In 2010, Lesotho listed grounds for legal abortion in its penal code. In 2021, the Parliament of Lesotho and church leaders debated legalisation.
Unsafe abortions cause about one-fifth of maternal deaths in the country. Few hospitals provide abortion. Government guidelines provide for post-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.
Legislation
Section 45 of the Penal 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.
Lesotho does not have national guidelines on safe abortion or post-abortion care (PAC).[2] Lesotho's abortion law is one of the most restrictive in the region.[3]
Legislative history
Lesotho had a total ban on abortion before legalising abortions to save the life or health of the pregnant woman.[4]
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 the SADC Parliamentary Forum. Moshoeshoe proposed a referendum on abortion. Church leaders agreed.[6]
Prevalence
In 2015–2019, 67% of pregnancies were unintended 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 of maternal 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]
Access
According to the Ministry of Health, as of 2015 only 10% of hospitals provide safe abortion, and medical 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 on Facebook. 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 from traditional healers.[12]
Post-abortion care
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 the Ministry 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] The Queen Mamohato Memorial Hospital, the only 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 lists manual vacuum aspiration (MVA) for PAC.[1] As of 2015, 4–7% of facilities provide MVA, and misoprostol 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 capital Maseru, 73.7% of PAC patients received post-abortion family planning, but only 25.9% were briefed about it.[13]
Societal factors
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's Mexico City policy, in effect under Donald 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 for Planned Parenthood's distribution of condoms 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's National 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 the United 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]
