For the unmarried women of Zanzibar there are some forbidden concepts. Sex, contraception, unwanted pregnancy, solo motherhood. Or abortion. This archipelago of two islands off the coast of Tanzania, a heavenly holiday destination, lives between contrasts. On the one hand, the modernity that tourism has brought with its white foreigners in bikini, discos that spit music until late at night, cosmopolitan restaurants and luxury hotels. On the other, the tradition imbued from birth to its inhabitants. And above all to them. Modest women out of obligation in a 95% Muslim society, not radical, but very conservative. In Zanzibar, tourists show thighs, shoulders and navels, but those born there wear veils. In Zanzibar, countless European or American couples on vacation hold hands in the street and share intimacy in the bedroom, but they, those there, cannot have sex before marriage because it is frowned upon, because it is stigmatized and an marginalization for life.
As it is assumed that women do not have sexual intercourse before marriage, there is no risk of pregnancy, so there is no reason to use contraception. But the reality is more complex. Sex is practiced and it is done without protection. “For single or divorced women, access to contraceptive services remains a problem. Negative social norms about premarital sex probably explain the reluctance of some providers, planners, and policy makers to address the unmet need for contraception that exists.” explains Francesca Morandini, director of the Unicef office in Zanzibar.
For its part, the NGO Marie Stopes International, who has been dedicated to family planning on the islands for many years, reveals that most of the participants in her studies see contraceptives as a tool to spread out the number of children and that, although it is easy to find condoms in pharmacies and other shops, adolescent girls are suspicious and do not feel treated privately or confidentially, but rather insecure when shopping because they could be seen by anyone.
Difficulties in accessing contraceptive methods affect about 225 million women worldwideAccording to the World Health Organization (WHO) something that, if solved, would prevent many unwanted pregnancies and the death of thousands of women due to induced abortions that went wrong. In this archipelago, only 14% of married women of reproductive age take precautions, one of the lowest rates in Africa, according to the Tanzania Government Demographics and Health Report 2016. Among sexually active single women, only four out of ten gain access to these methods, according to Unicef. And one more piece of information: the same organization estimates that more than 40% of pregnancies are unintended and that around 18% of women begin to have children in adolescence.
At the Uroa health center, a fishing town facing the Indian Ocean, the consequences of this discrimination are evident. Nurse Hifadhi has been serving neighbors for 35 years, and she knows them very well. “There are two profiles of contraceptive users: some are married women and widows who see someone and want to avoid having more children; they do ask for them. Unmarried young women do not use them, they never come here. They are afraid to get close. because everyone in town knows each other and they will end up knowing if any of them are pregnant or if they use any preventive measure without being married. ” Uroa has a total population of 2,828 women, 778 of reproductive age, according to data from this health center. Of these, only 293 have requested a prevention method.
Only 14% of married women of reproductive age take precautions in Zanzibar
What happens to a woman who stays in condition? “Here, if you get pregnant without being married you are a prostitute “, says Mariam Hamdani. 73 years old, she is the founder of the only traditional music band formed by women from Zanzibar. Her lyrics denounce that they have fewer rights. A single mother confronts to marginalization and stigma, and so there are two options: marry or risk a clandestine abortion, since this practice is illegal in Zanzibar. Sneaking interruption of pregnancy is life-threatening, but Marie Stopes International has proven that women, especially adolescent girls, prefer to face this possibility rather than the consequences of having a child alone. “They are considered a disgrace for the family and motherhood is perceived as something that ruins their life and their future, including the possibility of choose a husband (…). They are frequently expelled from school or home, “reads a report from the organization.
Sulhiya, 17, from Uroa, chose to get married. She covers part of her face with an orange veil, and smiles nervously every time she has to answer a question. Dealing with topics such as sex, abortion or contraception is not an easy task for her, she is ashamed. She is holding her 10-month-old baby Akhla, whom she has taken to the health center for a checkup. “I got pregnant by accident and my boyfriend decided that we get married,” she admits after some reluctance. Her parents did not reject her, but they did recommend that she consummate that marriage with the child’s father so that their union and the baby would be “official.” He did so. She finished secondary education during pregnancy and, since she is a mother and wife, she no longer studies; she has become a housewife. If he could, he would like to train in something related to painting. She wants to have three children, but not for now, so she uses a subcutaneous implant. Being a married woman, she is not so frowned upon anymore.
Both public and private hospitals as well as NGOs and UN agencies (Unicef, Marie Stopes or Engender Health) report on real methods of contraception and even organize training meetings with couples in the rural communities of the islands of the archipelago, although they often find reluctance because the interested ones need the permission of the husband to use them. “When they are told for the first time to do some family planning, they respond: ‘my husband told me that if I do it, he will divorce.’ It takes a lot to convince them, but in the end they usually agree. And many do it in secret,” she says Rukia Mohamed, a nurse in the obstetrics and gynecology area of the Mnazi Mmoja public hospital, the largest in Zanzibar. Perhaps for this reason, injections and intercutaneous implants are the preferred methods there by the users. “The injections last up to three months, they come here to get them. It is the most common because it is the one that nobody sees, the most discreet.” Meanwhile, in the small health center of Uroa, nurse Hifadhi maintains that most of her patients have spousal consent. “It is a decision made with the husband, they are rarely hidden.”
When told to do family planning, they respond, ‘If I do it, my husband gets divorced.’ It costs a lot to convince them
The most used modern methods are injectables and subcutaneous implants (6% and 3% respectively) but still 9% of women believe in traditional methods. Khadija, 35 years old and seven and a half months pregnant with her fourth child, is admitted to the hospital because her uterus threatens to detach. She says that she does take precautions: “the calendar,” she says nonchalantly. This is, simply, to calculate when one is fertile or not, a very unreliable method, like the reverse, on which the nurse Rukia assures that there are also adult women who believe that it works.
As in the case of Sulhiya, a pregnancy means motherhood, at least in theory, because voluntarily interrupting it is a crime punishable by jail and is only allowed if the woman’s life is in danger. “Abortion is one of the main causes of admission to the Mnazi Mmoja hospital but, as it is not legal, it is difficult to establish how many of the admitted cases are due to spontaneous causes and how many were clandestinely induced,” Morandini details.
In the evacuation room, two nurses and an anesthetist are preparing a patient for a curettage after her pregnancy has been terminated. It is the day to day of the hospital. At the entrance to this room, Rukia agrees with Morandini’s estimates. He asserts that at least half of the pregnant women who come to the consultation would like not to have the baby. “Many come from complications derived from abortion, about eight or ten per day.” A glance at the record book reveals that in the first three weeks of the current month 115 patients were admitted for this cause. “They come when it has already happened. When they get married and become pregnant, they continue to do very hard jobs, carry heavy objects, buckets of water … Most of them lead a very hard life,” he says. This is what happened to Rehema, 24 years old. Haggard, in pain and looking depressed, she rests on a cot on a colored cloth. He just lost a fetus, the second one already. “With the previous one, the same thing happened to me, but the doctors don’t know the cause, they say we have to wait to see what the problem is.”
Women abort using the most varied methods and with dire consequences for their health. They turn to midwives, traditional doctors, clandestine clinics and, most of the time, they do it themselves at home to avoid the costs of paying someone. Marie Stopes’ research reveals that the cost is around $ 45 in a country where the median per capita income is $ 600 per year.
16% of maternal deaths are due to unsafe abortion
Among the most widely used methods are the ingestion of certain types of herbs, detergent, medicines or inserting needles through the vagina to the uterus. But it doesn’t always work out. In fact, Unicef estimates that the annual maternal mortality rate is 450 pregnant women for every 100,000 live births – in Spain it is six – and that 16% of them are due to an unsafe abortion, “but many occur in remote communities and not they are notified “, Morandini warns. The main causes are: postpartum hemorrhage (42%), eclampsia or hypertensive disorder of pregnancy (19%), severe anemia (11%), ruptured uterus (7%) and sepsis (5%).
“The problem with abortions is that they cause infections and death, they bleed a lot when they do it at home, I’ve heard that,” says Zuhena, 47, from Uroa. Like all the neighbors consulted in the health center, her answers become vague when it comes to addressing the issue of abortion. They all know about cases, but none of them want to talk about specific people. They are open secrets, rumors, gossip. “I have heard some cases, and they aborted because of the fear that the family and parents gave them, and also because of the gossip of the people,” says Asia, 30 years old and from the same locality.
In Stonetown, the capital, Khadija, 22, a university student admits that her best friend from college is just under three months old. That she hasn’t been dating her boyfriend long. You haven’t decided what to do yet. “I tell him that he must have the child because the other option is very dangerous,” he asserts. The aforementioned does not allow her name to be revealed and she does not want to talk about her case, she does not want to meet any journalist. She hides her secret in the depths of her thoughts and her fledgling belly is still camouflaged under her hijab. In other parts of the world I would get by with a little help. But here in Zanzibar, you know that whatever you do, your life just got really complicated.