Tanzania’s abortion dilemma: The silent crisis costing lives

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

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

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

When she was 17, she discovered she was pregnant, the result of a relationship that turned abusive. Having no legal options to terminate the pregnancy, she sought help from a local health centre.

“They refused to help me and told me what I wanted was illegal. The fear in their eyes made me know 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 almost died,” he says softly. “I lost a lot of blood. My family found me unconscious and immediately took me to the hospital. That’s how I survived.”

Fatuma is today calling on Tanzania to reconsider its stance on abortion. “I was lucky, but many girls in my situation don’t make it. The law should take into account cases like mine (rape, incest and health risks). We need safe options, not death sentences,” she says.

Tanzania is one of the signatories of the Maputo Protocol, a regional agreement aimed at protecting women’s reproductive rights. The protocol allows abortion under certain circumstances, such as rape, incest or if the woman’s mental or physical health is at risk.

Despite this, Tanzania’s laws remain strict and abortion is only permitted if necessary to save a woman’s life.

Justice Mathew Mwaimu, Chairman of the Tanzania Commission on Human Rights and Good Governance (CHRAGG), acknowledges this legal tension. “There are exceptions to the law,” he says. “But enforcement is unclear and fear of prosecution pushes many healthcare workers and women into silence.”

The judge also explains that sections 150, 151 and 152 of the Tanzania 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 creates a situation where exceptions are hidden and there seems to be 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 caused by unsafe abortions.

These deaths are all too common in Tanzania, especially among young girls like Fatuma, who face social 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 abortion each year.

Many more likely went unreported. The cost of these complications is not only in life but also in long-term health problems such as infertility and chronic pain.

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

Abortion was legalized in South Africa in 1996 under the Choice of Termination of Pregnancy Act. Since then, the country has seen a significant decrease 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; It gives healthcare providers clear guidelines to follow, reduces confusion, and ensures women have access to safe abortion services.

Dr., a reproductive health specialist in Dar es Salaam. “Tanzania needs to look at these examples,” says Amina Mwakyoma. “By legalizing abortion under certain conditions, we can save thousands of lives each year. This is not about promoting abortion; it is about protecting women from unsafe practices.”

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

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

The Department developed guidelines in 2015 and 2020 to help healthcare providers comply with existing law, but these guidelines have limitations.

“Guidelines are helpful, but without legislation to support them, providers are still hesitant,” says Dr Makuwani. “We need clearer legal frameworks that allow providers to provide safe services in situations where pregnancy endangers a woman’s life or health.”

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

Beyond legal reforms, experts argue that public education on reproductive health is vital. Many women in Tanzania are unaware of their reproductive rights and 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 should invest in reproductive health education,” says Dr Mwakyoma. “If women are empowered with information, they will be less likely to resort to unsafe methods.”

The government has also begun discussions on improving access to birth control, which could help reduce the number of unwanted 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 momentum for change.

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

For now, many women will continue to face the impossible choice between risking their lives or enduring unwanted pregnancies. But with continued advocacy and legal reforms, Tanzania can 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 daughters to unsafe abortion,” says Fatuma. “It’s time for Tanzania to change.”