Malawi’s maternal mortality is among the highest in the region. However, Malawi Government has made significant strides to address this challenge over the last decade. In 2009, the Government adopted the first National Sexual and Reproductive Health and Rights (SRHR) Policy which was revised in 2017.The goal of this Policy is to provide a framework for the provision of comprehensive SRHR to all women, men, and young people through informed choices enabling them to attain their reproductive rights and health goals safely and freely in line with the Constitution of Malawi as well as the Public Health Act. For instance, Section.3.1.2.11 of the National SRHR Policy (2017-2022) states that abortion shall be provided to the full extent of the existing national law and guidelines shall be formulated to properly interpret the law. Furthermore, Section 3.2.2.9 provides for post abortion care (PAC) services.
In 2013, the Government of Malawi adopted the Gender Equality Act ensuring the equal protection and status of women and girls in the state. In line with the Constitution, the Public Health Act as well as the SRHR Policy, Section 19 of Gender Equality Act specifically provides for the right to SRHR of all persons in Malawi. Since the enactment of this law, Government has continued taking steps to ensure realization of sexual and reproductive health rights of all people in the country.
According to Section 243 of the Penal Code, pregnancy can only be legally terminated by a qualified health personnel to save the woman’s life. However, women and girls are terminating their unplanned pregnancies in clandestine settings which is contributing to 18% of maternal mortality, high morbidity from unsafe abortions and its related complications.
To ensure the health workforce is ready to meet the identified challenges, it is necessary to align national service delivery guidelines with the latest evidence and clinical standards. The goal of these guidelines is to facilitate the provision of safe and essential health services that are necessary to treat a pregnant woman or girl in saving her life as well as women and girls in post abortion situations. This document is directed to health providers and service delivery managers in guiding how, by whom, and in which facilities may these services be provided to save a woman’s life as well as provision of post abortion care within the frameworks of the SRHR Policy as well as laws of Malawi.
It is the hope of Malawi Government that these guidelines will serve as the basis for ongoing training and support to the health workforce, to ensure sustainable access and availability of comprehensive sexual and reproductive health care for all women and girls.
The Ministry of Health remain committed to protecting the health and well-being of all people in this country. This guidance offers clinical and medical authority necessary for preventing maternal deaths by providing essential and life-saving health care to women and girls when and where they need it.
Dr Charles Mwansambo, Secretary for Health
The guidelines are divided into six sections: Introduction and Chapters 1, 2, 3, 4 and 5.
The introduction outlines the current trends in abortion and its consequences, at the worldwide level and in Malawi. It also discusses key SRH indicators related to maternal health and PAC services. Chapter 1 presents the current legal framework, internationally and in the local context. It explains Malawi laws and policies that inform abortion and PAC services. It also includes guidance on when it is medically acceptable to provide induced abortion services within the current legal framework. Chapter 2 discusses the surgical methods of provision of comprehensive abortion care services including PAC. In chapter 3 the medical methods for conducting abortion and post abortion care are discussed. Chapter 4 presents the family planning for post abortion care and abortion services. Chapter 5 depicts task sharing in Malawi for the provision of these services to increase access and quality of post abortion care services in Malawi. The appendix provides job aides that would support service providers in the provision of quality comprehensive abortion care services.