Under the shade of a tin roof, amidst the household sounds of chickens, fussing babies, and chai being served, a group of 60 eastern African men and women took turns role playing the plight of women desperately seeking abortion. They were participants in a "Training of Trainers" conference convened by a small NGO in rural Tanzania and the Dutch reproductive rights NGO Women on Waves.
Women on Waves employs often radical methods to increase global awareness and access to safe abortion, with a focus on medical abortion using the drug misoprostol. In 2007, misoprostol was registered in Tanzania as a drug to stop postpartum hemorrhage (PPH). PPH is the leading cause of maternal mortality in Tanzania and across the globe, commonly due to lack of affordable and accessible medical care. Pharmaceutical companies and women's health groups across Tanzania are running awareness campaigns to equip Tanzanian pharmacies with misoprostol for PPH.
However, few people there know that the drug can safely induce abortion if taken off-label in the appropriate dosage.
At the conference, local activists and volunteers from around the world trained 60 Tanzanians, Congolese, Rwandans, and Burundians in how to find and keep misoprostol in pharmacies, how to use it safely for first-trimester abortion, what to do in case of complications, and how to train others with this information. The idea is that the information will travel virally across the country, to parallel the awareness campaigns by pharmaceutical companies.
The activists connected rural pharmacists and distributors in the capital, and discussed starting up new pharmacies to keep the drug available. They spoke with women who were interested in following a microfinance model to become suppliers in areas outside of the reach of pharmacists, and with religious and activist leaders from refugee camps who wanted to strategize how to get the pills into the camps.
The training was held in a rural part of Tanzania near Congo and Burundi. Surrounded by such troubled nations, this area of northern Tanzania shelters a flood of refugees, and in their wake the inevitable NGOs. The area also combines stunning poverty, a lack of access to contraception, rape as a war crime, and an AIDS epidemic that has infected one in four Tanzanians. Because of these conditions, the need for abortion overshadows the moral arguments that play out in the US. Yet the law still imprisons women who abort, or anyone who helps them, so abortions are not available in hospitals or clinics. Instead the women use blue. Most people in the area know at least one woman who has died in attempt to abort. Women often use sticks or a strong tincture of cassava root, but in conversation they also bring up blue, a mysterious reference I did not grasp until I was invited to visit a friend's soap factory. There I was introduced to a brilliant deep cobalt blue powder that sticks under your fingernails and stains your hands, like henna. This was blue. The powder is mixed with water to produce a strong household liquid bleach used for disinfecting and cleaning. This is what women drink to terminate unwanted pregnancies, often corroding their internal organs and ending their lives. One-third of maternal deaths in Tanzania are due to unsafe abortion practices like drinking blue, and WHO research demonstrates the Eastern African region to have the second highest rate of unsafe abortions in the world.
The dissemination of information has always been at the heart of Women on Waves' initiatives. Their work in Europe and Latin American focuses on increasing access to a drug that women already know about and desperately need. The difference in Tanzania is that access to the drug already exists. The drug was available without a prescription in nearly every pharmacy the volunteers visited, and not once did a pharmacist express suspicion of illegal use. The cost is low enough for most of the participants, who ranged in demographic, nationality, and profession, to agree it was affordable.
Women in Tanzania simply lack the information on how to use misoprostol as an abortifacient. Without this knowledge the medicine is an idle tool. Consequently the typical mother of five, who doesn't know about misoprostol, who wasn't educated about contraception, who can't possible afford a sixth child, instead drinks cobalt blue bleach, either killing herself or barely living to perpetuate the myth that blue is a viable remedy.