ANTANANARIVO (Thomson Reuters Foundation) - Safidy is a 17-year-old who lives in Madagascar’s capital, Antananarivo. She and her boyfriend didn’t use contraception, they didn’t know where to find it and didn’t have the money to pay for it.
When she became pregnant she sought help to end the pregnancy. Abortion is illegal in Madagascar, but clandestine terminations are performed regularly in the Indian Ocean nation.
“The doctor assured me that it will work and we trusted him,” said Safidy, who did not want to reveal her full name. “(But) I had pain, I bled.” She eventually needed to seek medical care for complications.
Campaigners say if young people in Madagascar had access to contraceptives many unsafe abortions could be prevented. About 10 women on the island die each day due to complications in pregnancy and childbirth, including terminations, according to the U.N. population agency UNFPA.
This week Madagascar’s Senate is set to debate legislation that would modernize a family planning law that dates back to 1920 and prohibits the promotion of contraception.
Health organizations say the law is an anachronism from the French colonial era that contradicts the global commitments Madagascar has made to provide family planning services.
“All of the (contraceptive) providers are illegal, all of the programs,” said Nirina Ranaivoson, the head of Health Policy Plus in Madagascar, a member of the technical working group on the new law.
Even if the old law is not routinely enforced, organizations that provide family planning services, including government departments, are disregarding the letter of the law.
“Organizations that provide family planning services were worried that someone at some point could challenge them in terms of what they were providing,” said Derick Brinkerhoff of RTI International, who was involved in a recent study on family planning legislation in Madagascar.
The colonial law originated from a pro-natalist stance influenced by the decline in France’s birth rate around the time of the First World War, he said.
At least 10 other former French colonies in Africa have repealed similar laws, some as early as the 1960s.
FOCUS ON YOUTH
Advocates say the most important part of the new law is the explicit commitment to making access to reproductive health services a universal right, regardless of age.
At present there is confusion over the legality of providing contraception to young people. Certain interpretations of the law suggest that under-18s require parental permission to use contraception.
Lalaina Razafinirinasoa, the country director for Marie Stopes International (MSI) in Madagascar, says one doctor she worked with faced legal action and a fine for providing contraception to an underage girl after her parents complained.
While such cases are rare, a lack of clear guidelines on contraception for young people has created confusion and fear among frontline health workers, she said.
“Our providers have been worried about providing to young girls even though we know the fertility rate is high amongst this group.” said Razafinirinasoa.
It is crucial young people get access to contraception under the new law, said Pierre-Loup Lesage, head of Population Services International (PSI) in Madagascar.
“It’s a country where 50 percent of first pregnancies happen before 18 years old.... Legally speaking we need to have rules in place that are way more flexible than they are now,” he said.
As well as prohibiting the promotion of contraception the 1920 law criminalised abortion. The new law, if it is passed as currently written, would allow for abortions when the mother’s life is in danger, with the written approval of two doctors.
“Therapeutic abortion is highly restricted in Madagascar, it is maybe the most restrictive country in Africa for abortion rights,” said Lesage.
Even though the legislative changes would offer more leniency, “it’s not like abortion rights for everybody, it’s still very restricted,” said Lesage.
Confusion over some of the provisions in the new law delayed its passing in the Senate in June.
This time, family planning advocates the draft will pass.
“Having a law on family planning will provide us with a clear framework for action. It will also be a very important signal to the world,” Constant-Serge Bounda, head of the UNFPA in Madagascar told the Thomson Reuters Foundation.
At the Family Planning 2020 summit in 2012, the Malagasy government committed to increasing the contraceptive prevalence rate to 50 percent and decreasing the unmet need for family planning by half, by lowering it to 9 percent by 2020.
Benjamin Andriamintantsoa, an opposition member of parliament said the new law would help the government meet those commitments.
“This is going to say that family planning is an important aspect of national development,” said Andriamintantsoa. “...one of the most important aspects of development for a developing country like Madagascar.”