Telma Mateus Vilanculos (left, 28yo) is a midwife student. She aborted at 27 because she could not manage the pregnancy /birth of a baby and her studies. "The nurses and midwives in at the hospital told me about safe abortion, and I got all the information from my colleagues at the hospital. I received all the care I needed at the hospital. I am now 7-month pregnant and I will have a baby now that I have finished my studies." 16 May 2023. Beira, Mozambique. © Miora Rajaonary / MSFMay 2023. Beira, Mozambique. © Miora Rajaonary / MSF
In Beira, a city on Mozambique’s central coast, Médecins Sans Frontières (MSF) is connecting hard-to-reach communities with safe abortion care and other sexual and reproductive health services.
Mozambique has one of Africa’s most liberal abortion laws, allowing abortion on request during the first 12 weeks of pregnancy and up to 24 weeks in limited circumstances, including fetal abnormality.
Though abortion has been legal since 2014, many people still face obstacles to accessing this care, including stigma, misinformation, and corruption, such as charging for services that should be free.
MSF has worked in Beira for nearly a decade. We run several programmes in partnership with local communities and Mozambican Ministry of Health staff in the city to overcome such barriers, provide accurate health information, and increase access to safe abortion care.
Our priority is to reach communities that are often neglected by the health care system or avoid seeking care due to fear of stigma or discrimination, including sex workers, adolescents, transgender people, and men who have sex with men.
Working with communities to break down barriers
Our approach is community-centred and peer-led, aimed at creating safe, trusting environments where all people feel comfortable accessing the healthcare they need. We provide direct care and health education through mobile and community clinics in locations where patients feel comfortable seeking care.
Three years ago, Glória* became pregnant. Too afraid to go to the hospital due to rumours she had heard about the high cost of care and the need to bring a witness, she induced an abortion herself, at home.
“I went through it on my own. It was terrible,” says Glória. She became scared for her life, so she decided to face her fears and seek post-abortion care at the health centre. Contrary to what she’d heard, the team at the health centre helped Glória have a safe abortion.
After her positive experience, Glória is now trying to counter the myths that prevented her from seeking a safe abortion. “I started this already with my friends. If they want to [have an abortion], I tell them to go to the health centre and they will [help you],” she says.
Decreasing stigma
MSF teams train and mentor peer educators to provide reliable health information, guidance, and support to their communities on safe abortion care and other health issues including HIV and sexually transmitted diseases. We also support 11 Ministry of Health facilities in Beira to decentralise safe abortion care across the city, bringing it closer to communities.
Staff at these clinics now provide roughly 700 safe abortions per quarter. From January 2022 to June 2023, the provision of safe abortion care increased by 41 per cent, and post-abortion care decreased by 73 per cent.
While post-abortion care includes spontaneous abortion (known as miscarriage) as well as unsafe abortion, we believe the decrease is likely due to fewer women resorting to unsafe methods to end their pregnancy now that safe abortion care is more easily accessible.
The decentralised approach has three pillars: donating supplies of abortion medications and contraceptives, training staff in the provision of safe abortion care, and a mentorship programme to increase the quality of care.
The main goal of the mentorship programme is to equip healthcare workers with skills to appropriately serve people from marginalised groups, particularly sex workers, aiming to make health facilities places free of prejudice, where everyone feels safe to ask for care.
Emily is a sex worker living in Beira with her husband and the youngest of three children. She is currently the sole provider for her family. She has been coming to MSF’s community clinic in Beira since 2018. In December 2022, Emily became pregnant and came to the clinic for safe abortion care after receiving information and support from a fellow sex worker.
“We encourage each other to visit the clinic,” says Emily. “We know each other as friends, and no one laughs at the other… because we experience so many different things during work.”
Some health staff are hesitant to provide medication abortion beyond 12 weeks, despite it being legal in Mozambique up to 16 weeks in cases of sexual violence. Our teams are trying to address issues like this through our mentorship programme with Ministry of Health staff at the clinics we support throughout Beira.
Various local advocacy groups are also calling for the 16-week limit to be extended to all people seeking safe abortion care, as limiting access to this service in the second trimester severely endangers the lives of women who were not able to access abortion services earlier in their pregnancy.
