The Importance of Family Planning Training in Zimbabwe: Part Two

During the last week I was in Zimbabwe, I had the opportunity to spend some time at Harare hospital. Harare hospital established a post-abortion care unit over a decade ago, which was meant to be a manual vacuum aspiration (MVA) clinic. MVA is an inexpensive, safe, and easy technique that can be used to perform abortions through the early 2nd trimester, as well as to treat complications of unsafe abortion. In Zimbabwe, abortion is legal but highly restricted. Even in cases of rape, incest, or to save the life of the woman, hospital administration permission must be obtained, and in some cases, court magistrates or the opinions of two independent physicians must be obtained. These restrictions, combined with the extreme poverty, unequal status of women, and lack of access to contraceptives, have led to an epidemic of unsafe abortion in Zimbabwe.

The MVA clinic, or “Room 20” as it’s called there, consists of a large room with 6 beds, which were almost always full throughout my stay. Even more alarming, was the long line of women waiting outside Room 20, which often led down the hallway and around the corner from the clinic.  These women typically were suffering from bleeding and/or infection, repercussions of unsafe, illegal abortion. After getting to the clinic, they typically wait several hours to be seen, even before they receive treatment. Many women wait hours or days for their family members to bring the money needed to pay to be seen. Many women waited for the doctor, who was typically covering many other patients at the same time, particularly the busy labor and delivery unit.

I was able to work with a few residents the days that I was in Room 20, teaching them MVA technique. The most memorable patient was one of the first I saw- a woman who came in hemorrhaging and severely anemic.  She was somnolent and unable to speak, but her chart indicated she had two children. The resident and I quickly performed the MVA and were able to stop her bleeding, but she needed a blood transfusion urgently. Several days later, due to significant blood shortages, we were still waiting for a blood transfusion.

My trip to Zimbabwe was a humbling experience, as a physician, an American, and as a woman. It was heartbreaking to see patients that needed so little in order to be treated and not be able to treat them.  At the end of my trip, I felt that I had accomplished so little of what I’d hoped for, but I did learn one simple and important lesson that will forever be ingrained in me: contraception saves lives. Contraception is safe, cost-effective, and it saves women’s lives.

I am optimistic about Zimbabwe’s future. It has a talented, educated, and dedicated population of physicians, nurses, and other professionals. The residents I worked with wanted to learn more about contraception and wanted to be able to provide a full range of options to their patients. Recently, Dr. Valerie Tagwira, a family planning specialist and faculty at UZ, started training residents regularly in IUD insertion. She’ll soon be joined by another family planning specialist from the United States, Dr. Diane Morof, who I know will continue to be a strong advocate for safe abortion in Zimbabwe.

Abortion should be safe, legal, and accessible everywhere, including Zimbabwe. But until it is, we must train clinicians to insert LARCs, educate women about their contraceptive options, and continue spreading the message that contraception saves women’s lives.

Meredith Warden MD, MPH is a Family Planning Clinical Fellow and an Ob/Gyn at the University of California, San Francisco.