InLesotho,abortion isillegal unless the pregnancy poses a risk to life or health.
In 2010, Lesotho listed grounds for legal abortion in itspenal code. In 2021, theParliament of Lesotho and church leaders debated legalisation.
Unsafe abortions cause about one-fifth ofmaternal deaths in the country. Few hospitals provide abortion. Government guidelines provide forpost-abortion care, but few facilities exist. The government has recommended that women seeking abortion travel to South Africa,where it is safe and legal. Clandestine abortions are available in Lesotho from foreign physicians. Women who are likely to have abortions are those who have an unmet need for contraception, are young, or get pregnant outside of marriage.
Section 45 of thePenal Code Act 2010 criminalises abortion unless there is a legal defence:[1]
- A person who does any act bringing about the premature termination of pregnancy in a female person with the intention of procuring a miscarriage, commits the offence of abortion.
- It shall be a defence to a charge under this section that the act intended to terminate pregnancy was performed by a registered medical practitioner –
- in order to prevent significant harm to the health of the pregnant female person, and the person performing the act has obtained a written opinion from another registered medical practitioner to the effect that the termination of pregnancy is necessary to avoid significant harm to the health of the pregnant female person;
- in order to prevent the birth of a child who will be seriously physically or mentally handicapped, and the person performing the act has obtained in advance from another registered medical practitioner a certificate to the effect that the termination of the pregnancy is necessary to avoid the birth of a seriously physically or mentally handicapped child; or
- in order to terminate the pregnancy of a female person who is pregnant as a result of incestuous relationship or victim of rape.
— Penal Code Act of 2010, Section 45[2]
Lesotho does not have national guidelines on safe abortion orpost-abortion care (PAC).[2] Lesotho's abortion law is one of the most restrictive in the region.[3]
Lesotho had a total ban on abortion before legalising abortions to save the life or health of the pregnant woman.[4]
In its 2018 review of theAddis Ababa Declaration on Population and Development, the government of Lesotho listed management of unsafe abortion as a priority.[2]
The chair of the Social Cluster Committee,Fako Moshoeshoe, suggested the legalisation of abortion. He cited the high rate of abortion complications and the need for increased public health education.[5] On 30 March 2021, 26 members of parliament met with a group of church leaders who opposed abortion. The meeting was led by the Southern Africa HIV and AIDS Information Dissemination Service, along with theSADC Parliamentary Forum. Moshoeshoe proposed a referendum on abortion. Church leaders agreed.[6]
In 2015–2019, 67% of pregnancies wereunintended and 24% of these resulted in abortion. Between 1990–1994 to 2015–2019, the unintended pregnancy rate remained constant and the abortion rate increased 28%.[7] According to the 2022 State of the World Population Report, 60% of unintended pregnancies in the country result in abortion, and the unintended pregnancy rate is rising.[8] Abortion data collection in the country is sparse.[1][2]
As of 2015, about one-fifth ofmaternal deaths in Lesotho are caused by spontaneous or induced abortion. Lesotho has a high maternal mortality rate, especially in rural areas.[2] In some hospitals, unsafe abortion may cause up to 50% of deaths of women aged 13 and up.[9]
Women are regularly reported to the police for suspected abortions. Some do not seek medical attention for unsafe abortions due to fear of prosecution.[10]
According to the Ministry of Health, as of 2015 only 10% of hospitals provide safe abortion, andmedical abortion is available in 18% of hospitals and 14% of health centres. Lesotho's guidelines for healthcare providers deal with referral for legal abortion.[2]
Foreign medical professionals often perform illegal procedures for high prices. They often avoid prosecution as they can flee the country and women are afraid to report them. Many women search for abortion services onFacebook. Dozens of Facebook pages advertise safe abortion pills and services. Women who receive these pills experience bleeding and faintness. Some receive procedures that do not work. Local newspapers advertise abortions.[10]
The Ministry of Health recommends that women travel outside the country to receive abortions. In neighbouring South Africa,safe and legal abortions are available. Critics say it is hypocritical that the government suggests getting abortions abroad instead of legalising abortion.[10] Few women in Lesotho can afford the cost of travel.[11]
In the 1990s, most abortions were conducted unsafely by unqualified providers. They used chemicals, herbs, or physical methods to induce abortions. Some girls sought abortions fromtraditional healers.[12]
The government's National Health Strategic Plan 2017–2022 noted that abortion is the number one cause of hospital admissions among women.[2] According to theMinistry of Health, the rate of hospital admissions due to spontaneous or induced abortion is 13%, as of 2018.[10] In 2021, gynaecological treatment due to abortion was received by 35.7% of girls aged 10 to 15, 8.2% aged 15 to 19, and 10.6% aged 20 to 24.[8] TheQueen Mamohato Memorial Hospital, theonly referral hospital in Lesotho, receives a PAC patient every day, as of 2020.[5]
Few PAC facilities exist. Training for health providers is poor.[1] As of 2015, only 15% of hospitals and health centres provide PAC.[2]
The Essential Service Package listsmanual vacuum aspiration (MVA) for PAC.[1] As of 2015, 4–7% of facilities provide MVA, andmisoprostol is available in 86% of hospitals and 6% of health centres. Most providers do not want to perform MVA.[2] In 2010, at Queen Elizabeth II Hospital in the capitalMaseru, 73.7% of PAC patients received post-abortion family planning, but only 25.9% were briefed about it.[13]
Sexual and reproductive healthcare in Lesotho is limited by lack of personnel and training. Services rely heavily on donors, which can cause loss of funding. The U.S. government'sMexico City policy, in effect underDonald Trump, prohibited foreign organisations receiving U.S. funding from performing or distributing information about legal abortion, which limited information about Lesotho's law allowing abortion to preserve health.[2] The policy's instatement in 2001 cut off funding forPlanned Parenthood's distribution ofcondoms in the country.[14]
Lesotho has a high unmet need for contraception, which leads to unintended pregnancies and unsafe abortions.[15] Many women are aware of family planning services, but many do not use them or disapprove of them.[13]
Pregnancies and abortions are common among adolescents. They often face judgement or refusal from providers. The Ministry of Health'sNational Quality Standards for Young People Friendly Health Services in Lesotho suggested the expansion of youth-friendly health services including safe therapeutic abortions, screening for abortion complications, and PAC.[2] The Ministry of Health holds sensitisation programs to educate young people about abortion, supported by theUnited Nations Population Fund.[5]
Many women receive abortions after getting pregnant outside of marriage. Some face financial issues and have relationships with married men who support them, who abandon them after the pregnancy.[5]
