Please save our little girls: An appeal to Malawi's Attorney General
On 17thDecember 2021, I convened a meeting at Ufulu Gardens Hotel in Lilongwe. The aim of the meeting was to discuss Malawi's legal position on the termination of pregnancy for pregnant girls below the age of 18, whose pregnancy is due to sexual violation. Health professionals attended the meeting, including clinicians and obstetricians and gynaecologists, Ministry of Health officials and lawyers, including from Malawi's Attorney General's chambers.
I invited a Senior Chief from Mulanje to share her experience with the participants at the meeting about a little girl.
The little girl
One day, this traditional leader received guests at her home. They were parents and their young daughter, about 10 years old. The parents looked distressed. The mother was crying. When she asked them what the matter was, the mother, in between sobs, narrated their ordeal.
Their school-going daughter seemed unwell on this day, so they took her to the hospital. On examination, the clinician told them that her unwellness was because she was pregnant. The parents were shocked because their daughter had not even begun her menses. The parents found out from their daughter that a man from their village had been having sexual intercourse with her.
The parents were devastated. Their child was so little. They could not imagine her surviving carrying a pregnancy to term. Even the clinician agreed that the pregnancy was a risk to her health and life. The parents then requested a termination, but the clinician refused. He told them that pregnancy termination was illegal under Malawi's laws.
That is when the parents and their daughter came to their traditional leader for help. The traditional leader offered to help them talk to the clinician. She accompanied them back to the hospital and pleaded with the clinician to assist the parents and their daughter. Initially, the clinician refused, but the party persisted until the clinician agreed. He gave the girl some pills and told them to go home to wait for the drugs to act. He said the medicine would clear out the uterus. After some time, indeed the pregnancy terminated. The girl did not even require to return to the hospital for further treatment.
Such stories are not uncommon
The doctors and clinicians at the Ufulu Gardens' meeting commented that every once in a while, they receive such requests to terminate the pregnancies of little girls. Unfortunately, the mothers and their daughters are told that terminations are not permitted under the law.
It is not a secret, however, that some distressed mothers (or girls) find other means to terminate the pregnancy. Parents with connections and resources will access relatively safe abortions for their daughters. Those parents who cannot afford it will either access unsafe methods or give up and accept their fate. It is mostly poor families who bear the harsh burden. It means dropping out of school for most girls from such poor families.
Fortunately for our little girl from Mulanje, her story ended well because of persistent parents, a determined traditional leader, and of course, an understanding health provider. Other girls in a similar situation get injured or die trying to terminate the pregnancy. Even when forced to carry the pregnancy to term, they suffer consequences they could have avoided if the termination were accessible.
What the law says
Though health provider routinely tell parents and their little girls that termination of pregnancy is illegal in Malawi, that is not the whole truth. Yes, the law restricts the termination of pregnancy. However, the law permits pregnancy termination to save the pregnant person's life.
Is the life of a 10-year-old pregnant girl endangered by the pregnancy?
At the meeting, I posed this question to the experts, the obstetricians and gynaecologists: Is the continuation of pregnancy risky to the health and life of our 10-year-old girl. Their response was that it would be significantly risky for the girl to continue with the pregnancy, even if there were no intervening medical conditions such as heart disease. The obstetricians and gynaecologists unanimously said they would favour terminating such a pregnancy on the grounds of protecting the life and health of the girl. They told the meeting participants that they would support such an interpretation of the law that would allow such girls to terminate their pregnancy.
Would the obstetrician and gynaecologist legally terminate such pregnancy in Malawi?
I further asked the obstetricians and gynaecologists if they would terminate such a pregnancy to save life under the current law. They said they would not because the law is unclear about this particular circumstance.
Even after reading the Ministry of Health's Standards and Guidelines on Post Abortion Care which have interpreted Malawi's position on termination of pregnancy (see pages 6 to 11 of the Standards and Guidelines), it was still not clear whether doctors would not be prosecuted for terminating the pregnancy of the 10-year-old. The guidelines are clear about interventing conditions such as heart disease and others, but not the case of sexual violation including rape and defilement.
The lawyers at the meeting agreed with the doctors that the language of the law alone was not clear for anyone to confidently hold the opinion that terminating the pregnancy of a 10-year-old girl was legal in Malawi.
Keeping the case of the 10-year-old in abeyance is injustice
Now, this is not a situation where it is clear to everyone that the law absolutely prohibits termination in the case of a 10-year-old girl. Rather, the position is unclear until some authority clarifies the law. However, the failure to clarify the law is a great injustice to those whose life and health depend on the service in question. This is because it could as well be, that on clarifying the law, we would realise that this little girl has had the legal right to access abortion all along. It could be that we have misconstrued the law, costing many girls' health and life.
It is not impossible to clarify the law. It is not even a complex legal task. I bet our Attorney General can clarify the position for this little girl to the Ministry of Health, which in turn would provide the appropriate guidance to health providers in the country. Therefore, keeping the position on termination for such girls in abeyance is a serious injustice.
One way or the other, the Attorney General's clarification would serve justice
If the Attorney General were to explain that the law is that it is legal for a 10-year-old to terminate a pregnancy to save her life, it would put the matter to rest. It would end the distress parents and their daughters experience in such circumstances.
However, suppose the Attorney General were to explain that the 10-year-old cannot legally access abortion under the Malawi law. In that case, it still serves justice because now that the position is made explicit, activists for justice, and distressed parents and their daughters are clear about the fight.
I dare the Malawi Government to save our child
Parents already believe it is in the young child's best interest to terminate the pregnancy to save her life. That is why these parents rushed to the traditional leader for help.
The medical experts in Malawi also believe it would be in the child's best interests to permit a girl in such circumstances as the little girl to terminate the pregnancy. They affirmed this position at the Ufulu Gardens' meeting.
The Malawi government should take the small but hugely significant step to clarify whether girls of such young age and pregnant because of sexual violation are entitled to legal abortion.
Please, Attorney General, Sir, such a clarification of the law on abortion would serve the justice for which your office represents.