In the middle of the night at St. Theresa Hospital, popularly known as KwaHeni, Dr. X was called to attend to a heavily bleeding teenager.

He found her lying in a pool of blood in the scotch cart that had brought her from the village. Tears rolled down her cheeks, a silent testament to the pain she was enduring.

Relatives explained that she had drunk a concoction in an attempt to terminate a four-month pregnancy.

Shami Dhliwayo, 18, had been impregnated by her 19-year-old boyfriend, an upper-sixth student at Mafomoti High School who was not prepared to take up the responsibilities of fatherhood and being a husband.

What confronted Dr. X was a medical emergency complicated by an ethical, moral, and legal dilemma.

“I knew trying to terminate was illegal because she wasn’t raped, she was healthy, and the fetus was okay. I told her relatives she needed a police report before I could touch her,” he says.

Dr. X explains that Zimbabwean law is unclear on how health practitioners should respond to a botched abortion already in progress, whether to complete the procedure or attempt to save the fetus.

“To be honest, I didn’t know if this was the correct procedure. I was caught in between saving her life, ethics, law, and also the thought of making a mistake; I could end up in jail, and what would happen to my family?” Dr X says.

“Unfortunately, she passed away before I could lend my hand, waiting for a police report,” he adds.

Zimbabwe’s Termination of Pregnancy Act, Chapter 15:10, permits legal abortion primarily when the pregnancy endangers the woman’s life, results from rape or incest, or where there is a high risk of fetal handicap. The Act further outlines how abortions should be conducted, including required procedures, certifications, and provisions for conscientious objection.

However, these legal processes are often slow. Required documentation can delay urgent care, sometimes with fatal consequences.

Hamida Ismail-Mauto, SAT Zimbabwe Country Operations Manager, says the Act forces health workers to navigate a maze of legal requirements.

“These include court orders, two-doctor certifications, and police reports before they can provide a lawful abortion, which creates confusion, delays, and a chilling effect that makes providers hesitant to act even when a woman’s life is at risk, ultimately limiting timely, life-saving care.

“The restrictive nature of the Act drives women to seek unsafe, clandestine abortions, which significantly raise maternal mortality. When safe, legal procedures are unavailable, women risk severe complications such as hemorrhage, infection, and death,” she said.

In Shami’s case, the pregnancy resulted from consensual sex, and there were no known health complications. She, therefore, did not qualify for a legal abortion.

Although Zimbabwe’s Education Act allows girls to remain in school during pregnancy, Shami’s deeply held religious beliefs made her believe she had committed an unforgivable wrong.

Her aunt, Chenai Dhliwayo, expressed concern over the role of religion and family expectations.

“We are made to believe that if one falls pregnant, they should get married without fail.

“When Shami’s boyfriend refused responsibility because he was also just a child, she saw it as the end of her world. We are also to blame; we should have provided her with all the support we could,” she said.

Zimbabwe’s stringent abortion laws push many women towards unsafe, backyard procedures, contributing to high maternal mortality rates.

An estimated 80,000 illegal abortions occur annually, with about 25% of unintended pregnancies ending in unsafe abortions. Studies estimate that 16–25% of maternal deaths are linked to complications from unsafe abortions, particularly among adolescents. Many of these deaths could be prevented through better reproductive health education, access to contraception, and safe abortion services.

Ismail-Mauto notes that fear of prosecution often causes women and health workers to delay care, worsening health outcomes.

She argues that reforming the Termination of Pregnancy Act is critical to ensure the law reflects lived realities, protects women’s lives, and removes unnecessary barriers that delay care. Until adolescent reproductive health services are strengthened and the law is aligned with public health needs, health workers like Dr. X will continue to face impossible choices where fear, confusion, and delay can mean the difference between life and death.

In October 2025, Dzivarasekwa Member of Parliament Edwin Mushoriwa proposed amendments to the Medical Services Bill in the National Assembly. The proposed changes incorporate revisions to the Termination of Pregnancy Act, particularly aimed at reducing bureaucracy and expanding access to safe and legal abortion for victims of unlawful sexual intercourse.

Legal expert Sekai Madzimure says that while the act contains provisions, some are not legally binding.

“If a medical practitioner fails to provide appropriate care for complications resulting from unsafe or failed abortions, they could be accused of negligence or malpractice, especially if their actions are deemed to have worsened the patient’s condition.

“Also, even if the practitioner is acting in good faith, involvement in cases of illegal or unregulated abortions could expose them to criminal proceedings, especially if procedures deviate from legal requirements. This often makes health professionals afraid or slow to help in failed abortion complications,” Madzimure said.

She added that the Act requires medical practitioners to report certain cases, such as emergency terminations or complications. Failure to report or properly document such cases may result in investigations or legal consequences.

Zimbabwe is a signatory to the Maputo Protocol, formally known as the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, adopted in 2003. The protocol guarantees women’s reproductive health rights, including control over fertility and the right to decide whether and when to have children.

Article 14 obliges state parties to authorize medical abortion in specific circumstances, including sexual assault and cases where pregnancy endangers the life of the mother or fetus.

While Zimbabwe partially complies by permitting abortion under limited conditions, gaps remain. Certain groups—including minors pregnant through consensual sex and victims of marital rape—are excluded, highlighting the need for further legal alignment with the protocol.

“There is no single day that passes without me thinking of that fateful day. I keep thinking I should have done something, but I was caught in between law, ethical considerations, and what was in front of me,” Dr. Chingini said.

Many voices say there is an urgent need for policy reform to modernize the Termination of Pregnancy Act of 1977, bringing it in line with contemporary public health realities and ensuring that both women and healthcare workers are protected.