceded its power over two clinics to the Society for Family Health, an organisation that still receives US government donor funding.

Public discourse on abortion

During the 1990s, only a few years after Namibia gained its independence from South Africa, a fierce debate took place among politicians and women’s rights activists such as Rosa Namises about the reform of Namibia’s strict abortion law. At the time, the law was seen to be a replica of the discriminatory laws of the Apartheid regime. However, calls for reform of the law were suppressed due to the strong conservative Christian views and norms of the Namibian government. Between 2009 and 2011 further attempts were made to liberalise Namibia’s abortion law. Civil society organisations attempted to table the issue again, but were met with serious opposition from religious groups and the government (HEARD, 2016).

The debate on the reform of Namibian abortion legislation was reignited in 2017, when national police statistics revealed that 16 cases of abortion and 28 cases of “baby dumping” had been reported in that year. In 2017, Dr Bernard Haufiku, the former Minister of Health, executive board member of the World Health Organisation and SheDecides Namibia champion, called for the revision of the law criminalising abortion in the country. This call came after an unprecedented 7 335 illegal abortion cases were recorded at state facilities in 2017. Minister Haufiku was quoted as saying that the actual figure could be 10 000, since many of the cases involving women younger than 25 years go unreported (Tjihenuna, The Namibian Newspaper, 28 March 2017, Unsafe abortions reach 7 000 mark).

These 7 335 cases comprised only 138 medical abortions (authorised cases), which constituted 2% of the total cases. In most cases, illegal abortions are only reported to healthcare facilities when the abortion is incomplete, or if the woman suffers from haemorrhaging and infection. The high number of illegal abortion cases has brought the debate on liberalising the Namibian abortion law to the fore again (Tjihenuna, The Namibian Newspaper, 28 March 2017, Unsafe abortions reach 7 000 mark).

What also needs to be considered is the draft consolidated National Reproductive and Child Health Policy of 2008, which states that estimating the incidences of unsafe abortion may be difficult in Namibia where abortion is only legal under certain conditions. The policy recognises the need for post-abortion care, in line with commitments made by governments at the International Conference on Population and Development in Cairo in 1994 to reduce the need for abortion by expanding and improving family planning services. The draft policy also recognises that lack of access to abortion of unwanted pregnancies discriminates against women in poor households, who are forced to resort to unsafe abortions, while the wealthy are able to procure safe abortions despite the legal regulations (Ministry of Health and Social Services , 2008).

The abortion debate was further reignited in June 2020, when a local Namibian woman, Beauty Boois, called for the legislation. In her Petition Ms. Boois, stressed Namibian women have been left with no choice but to break the law to practice their right of choice and in the process risking their lives and health as well as their well-being to obtain illegal abortions, her petition is stated to have received over 6000 signatures. The petition received mixed reviews, with strong Christian groups launching their own petition which received 4 736 signatures and promoted for heated debate from both sides. The Petition, received support from, Deputy Minister Dr. Esther Muinjangue, who went on to motivate the on abortion in parliament, stating that national leaders should allow for debates on the issue in order to weigh in the pros and cons. The petition also further received support from former Minister of Health, Dr Libertina Amathila who stated that abortion is a longstanding issue that needed to be dealt with (Ikela, New Era Newspaper, 26 June 2020, Abortion debate heats up…Church, parliament enter fray).  

The abortion petition has been tabled in parliament; however, the motion is still yet to be debated and voted on in parliament.

In summation, although access to modern contraceptives has improved in Namibia over the past 30 years, it remains unclear to many healthcare workers and advocates for sexual reproductive health rights why many women risk their lives by resorting to unsafe abortions. There is therefore an urgent need for a robust debate on liberalising Namibia’s abortion law. The discussions on post-abortion care in the draft National Reproductive and Child Care Policy of 2008 indicate that there is the political will to legalise abortion and prevent unsafe abortions at an international level. However, there is still a lack of political will at the national level, particularly among lawmakers in parliament. Unsafe abortions and “baby dumping” cases reported to the Namibian police and hospitals have increased at an exponential rate, reaching an alarming level. This indicates that the provision of modern contraceptives alone is not sufficient for safeguarding the sexual reproductive health rights of young women and adolescents in Namibia.

Case Study

I was just 16 when I found out about my pregnancy and I could tell you all the reasons why it was logical to go forth with the decision of abortion but at the end of the day none of them will really matter. It haunts me to this very day knowing that I chose to abort a living creature that was growing inside of me.

My partner and I where both in high school, I was in the tenth grade, he was in the twelfth grade.  Unfortunately, by the time I found out I was pregnant, we were no longer together. I knew at that time that we were not mentally ready or old enough to take on the responsibility of raising a child, so I kept the pregnancy from him.  As a result, I went through this traumatic ordeal without the support of a partner. I had to think about my future and my school. Yes, I know I am really starting to sound self-centered I could have picked a different route and being young is not an excuse but other circumstances also led to me not wanting to keep the pregnancy:

As a preacher’s daughter, having sex outside of marriage is against our moral values and beliefs; hence, this put me in very a tight spot because discussions about sex, pregnancy or abortion were not topics discussed in my home until you were a certain age. I can clearly remember when my older sister fell pregnant at the age of 19 my parents were devastated. The church made such a big fuss about it. They put pressure on my dad to set an example as the leader of the church and he forced my sister into early marriage to cover up the “humiliation”. I felt deeply torn with so much fear and confusion, I couldn’t even tell my parents of the horror that was going through my head. I knew if I had to tell my parents and the church found out about my pregnancy it would have been an extreme scandal and I would be condemned for fornicating. I was always pro-choice but I never knew it would be my choice.

I contemplated suicide as I had been raised in a physically and emotionally abusive house, which led to my depression. I believed that raising a baby at that age would have only made me an incapable mother. Abortion felt like my only option but it is also a criminal offence in my country. I felt compelled to get the pills for the abortion illegally and terminate the pregnancy myself despite the complications it might cause on me.

I remember sitting on my bed holding the package for 30 minutes straight trying not to think about what might happen if this went wrong. Then suddenly I started feeling dreadful, but there was no turning back I already had paid a huge amount of money for these pills so I made peace with what I had decided. I took the first pill as instructed by the person from whom I had bought them. I waited 10 minutes for any signs or symptoms but I grew impatient, so I swallowed the second pill. I can surely remember after two to three hours, I started experiencing mild cramps, which felt my normal period cramps but with time, they became stronger. It felt like a grinding whisk, I did not even realise how much blood and clots were coming out of me, the pain was inexplicable. I tried my best to contain myself and not give out any signs because my big sister was home but she was not aware of what was happening in my room. I held on the surface of my wall but I could not stand up straight, my vision became blurred and I started feeling nauseous and dizzy. The pain was so unbearable. Suddenly I felt an extreme throb in my abdomen, which was my breaking point. I could not hold it in anymore; I screamed and shouted for my sister to help me. When she reached, my door she just couldn’t stop staring in disbelief and I just kept on saying “I’m sorry”, “I don’t want to die”, I just couldn’t stop crying. After that the only thing I remember was waking up in a hospital bed confused, ashamed and regretful as the reality of what I had done set in.

I was unsure of how to feel afterwards even though this was something that my sister and I kept between us. At first, I pretended to be fine but could not keep on lying to myself anymore. I didn’t expect this abortion to wreck my life like it did. Not only did it come with resentment but also the complications, which include excessive menstrual bleeding and severe abdominal pain that can last up to a month. I go through every month when I am on my period and this is a constant reminder of what I did.  I became such an emotional being I’m not the same knowing that what I chose will mess with my head forever, knowing that I killed my child, knowing that I took a life that might have been destined for greatness. I’m still in a very dark place and I’m still learning to forgive myself. I constantly fight suicidal thoughts even though this happened 3 years ago maybe one day I’ll come to a point of conviction and make peace with my past. If I had a choice to relive that day, I would take it back. It was a traumatic experience, which changed me completely.