Unsafe Abortions in Tanzania

Alison Norris advises a woman in Zanzibar.

Unmet contraceptive need in the country of Tanzania is high. According to Demographic and Health Surveys data, only 24 percent of married couples use a modern method of contraception, and 22 percent have unmet need. In Zanzibar, a semi-autonomous string of islands in Tanzania, the unmet need is more extreme.

One result of the high unmet need and unwanted pregnancies in Zanzibar is a high prevalence of unsafe abortion, which can lead to infection, to hemorrhage, or to infertility. In Zanzibar, as in many other places around the world, unsafe abortions are induced either by oral ingestion of herbs or other substances, or by vaginal insertion of a substance into the cervix or the uterus. Such substances include herbs, chloroquine, laundry detergent and ashes. Not surprisingly, the highest rate of complication occurs among those who induce abortion by insertion.

Alison Norris, MD, PhD, a postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health, is preparing a study to look into the causes and effects of unsafe abortion in Zanzibar. In a talk on Tuesday, she cited two broad reasons why contraception prevalence—and thus, unwanted pregnancy—is so low in Tanzania: religion and culture. In Tanzania, which is predominantly Muslim, the generally held belief is that God decides if you have a child or not. According to Norris, the cultural challenges to contraception are many: husbands worry about the fidelity of their wives if using contraceptives; mothers-in-law harass their daughters-in-law to become pregnant; and the widely held belief is that if you don’t have money, your wealth is in your children.