Dora Mkize* (20) screamed for joy when
she found out she was
unplanned, she was
excited to become a mother and her
delight escalated when doctors at the
KwaZulu-Natal hospital told her she
was having twins.
But Mkize's joy turned to horror
when she found out that one of her
babies was not developing properly.
Her doctors advised her to terminate
the fetus — through a caesarean
section operation — because
there was no hope for its survival
and it could also endanger the
Mkize, already almost
eight months pregnant, could not
face aborting her baby.
Anaemia was the cause of the second
baby's irregular development.
Mkize could not provide enough
nutrients, mostly iron, for both
babies to develop properly. Her doctors
told her that, if she had been
diagnosed earlier, simple daily supplements
of folic acid could have prevented
But she only found out that she was
pregnant at six months.
Unplanned pregnancyAlmost half of all pregnancies globally
are unplanned, according to
a 2014 study conducted by United
States-based research organisation
Published in the academic journal
Studies in Family Planning,
the research found that 40% of the
85-million pregnancies in 2012 were
unintended. Half of these pregnancies
were aborted, 38% resulted in live births and 13% ended in
Africa had comparably lower rates
of unplanned pregnancies at 35%,
but the authors said more abortions
occurred in African countries than
in developed countries. And many of
these abortions are unsafe because
they are illegal or frowned upon.
"Each year in the developing world,
thousands of women die and many
more are seriously injured as a result
of unsafe clandestine abortions," the
Many women face "deep trauma"
as a result of unplanned pregnancies
for many reasons, said Sylvester
Chima, a medical ethics expert from
the University of KwaZulu-Natal.
"Not planning for a family often
results in serious health consequences,
not always the fault of the
mother but almost always she will be
the one to suffer," he says.
Fetal alcohol spectrum disorderMany women unknowingly take
unsafe medication, drink alcohol or
smoke tobacco, which could harm
their fetus. Recent research has
shown that the highest reported
rates of fetal alcohol spectrum disorder
(FASD) are in Africa.
The US Centers for Disease
Control and Prevention described
FASD is a "group of conditions that
can occur in a person whose mother
drank alcohol during pregnancy"
resulting in mild to severe consequences
such as stunted growth,
intellectual disabilities, abnormal
facial features, vision and hearing
issues as well as problems with the
heart, kidneys or bones.
One in 10 grade one children has FASD in parts of the Eastern Cape,
a Foundation for Alcohol Related
Research study found. Although
many of the women in this study
continued to drink once they knew
they were pregnant, others did not.
Chima says the emotional consequences
for a woman can be
"A woman can experience debilitating
guilt and then face another ethical dilemma: to choose to terminate,
if that is a legal option in her
He says 11 African countries have
criminalised abortion and many
others restrict the procedure to
special cases such as pregnancy
by rape or incest, and as a result of
abnormalities in the fetus.
Safe or unsafe abortions?"Many
women then face the added burden
of whether to choose unsafe abortion
services or risk her life or have
the unwanted pregnancy despite the
consequences." Women on the continent, especially
those in rural areas, could
be further disadvantaged by weak
health systems that do not have the
medical equipment needed to identify
An example of this was the recent
outbreak of the Zika virus in South
America, which placed many women
in the situation of "having to decide
to terminate even if it is against
one's religious beliefs or not having
the choice at all and giving birth to
a baby who will die in a matter of weeks," Chima says.
Lifeline: A man kisses his two-month-old great-grandson, born with microcephaly. (Reuters)
The virus is transmitted by mosquitoes,
causing mild fever-like
symptoms, and pregnant women
who are infected risk giving birth to
children with microcephaly — underdeveloped
brains — according to the
World Health Organisation.
"These parts of the brain oversee
bodily functions that don't require
active thought. Affected children will
need constant care for the remainder
of their lives. Health professionals
are unable to confirm the life
expectancy of a baby with microcephaly
who is severely intellectually
impaired, and the prognosis is not a
good one," says Chima.
But even with access to safe abortion
and sophisticated medical attention,
Chima says women face an ethic
and moral dilemma.
"With a duty to protect women's
autonomy and preservation of scarce
healthcare resources on the one
hand, but the fetuses' right to personhood
and the doctor's moral obligation
to society on the other, counselling
women to make an informed
decision is a real challenge," he says.
Mkize found the medically advised
choice too difficult to make. "I
trusted in God to make the decision
for me," she says. "I can't decide
to end this baby's life — I shouldn't
Her healthy baby survived when
she gave birth at nine months by
caesarean section. But she spent
two weeks in hospital watching her
second child through the glass of an
"I knew I had my daughter at home
but that she did not replace my other child," she says.
The young mother struggled to
breastfeed her healthy child because
she was spending so much time at
hospital, but she found it almost impossible to leave. The baby died after nine weeks at the hospital. "It was the worst thing I have
experienced in my life," she says.
"Watching my baby die."
* Not her real name
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