Doctor Attitudes and the Effect on Access To Safe Abortion in Zambia

This piece originally appeared on the Ipas website.

Dr. Mutinta Muyuni, a practicing obstetrician/gynecologist in Lusaka, Zambia, provides comprehensive women’s health care, including safe abortion to the full extent of the law. As an ally who advocates publicly for women’s right to safe abortion care, she says she is “not ashamed of my work, and we shouldn’t be ashamed … I reached the stage where I can be a public face for the many people who cannot show their faces.” Dr. Muyuni encourages colleagues to save women’s lives by providing safe abortion care and discusses how Ipas’s values clarification traininghelped her become an advocate for compassionate abortion service provision.

Dr. Muyuni was raised Catholic and in an anti-abortion environment. She remembers looking at anti-choice propaganda in high school that a friend had gotten “from Americans.” She recalls how “they described the procedures in a very brutal way… we were really thinking, oh, you know, abortion is such a bad thing. … I wasn’t exposed to any materials that defended a woman’s reasons or what would happen to a woman if she did not have a safe abortion.” She adds, “In my country people die so much, you get numb, you lose the feeling for where they’re coming from, are they part of a family? Is it someone’s sister? Someone’s mother? But after a while, you start to think, what does it mean if this woman is dead? What does it mean for her family? What does it mean for the country if we’ve lost this woman?”

Later Dr. Muyuni became an obstetrician/gynecologist and provided postabortion care, but only because she was required to professionally. With deep regret, she recalls how badly she treated women who came in suffering from abortion-related complications. She remembers performing manual vacuum aspiration (MVA) for patients: “I just used to do it because it was part of my job,” and adds, “I was one person who wouldn’t give pain relief… I used to feel, ‘Ok, those who I felt had induced abortions, serves them right. Let them feel the pain. Maybe next time they won’t have an abortion. Maybe next time they will be more careful.’ I was that kind of doctor.”

Dr. Muyuni asked to attend an Ipas medical abortion training in 2009 because she wanted to improve her clinical skills. Part of the training included values clarification exercises, during which participants identify and address barriers to abortion service provision, access and quality of care stemming from misinformation, values conflicts, negative attitudes and lack of respect for women’s rights. During the training, Dr. Muyuni says she was “really touched to be able to look at a woman as something that means something to somebody. It’s not just a patient; she’s not just a statistic. She may be someone who sells ground nuts at the corner or someone who sits at home to sweep and welcome people home at the end of the day. For somebody, she makes a difference, and someone will miss her if she goes. And I can prevent her from going if she meets me.” She reflects on her past: “You know, I sent so many people away. And I thought, ‘Whatever happened to those women? Are they still alive?’ And it was something that I regret.”

Dr. Muyuni explains how she came to see abortion and her role in abortion care differently after the values clarification exercises helped her put herself “in the patient’s shoes.” She also adds how the values clarification exercises “don’t push you to be pro-choice.” The process helped her reevaluate her “thoughts about abortion, about women and about life.” Beyond her own transformation, she also understood that she “had to do things” to effect broader changes in how abortion services are delivered to women and providers are treated.

She describes how health-care providers and clients often face confrontations by other staff and people who don’t support abortion rights: “When people come up to you and talk to you and say, ‘But doctor, you are such a nice person; why are you providing services? But you do know you are going to burn in hell for what you are doing,’ and they would say this in front of the patient. I still advise all my clients, ‘In this hospital, it is not everybody who is pro-choice, so brace yourself for what you might hear. Don’t let it scare you; it is not your fault that you have to make this hard decision.’ Some of them were not prepared to hear such abuse.”

Dr. Muyuni says she “wanted to share what I had learned and spread the feeling, the change that I had through whatever example I could give.” She uses some of the values clarification exercises she learned during her training to teach other staff members in the hospital to recognize the impact of their attitudes on clients, providers and quality of care. Now she says that “their attitude has changed through our quiet advocacy, through our example. Now it’s no longer a place where a woman may die seeking a safe abortion because she’s left to bleed because the nurse won’t call the doctor if she has noticed and says, ‘Ok, that will teach you.’”

Dr. Muyuni explains her role as an advocate by gesturing toward her heart: “You’ll notice I’m wearing a badge. I do that at work as well…It’s letting people know that I’m not afraid to stand up for my work.” She continues: “I think if you can work with one positive person or group of people who really stand up for their convictions and say, look I’m tired of seeing women dying and I want to make a difference, and if you want join me, let’s work together. Everyone has a role to play. If you are going to talk about contraception, do it; if you are going to talk about abstinence, do it; but don’t be a barrier and restriction to other providers.”

And there is progress: abortion has become less stigmatized, and providers discuss abortion more openly at the hospital where she works. “I don’t want abortion to be a secret at work… We have moved from the place where we can’t talk about abortion to the place now, today, months down the line, we are able to openly discuss even elective abortions … which I think is progress.”

Dr. Muyuni was asked what she would say to providers who don’t feel ready yet to publicly proclaim their convictions on abortion. “I’d urge them to do their part, wherever they can fit in. You don’t have to start with terminations today if you are not ready, because if you provide it and you are not ready, you may do more harm than good. So, start with contraception if you’re comfortable there; start with STI [sexually transmitted infection] screening and prevention if you’re comfortable there, but get up and do something toward this continuum of comprehensive abortion care. So, that’s what I’d say to someone who feels they’re not yet ready: there’s always something to do.”

Ipas is a nonprofit organization that works around the world to increase women’s ability to exercise their sexual and reproductive rights, and to reduce abortion-related deaths and injuries.



3 responses to “Doctor Attitudes and the Effect on Access To Safe Abortion in Zambia

  1. Pingback: Weekly Wrap Up
  2. Very inspiring piece of work indeed. Keep it up doc. The reality is that women are dying from unsafe abortion despite all the debate around the issue.

  3. I don't think that there would ever be a thing so called "safe abortion". Abortion is neglecting an innocent life to live. I'm against abortion but I hope that practitioners would be more proactive in promoting women's health than tolerating abortion.

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