Tanzania’s abortion dilemma: the silent crisis that costs 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.

An example of this is that of a 23-year-old woman from Shinyanga, who almost died at the age of 17 after having an unsafe abortion.

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

At the age of 17, she discovered she was pregnant, as a result of an abusive relationship. Since there was no legal option to terminate the pregnancy, she sought help at a local health center.

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

Fatuma had no choice but to find an unlicensed practitioner who promised a solution. “The procedure was painful and I almost 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 calls on Tanzania to reconsider its position on abortion. “I was lucky, but many girls in my situation don’t make it. The law should consider cases like mine: rape, incest and health risks. We need safe options, not death sentences,” she says.

Tanzania has signed the Maputo Protocol, a regional treaty that aims 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, Tanzanian law remains strict and only allows abortion if it is necessary to save a woman’s life.

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

The judge further explains that sections 150, 151 and 152 of the Tanzanian Criminal Code provide a framework for abortion, but 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 in which exceptions remain hidden, making it seem as if there is no way out,” he says.

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

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

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

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

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

In South Africa, abortion was legalized in 1996 under the Choice on Termination of Pregnancy Act. Since then, the country has seen a significant decline in maternal deaths due 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 and gives providers clear guidelines to follow, reducing confusion and ensuring women have access to safe abortion services.

“Tanzania should look at these examples,” said Dr. Amina Mwakyoma, a reproductive health expert based in Dar es Salaam. “By legalizing abortion under specific circumstances, we can save thousands of lives every year. This isn’t about encouraging abortion; it’s about protecting women from unsafe practices.”

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

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

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

“The guidelines are helpful, but without a law to back them up, providers are still reluctant,” says Dr. Makuwani. “We need clearer legal frameworks that enable 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 reality women face. Unsafe abortions are killing our daughters, our sisters and our friends. It’s time to act and save lives.”

In addition to legal reforms, experts argue that public education about reproductive health is crucial. Many women in Tanzania are unaware of their reproductive rights and do not know where to seek help.

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

“Tanzania needs to invest in reproductive health education,” says Dr. Mwakyoma. “If women have knowledge, they are 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 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. Although the law remains restrictive, pressure is increasing on the government to reconsider its position and join the Maputo Protocol.

For now, many women will continue to face the impossible choice between risking their lives and enduring an unwanted pregnancy. 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 must stop losing our girls to unsafe abortions,” says Fatuma. “It is time for Tanzania to change.”