Stories of safe abortion care in Mozambique

29 Jan 2024

In every country, women from all walks of life may seek out an abortion at some time of their lives due to many reasons.

Where safe abortion care is too difficult to access, people with an unwanted pregnancy often have no choice but to resort to unsafe abortion, one of the leading causes of maternal mortality globally. 

To reduce the high number of women dying from unsafe abortion, Mozambique in 2014 legalised abortion up to 12 weeks and beyond in cases of rape, incest, and severe foetal anomalies such as heart defects. This essential care is provided free of charge. But even though abortion is free and legal, other barriers including stigma and misinformation can still make it difficult to access safe care.  

In the city of Beira, Médecins Sans Frontières / Doctors Without Borders (MSF) provides safe abortion care to women, girls, and other pregnant people from communities that are often excluded from health services or who might avoid seeking care for fear of stigma or discrimination, including sex workers and adolescents. 

To increase access to safe abortion care across the city, MSF’s team also trains staff working at clinics run by the Mozambican Ministry of Health. 

A member of MSF's community outreach team speaks with a patient

A member of MSF's community outreach team speaks with a patient who received safe abortion care from MSF. Mozambique 2023 © Miora Rajaonary

Most abortions in Beira are medication abortions. Patients are given a combination of mifepristone and misoprostol pills to take at home. Decades of scientific research have shown that these two drugs will safely and effectively end a pregnancy over 95 per cent of the time, with a less than 1 per cent chance of severe complications. Staff walk patients through the process beforehand so they know what to expect, and they only need to come back to the clinic if they have questions or problems.  

At community clinics run by MSF and Ministry of Health clinics in Beira, we spoke with women who have had an abortion and the health staff who’ve supported them. We asked them if they wanted to share their stories.  

Here’s what they told us, in their own words.

*All patient names have been changed. 

"I don't want to have a child without dignity."

- Michelle, 34, sex worker and mother

I don't want to have a child without dignity.

I got pregnant because a condom broke. My youngest child was just one year old. I went to the health centre and was seen by MSF. The HIV test was negative. Then I took the pregnancy test, and it was positive. I started crying.  

Paula [an MSF nurse] asked me, "What do you want to do?" I said I didn't want to keep this pregnancy—it was an accident. I wouldn't be able to, it would be too expensive. I don't know the father. The best thing for me was to end this pregnancy.

They gave me a pill to take at the clinic. And they gave me more pills to put under my tongue at home after my meal. And that’s what I did. Before I left, I asked for a contraceptive implant so I wouldn't get pregnant again.

Many people have unsafe abortions. The traditional healer gives us some medicine to take, and we could die. I don't know how to get the [right] medicine to take on my own, but when I come to the health centre, they do know, and they can give it to me.   

At the health centre, when we speak out, we get help. With the traditional healer, we don’t get any support. At the health centre, we are not abused, we do not pay for anything. It is not allowed to just let people die.  

Michelle holds one of her three children.

Michelle holds one of her three children. Mozambique 2023 © Miora Rajaonary

"I decided I couldn't manage a child and school"

- Beatriz, 28, midwife trainee

[Last year,] I decided I couldn't manage a child and school at the same time, so I came here to the health clinic. They told me about the steps to have a safe abortion.

I had support from my family [and] from my husband. At first, he didn’t agree, but after we discussed my situation—that I was studying—he accepted it.  

In my experience, it is a myth that you can’t get pregnant again after having a [safe] abortion. Because I got pregnant again normally. Nothing changed and nothing will change. I'm seven months pregnant now. 

"I did it wrong. I did it at home without any support."

- Glória, 23

I was 20 years old when I had my first abortion. I did it wrong. I did it at home without any support.  

I was afraid to face the nurse. And there's always a rumour in the neighbourhood that you can't go to a health centre because they'll ask for a guardian; they'll ask for witnesses; they will ask for things that you can't give them. People told me that the nurses would charge me. That is a myth. There are lots of myths about the health centre and that's what made me afraid to go.

It went badly. It was scary, and I went through it on my own. Then, I was afraid of losing my life—so I went to a health center, and they helped me.

The second time [I had an abortion], I went to a health centre, and I felt better. They told me if there was any problem, I could come back—they said, “We will help you.” It was very good and safe.  

None of the things happened that they say in the neighbourhood. For any friend who is in this situation, I would refer them to the health centre, and I would tell them how I was treated. 

Glória speaks to an MSF nurse in the Ponta-Gêa Health Center in Beira

Glória speaks to an MSF nurse in the Ponta-Gêa Health Center in Beira, Mozambique, where MSF supports Ministry of Health staff providing safe abortion care and maternity services. Mozambique 2023 © Miora Rajaonary

"I asked her to keep it a secret"

- Olivia, 32, medical student  

To begin with, [I was afraid of] my family being disappointed in me. I was a little afraid that they wouldn't be willing to pay my school tuition. So that was a lot of it.  

I ended up telling my older sister. She did not approve at the time. Then she ended up accepting it. The only thing was that I asked her not to tell anyone at home, [especially] my parents. I asked her to keep it a secret so as not to create disruption in the family. 

"We share all our secrets."

- Emily, 34, sex worker and mother from Zimbabwe

I made the decision [to have an abortion] because, one, my child here in Beira was still young, and two, I had separated from my husband and then reconciled, so this pregnancy was not planned.

I always come here; this clinic helps us with issues related to our sex work. They explained to me that if I experienced any issues, I should come back. But everything was alright, I did not encounter any problems.

People share information, especially among women like me in sex work. We are free, we share all our secrets. We know each other as friends, and no one laughs at the other because we experience so many different things in our work.

Note: Women who come for safe abortion care often tell our staff the reasons for their decision, but they are not required to do so.

Emily is photographed from behind to protect her identity.

Emily is photographed from behind to protect her identity. Mozambique 2023 © Miora Rajaonary

"I perform safe abortions without any prejudice."

- Cintia Feliciano, nurse and head of MSF's maternity and safe abortion care services at Munhava Health Centre in Beira

I have been working on safe abortion care since 2020. I have no problem providing this service. At first, I didn't agree with providing it because of religion; the community; myths in general. But then I learned that many people were dying because of unsafe abortion. So, to prevent maternal deaths, I eventually accepted it. I perform safe abortions without any prejudice.

Some myths around abortion that I've heard in the community are: if you have an abortion, you will not be able to have more children; having an abortion is a sin; if you have an abortion you can't cook food for your family or you will kill your family members.  

We try to curb those myths by talking to people. We give talks here in the health centre, but we also go into the communities. We talk to community leaders to get the information out because people respect the neighbourhood leaders and the traditional midwives. [Some] people still refuse, but more are starting to accept it.

My friends and family still think abortion is a sin. Even for me, they say that I will not go to heaven. Others ask me, "Do you still receive communion in church?"  

Every once in a while, the stigma gets to me. Every now and then I get down, but then I think of the patient, and that’s it! 

Cintia speaks with a patient at Munhava Health Center in Beira.

Cintia speaks with a patient at Munhava Health Centre in Beira. Mozambique 2023 © Miora Rajaonary

"Just as I've been helped, I'd also like to help someone one day."

- Joana, 18, student  

When I was 15, I had an abortion, but it was not safe, I did not go to the health centre. I did it at home with traditional medicine—tree roots and pills—and had complications. I got very sick and was losing blood, so I had to go to the health centre, and they transferred me to the central hospital.

They couldn't help me at the hospital and wanted to send me back home. But my father didn't want to see me suffer. He had to make a lot of sacrifices to do it, but he sent me to a [private] clinic and put on a brave face. They took care of me there, examined me, gave me blood. I was there for three days. When I went home, I continued to have pain, but little by little, I started to improve.

People working with MSF's community outreach team perform a skit about safe abortion care to raise awareness

People working with MSF's community outreach team perform a skit about safe abortion care to raise awareness in an under-resourced neighborhood. Mozambique 2023 © Miora Rajaonary

I had told the man I was dating everything [that happened]. He didn't even call me; he just left.  

My mother didn't want to see me stop studying. I am the eldest and I also look after my seven brothers and sisters. So, with a child it wouldn't have worked. I also did it so my mother wouldn't have to make sacrifices. She and my father both work.

I came to this clinic to have a contraceptive implant put in. My mother accepted it. Now I feel happy.

Contraceptive care helps us. Because this area is where 13 [and] 14-year-old girls are at risk of getting pregnant. But since this project has been here, we've had access to protection. People reach 18, 19, 20 years without getting pregnant.  

A lot of people also have safe abortions. Unsafe abortion—running the risk of bleeding and dying—doesn't happen anymore.  

The community knows this project well, it has helped a lot of people.

After I finish school, I'd like to practise medicine. Just as I've been helped, I'd also like to help someone one day. 

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