Inside Zimbabwe’s Underground Pregnancy Termination Industry
Just after dusk one day in October 2022, Sarah collapsed at the entrance to her tiny home in Epworth, a suburb of Zimbabwe’s capital, Harare.
As her friends and relatives rushed to help her, they thought she had collapsed because of the sweltering heat. Only Sarah knew what was wrong.
Earlier that morning, Sarah, then 20 years old, had walked a few doors away from her home and quietly slipped into the home of a traditional healer. She had just learned that she was pregnant from a relationship with a man who said he wouldn’t support a baby. She knew that she couldn’t afford to raise the baby as a single mother and felt she had no other choice but to abort the pregnancy. In Zimbabwe, it is illegal to have an abortion except in a few special circumstances.
Sarah told More to Her Story that the healer led her to a room where she warned her that she could die from the procedure. Still, Sarah told her to proceed.
The healer inserted a clothes hanger through her cervix to end the pregnancy, Sarah said.
“It did not last long, but it was painful. I cried,” said Sarah, who requested that only her first name be used for fear of reprisal.
“I started bleeding,” she said.
Soon after, Sarah started feeling dizzy, weak, and confused, bleeding heavily. She became nervous, remembering stories of local women who had died attempting unsafe abortions. The healer gave her some traditional herbs to drink and sent her home. Sarah thought the bleeding would stop soon after.
Little did she know that the recovery would take weeks.
First, she landed on the ground as she got home, her friends and relatives rushing to help her.
Then, she tried to recover at home. “The bleeding did not stop. I could not walk for days. It was draining me,” said Sarah, radiant in a brightly coloured dress but solemn as she recalled her painful experience.
After about a week, she confided to her aunt that she had had an abortion. Her aunt immediately took her to a private clinic where physicians cleaned her uterus and treated her for an infection.
Frustrations with national restrictions
The experience of women like Sarah underscores a deeper frustration that women say they experience in Zimbabwe with pregnancy termination laws that restrict the ability of women to have safe abortions.
The southern African nation relies on laws established in 1977 under an archaic “Termination of Pregnancy Act.” The law allows for the legal termination of pregnancy in three circumstances, including when a pregnancy “endangers the life of the woman concerned,” there is “serious risk” the child will “suffer from a physical or mental defect” and be “seriously handicapped" permanently and “there is a reasonable possibility that the foetus is conceived as a result of unlawful intercourse,” such as rape.
Activists say the law restricts access to safe abortion for many women, forcing them to seek help elsewhere, where sharp objects like hangers and sticks are used to terminate the pregnancy.
There are two groups of people providing illegal abortions in the country, experts say. Medical doctors and nurses quietly acknowledge that they support abortions in informal settings like homes and lodges, smuggling pills and other equipment from pharmacies to secretly terminate pregnancies. Traditional healers and other untrained people also terminate pregnancies in their homes, but, unlike doctors and nurses, they do not have access to proper medical equipment. They often give women herbal concoctions or use sharp objects like clothes hangers and sticks to end pregnancies.
Too often, these unsafe procedures lead to death.
An estimated 462 women die in Zimbabwe for every 100,000 live births, as of 2019, according to data from the World Health Organization, and about 25 percent of those deaths are the result of abortions.
These statistics include cases of unsafe abortions reported to public health providers, and women’s rights advocates said that the actual number of cases could be much higher because of underreporting.
In 2016, an estimated 65,300 induced abortions occurred in Zimbabwe, according to the WHO. This translates to a rate of about 17 abortions for every 1,000 women aged 15 to 49.
Only 25,200 of the abortions, or 39 percent, received facility-based post abortion care, according to the WHO. About half of the women were treated for complications related to abortions, according to the data, with the majority of abortions being unsafe.
Among these women treated for complications after abortion, 78 percent had mild or moderate complications, 19 percent had severe complications, while 3 percent died or nearly died from complications.
Loice Vavi, a spokesperson of the Zimbabwe Confederation of Midwives, based in Harare, said Sarah is lucky to be alive.
Vavi said women who undergo unsafe abortions risk infections, anemia due to excessive bleeding, and death due to hypovolemic shock, a medical emergency caused by a sudden loss of blood.
Vavi said that the risks occur because the place where the procedure occurs often isn’t sterile, and the instruments used also often aren’t sterile, leading to infections that often go untreated.
Women can suffer from heavy bleeding, or hemorrhage, during and after abortions due to leftover tissue from the pregnancy, blood clotting, a weak or non-contracting uterus that can’t stop bleeding, and a lack of knowledge on how to control bleeding.
Vavi adds that some women use unsafe methods, like inserting sharp objects such as wire to try to end a pregnancy, resulting in tears or holes in the uterus, injuries to other nearby organs, like the bladder, and, in severe cases, the damage may require doctors to remove the uterus altogether — a surgery called a hysterectomy.
‘Afraid to go to the clinic’
If Sarah were caught having an illegal abortion, she could have been sentenced to a jail term of up to five years or fined $700.
“I was afraid to go to the clinic because I thought I could be arrested,” she said.
In early December 2024, a Zimbabwe High Court judge ruled that current abortion laws are unconsitutional and expanded legal abortion rights access to underage pregnant girls and the victims of marital rape.
The Constitutional Court has yet to confirm the ruling, and even with no clear date expected, women’s rights advocates consider it a milestone victory for women and girls in Zimbabwe.
Edinah Masiyiwa, the executive director of Women’s Action Group, an organization based in Harare, said the ruling aligns with the constitution, which makes 18 the legal age of marriage.
“This means that if those under 18 years are raped, they will also benefit from safe abortion because they cannot consent to sex,” she told More To Her Story.
Women’s rights organisations and activists are now campaigning for abortion rights to be expanded to all women.
Masiyiwa said it is cheaper to support safe abortion than treat women for complications that arise after unsafe abortions.
“It would be good to expand legal abortion because women with unwanted pregnancies will always find ways to terminate their pregnancies,” she said.
Sipho Mpofu, the lead of monitoring, evaluation, accountability, research and learning and development at Shamwariyemwanasikana, an organisation based in Harare supporting women and girls, said the ruling acknowledged the severe physical and psychological challenges faced by these vulnerable groups and aligned with constitutional protections against the cruel and degrading treatment of women and girls in society.
“We applaud the High Court for the ruling that allows children to be children, not mothers,” she said.
Mpofu said that while the December Zimbabwe High Court ruling expands access to safe abortion for specific groups, it does not address the needs of all women.
“In practice, obtaining a legal abortion remains extremely difficult, leading many women to seek unsafe alternatives. Expanding legal access to abortion for all women could reduce the prevalence of unsafe procedures and associated health risks,” she said.
Traditional healers, like the one Sarah visited, are also less expensive than medical procedures.“They accept anything as payment, from groceries to furniture. In my case, I gave her my three used blankets,” said Sarah, sitting on a polished concrete floor.
Another woman, Trish, also from the town of Epworth, had an illegal abortion after she got pregnant at 19 with her boyfriend, who refused to take responsibility for the pregnancy.
“I had completed my high school and was about to proceed to university when I fell pregnant. I was eight weeks gone. My friend introduced me to a woman who helped me abort it using a stick,” said Trish, now 21. She also preferred to use only her first name.
A sociology student at a local university in Harare, Trish didn’t know what to do when she started bleeding profusely. After five days of suffering, she, too, went to a public hospital for help.
Sources told More to Her Story that some nurses and doctors from public hospitals are also operating underground abortion clinics in Harare.
Prices range from $30 to $50 for Misoprostol tablets, which are inserted in the vagina to cause an abortion.
Another method, “manual vacuum aspiration,” involves sucking the fetus through the cervix. It costs at least $100,
Innocent Mukudu, a medical doctor in Harare, said he began assisting women with abortions in 2005 and conducts the procedure about 20 times a year.
“It is my part-time job. Women beg me, and I assist them. I normally avoid pregnancies older than 13 weeks after formation of the embryo because of the high risks,” says Mukudu, who requested his name be changed to protect his identity.
“I give all my patients antibiotics for infections and painkillers for pain management. I use sterilised equipment, and I monitor them throughout the healing process.”
He said that if complications arise, he sends his patients to the hospital.
He said women with access to Misoprostol sometimes insert too many pills, leading to uncontrolled bleeding.
“In some cases, Misoprostol does not work,” he said, and that is when he turns to manual vacuum aspiration.
Mpofu said that if Zimbabwe allowed women to get safe and legal options, women would be less likely to resort to undercover yet dangerous procedures, potentially decreasing the incidence of complications and fatalities.
“Women would be granted reproductive autonomy and allowed to make decisions on their sexual and reproductive health,” she said.
Now, safe at home, Sarah is a single mother, and she said she hopes that lawmakers will hear stories like hers and reform the nation’s laws to expand abortion rights to all women. “I almost died,” she said.
“I do not want others to go through what I went through.”