Rethinking abortion law reform in Malawi: a multi-method study

Despite decades of sustained advocacy, Malawi retains one of the world's most restrictive criminal abortion laws. A draft Termination of Pregnancy Bill, developed in 2015 to propose semi-liberal reform to Malawi's abortion law, has yet to be enacted. In contrast, similar or less intensive advocacy efforts have resulted in liberalisation of abortion laws in other low- and middle-income countries (LMICs), including Zambia, South Africa, and Ethiopia. This qualitative case study examines the policy processes adopted by advocates and identifies potential pathways for abortion law reform in Malawi. Employing a multi-method approach, we conducted document analysis using the READ approach and semi-structured interviews with 14 key informants actively or formerly involved in Malawi's abortion law reform process. Data was analysed thematically using Bacchi's (2009) 'What's the problem represented to be?' (WPR) theoretical framework. The findings revealed evidence-informed strategies aimed at strengthening future advocacy efforts: coordinated advocacy integrating established and emerging organisations; ongoing demographic and lived-experience evidence to counter stereotypes and expose harms; careful reframing of language (e.g. replacing "Termination of Pregnancy Bill" with motherhood-aligned titles); intensive community engagement via trusted local champions; strategic timing mindful of political cycles and U.S. funding pressures (including the reinstated Global Gag Rule); further litigation to clarify and expand existing legal scope; and adequate funding to counter well-resourced opposition and sustain rural outreach. Drawing comparative insights from surrounding sub-Saharan African countries, we discuss drivers of reform and propose targeted strategies to advance abortion law liberalisation in Malawi and reduce mortality related to unsafe abortion.