Mbabane: A new report has found that Eswatini’s current legal and healthcare framework is unintentionally sustaining the country’s underground abortion industry, with the state ultimately bearing the cost of complications arising from unsafe procedures.
The report, commissioned by Journey of Hope for Girls and Women in Eswatini under the One Billion Rising Campaign, presents findings from a baseline assessment examining the interconnected challenges of Gender-Based Violence (GBV), Early Unintended Pregnancy (EUP), and barriers to integrated Post-Abortion Care (PAC).
According to the report, the existing legal-clinical framework has created what it describes as a “perverse incentive structure,” where abortion remains criminalised while post-abortion care is ethically and medically mandated. This dynamic, it notes, allows unqualified providers to operate with minimal deterrence, as complications resulting from unsafe abortions are treated within the public health system.
“The state has inadvertently subsidised the backyard abortion industry,” the report states, noting that public health facilities absorb the costs of treating complications that arise from illegal procedures that could otherwise be prevented through regulated and safe service provision.
The findings are set against a backdrop of significant reproductive health challenges in the country. Maternal mortality remains high, while approximately one in three women reportedly experience sexual abuse before the age of 18. The report positions itself as a critical evidentiary baseline aimed at informing policy reform, strengthening health systems, and supporting community-led advocacy.
Financially, the burden of unsafe abortion is described as substantial but largely underreported in national health planning. While Eswatini allocates about 10 percent of its national budget to health, only 13 percent of that is directed toward reproductive health, with the sector heavily reliant on donor funding.
The report highlights that the cost of treating complications from unsafe abortions significantly exceeds the cost of preventive measures such as modern contraceptives or safe termination services. Regional estimates cited in the study indicate that treating incomplete abortions—which often require surgical intervention and extended hospital stays—is considerably more expensive than managing uncomplicated cases.
Evidence of this burden is illustrated through data from October 2012, when more than 1,000 women were treated for abortion-related complications at a single clinic in Manzini, according to the Family Life Association of Swaziland (FLAS). Using regional cost averages, the report estimates that this translated to approximately US$86,000 in monthly post-abortion care expenditure for that facility alone, representing a significant and unbudgeted strain on public resources.
The report further identifies an “efficiency gap,” noting that a full year of modern contraceptive services and supplies costs between 3 percent and 12 percent of what it takes to treat a single post-abortion care patient. This, it suggests, indicates the potential for substantial fiscal savings through increased investment in family planning services.
Beyond direct healthcare costs, the report outlines broader social and economic impacts. Women, particularly those in rural or low-income settings, face additional financial pressures when seeking post-abortion care. These include transport expenses, lost income, and caregiving costs, which can amount to nearly US$200 per case approximately E3 200 in local currency.
Educational disruption is also highlighted as a long-term consequence of early unintended pregnancies. The report notes that girls who leave school due to pregnancy face reduced lifetime earning potential. It further states that adult mothers are three times more likely to complete university compared to those who give birth at an early age, while each additional year of secondary education significantly lowers the risk of early pregnancy.
The state, in turn, incurs indirect economic losses through reduced tax revenue linked to lower lifetime earnings among women affected by early childbearing.
Despite widespread awareness of the health risks associated with unsafe abortion, the report reveals persistent barriers to accessing care. It notes that 90 percent of respondents acknowledged that women experiencing severe complications, such as heavy bleeding, should seek immediate medical attention.
However, fear of legal repercussions remains a major deterrent. The study found that 84 percent of urban and 78 percent of rural young women believe that individuals would avoid seeking medical care due to concerns that healthcare workers might report them to law enforcement authorities.
The report states that these systemic challenges continue to shape health-seeking behaviour and place sustained pressure on Eswatini’s public health system.
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