Tanzania’s abortion dilemma: The silent crisis costing lives

For many women, the lack of access to safe and legal abortions means choosing between carrying an unwanted pregnancy to term or risking their lives through unsafe procedures.

One such case is that of a 23-year-old woman from Shinyanga, who nearly died when she was just 17 years old after undergoing an unsafe abortion.

"I was scared, confused, and didn’t know who to turn to," says Fatuma (not her real name), recalling her experience as a teenager.

At 17, she discovered she was pregnant, a result of a relationship that had turned abusive. With no legal option to terminate the pregnancy, she sought help at a local health centre.

"They refused to help me and told me what I was asking for was illegal. The fear in their eyes made me realise they couldn’t risk it, so I left."

Fatuma was left with no choice but to find an unlicensed practitioner who promised a solution. "The procedure was painful, and I nearly died," she says softly. "I lost so much blood. My family found me unconscious and rushed me to the hospital. That’s how I survived."

Today, Fatuma is calling for Tanzania to review its stance on abortion. "I was lucky, but many girls in my situation do not make it. The law should consider cases like mine—rape, incest, and health risks. We need safe options, not death sentences," she says.

Unfulfilled promise

Tanzania is a signatory to the Maputo Protocol, a regional treaty that seeks to protect women’s reproductive rights. The protocol allows abortion under specific conditions, such as in cases of rape, incest, or when the woman’s mental or physical health is at risk.

Despite this, Tanzania’s law remains rigid, only permitting abortion if it’s necessary to save a woman’s life.

Chairman of the Tanzania Commission for Human Rights and Good Governance (CHRAGG), Judge Mathew Mwaimu, acknowledges this legal tension. "There are exceptions in the law," he says. "But the implementation is unclear, and the fear of prosecution pushes many health providers and women into silence.”

The judge further explains that sections 150, 151, and 152 of Tanzania’s Penal Code provide a framework for abortion, but they do not go as far as the Maputo Protocol in addressing cases of rape, incest, or mental health risks.

"The law seems to create a situation where exceptions are hidden, making it look like there’s no way out," he says.

The consequences of these restrictive laws are dire. The World Health Organization (WHO) estimates that about 13 percent of maternal deaths worldwide are due to unsafe abortions.

In Tanzania, these deaths are all too common, particularly among young girls like Fatuma who face societal stigma and lack of legal options.

A study by the Guttmacher Institute found that between 2013 and 2016, approximately 66,600 women in Tanzania were treated for complications from unsafe abortions each year.

Many more likely went unreported. The cost of these complications is not only paid in lives but also in long-term health issues, including infertility and chronic pain.

Countries like South Africa and Zambia offer a glimpse of what could happen if Tanzania were to adopt a more progressive stance on abortion.

In South Africa, abortion was legalised in 1996 under the Choice on Termination of Pregnancy Act. Since then, the country has seen a significant decrease in maternal deaths related to unsafe abortions.

Similarly, Zambia allows abortion in cases of rape, incest, or when the woman’s health is at risk. The law is more flexible, giving healthcare providers clear guidelines to follow, reducing confusion, and ensuring that women have access to safe abortion services.

"Tanzania should look at these examples," says Dr Amina Mwakyoma, a reproductive health expert based in Dar es Salaam. "By legalising abortion under specific conditions, we could save thousands of lives each year. This is not about encouraging abortion; it’s about protecting women from unsafe practices."

A call for legal reforms

Many stakeholders, including health professionals and women’s rights advocates, are urging the government to reconsider its position.

The Ministry of Health’s Director of Reproductive, Maternal, Newborn, Child, and Adolescent Health, Dr Ahmed Makuwani, acknowledges that there have been efforts to expand the legal framework.

In 2015 and 2020, the ministry developed guidelines to help healthcare providers navigate the existing law, but these guidelines have limitations.

"The guidelines help, but without a law to back them up, providers are still hesitant," says Dr Makuwani. "We need clearer legal frameworks that allow providers to offer safe services in cases where the pregnancy endangers the woman’s life or health."

The Executive Director of the Tanzania Women Lawyers Association (TAWLA), Ms Tike Mwambipili, agrees. "We need laws that reflect the realities women face. Unsafe abortions are killing our daughters, our sisters, our friends. It’s time to act and save lives."

Beyond legal reforms, experts argue that public education on reproductive health is crucial. Many women in Tanzania are unaware of their reproductive rights or where to seek help.

Cultural stigmas and religious beliefs further complicate the issue, making it difficult for women to access the information they need to make informed decisions.

"Tanzania must invest in reproductive health education," says Dr Mwakyoma. "If women are empowered with knowledge, they will be less likely to resort to unsafe methods."

The government has also begun discussions on improving access to contraception, which could help reduce the number of unintended pregnancies, a leading cause of unsafe abortions.

"By increasing access to family planning services, we can address the root cause of many unsafe abortions," says Dr Makuwani.

Tanzania’s abortion dilemma is far from resolved, but the recent discussions at the Tanzania Health Summit show that there is momentum for change.

The lives of women and girls like Fatuma depend on it. While the law remains restrictive, there is growing pressure on the government to reconsider its stance and align with the Maputo Protocol.

For now, many women will continue to face the impossible choice between risking their lives and enduring unwanted pregnancies. But with continued advocacy and legal reforms, Tanzania could become a country where women’s reproductive rights are fully protected, and unsafe abortions are a thing of the past.

"We need to stop losing our girls to unsafe abortions," Fatuma says. "It’s time for Tanzania to change."