THE BILL TO ENACT SAFE MOTHERHOOD LAW 2012. TO BE PRESENTED TO THE PARLIAMENTARIAN SAFE MOTHERHOOD WORKING GROUP ON FEBRUARY 2012. An Act providing for compressive maternal sexual and reproductive health rights, recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, the right to information on reproductive health , and the right to make decisions regarding reproduction free from discrimination, coercion and violence.
ENACTED by the parliament of United Republic of Tanzania.
PART I PRELIMINARY PROVISIONS
(1) This Act may be cited as the Safe Motherhood Act, 2012.
(2) This Act shall come into operation on such date as the Minister may by notice in the Gazette, appoint.
This Act shall apply to mainland Tanzania in relation to promotion of Universal access to maternal, sexual and reproductive health services and protection of reproductive rights.
In this Act, unless the context otherwise requires :-
“adolescence” means the period of physical and psychological development of an individual from the onset of puberty to complete growth and maturity between 11 to 19 years. “antenatal care” means the correct diagnosis of pregnancy followed by periodic examinations, screening and management of complications during pregnancy.
“Contraception” means the deliberate prevention of pregnancy by measures that prevent the normal process of ovulation, fertilization and implantation.
"emergency contraception" means contraceptive methods used by women immediately following sexual intercourse to prevent pregnancy.
"emergency obstetric care" refers to both basic and comprehensive lifesaving service for maternal complications being provided by a health professional in a medical facility.
“family planning” means conscious effort of couples or individuals and women to freely plan for and attain their desired number of children and to regulate the spacing and timing of their births with or without the use of contraceptive commodities.
“harmful practices” means religious and traditional practices that are harmful to women and girls ‘sexual and reproductive health.
“health care provider” refers to any person or institution that has been duly authorized to deliver health care services.
“health facility” means a facility authorized by the Medical and Dental Practitioners Board for the purpose of this Act.
“health regulatory bodies” refer to any agency or authority authorized by law to regulate the practice of medicine or health care provision.
“informed consent” means consent obtained freely without threat or improper inducement after appropriate disclosure to the patient of adequate and understandable information in a form and language understood by the patient.
“maternal mortality” means death of a woman while pregnancy or within 42 days of termination of pregnancy or delivery.
“maternal health care” means the health care a woman during pregnancy, childbirth and 42 days after childbirth.
“maternal morbidity” refers to severe diseases, physical, emotional or psychological or disabilities caused by pregnancy-related complications.
“ministry” refers to the ministry responsible for health
“minister” refers to minister responsible for health
“newborn health” means
“Post-abortion care” refers to treatment of incomplete and unsafe abortion and complications that are potentially life-threatening including post-abortion counselling and contraception services.
“reproductive health” means the state of complete physical, mental and social well- being in all matters relating to the reproductive system and its functions and processes, and is not merely the absence of disease or infirmity.
“reproductive health rights” include the right of all individuals to attain the highest standard of sexual and reproductive health and to make informed decisions regarding their reproductive lives, number and spacing of children free from discrimination, coercion or violence.
“sexual health” means state of physical, emotional, mental and social wellbeing in matters related to sexuality.
“termination of pregnancy” means the separation and expulsion, by medical or surgical means, of the contents of the uterus of a pregnant.
PART II ACCESS TO CONTRACEPTIVES AND FAMILY PLANNING
(1) The government shall ensure individual rights to control fertility, decide number and spacing of children, be informed and choose any method of contraception are respected and promoted
(2) It shall be the duty of the government to provide access to contraception and family planning services including commodities, counselling, information and education.
The Minister shall make regulations to ensure access to affordable, high quality and acceptable family planning services information, and prescribe guidelines to:-
guarantee full range of family planning methods both traditional and modern contraceptive methods, including emergency contraception.
guarantee family planning counselling, information and education regardless of marital status and age.
protect individuals’ right to give full and informed consent before accepting contraceptive methods.
ensure that all contraceptives provide to persons are of internationally acceptable standards.
protect right to privacy and confidentiality in the provision of family planning services.
eliminate restrictions on contraception including regulatory obstacles and prohibitions on the dissemination of information regarding contraceptives.
The health care provider prescribing a contraceptive method shall provide information to the person to whom the prescription is being given as to its advantages and disadvantages and ensure informed consent and confidentiality.
Any health care provider who violates sections 6 hereof commits an offence and shall be liable upon conviction to a fine not exceeding five hundred thousand shillings or imprisonment for a term not exceeding 3 months or both.
The Ministry shall promote and protect the right of men and adolescent boys to be informed and to have access to safe, affordable, and acceptable methods of family planning of their choice. Section to be discussed of its proper placement.
PART III MATERNAL AND NEWBORN HEALTH
9. The Ministry shall take appropriate measures to ensure availability of quality and free maternal and newborn services, information and education including.
a) Antenatal / Prenatal care
b) Intranatal / Safe delivery care
c) Postnatal /Post delivery care
10). The following persons shall be authorized to offer maternal health care:
a) medical practitioners
b) clinical officers
c) nurse midwives
11. (1) The Ministry shall strengthen the capacity of health regulatory bodies to ensure safe and high quality maternal and newborn health services and products.
(2)The Minister, in consultation with the health regulatory bodies shall make regulations to
a) promote best practices on maternal and newborn health
b) register and license health facilities and providers
c) carry out inspection in health facility to ensure and maintain high standard of maternal and newborn services.
d) set guidelines for health facilities to conduct annual births and maternal deaths review.
12. The government shall:
a) ensure that each village has a dispensary, each division has health center and each district has a hospital
b) employ an adequate number of midwives to achieve at least a minimum ratio of one (1) fulltime skilled birth attendant for every five (5) deliveries every day.
c) ensure health facilities have adequate and qualified personnel, equipment and supplies for offering emergency obstetric care.
13. The Ministry shall fund special programs on male involvement and participation in all areas of maternal and reproductive health services.Liability section is needed here... eg in cases of medical negligence resulting in maternal or newborn death.
PART IV SEXUAL AND REPRODUCTIVE HEALTH OF ADOLESCENTS
14. (1) The Ministry, in conjunction with relevant regulatory bodies, and other relevant Ministries, shall facilitate the provision of affordable adolescent friendly sexual and reproductive health services, information and education.
2)In the provision of sexual and reproductive health services to adolescents.
a) parental consent shall not be mandatory
b) principles of non discrimination, privacy and confidentiality shall be observed
c) all legal and regulatory barriers to adolescent sexual and reproductive health shall be removed
3) Any health care provider who violates Section 14 (2) hereof commits an offence and shall be liable upon conviction to a fine not exceeding five hundred thousand shillingsor imprisonmentfor a term not exceeding 3 months or both.
15. The government shall
a) fund and facilitate the provision of age appropriate sexual and reproductive health education for in and out of school adolescents by adequately trained teachers.
b) fund special programs for reducing the incidence of adolescent pregnancies and other adolescent reproductive health problems.
c) fund special programs that reflect the special needs of marginalized adolescents, such as street children, out of school and internally displaced adolescents.
d) protect adolescents against all forms of sexual violence, including rape, incest and trafficking.
16. The Ministry shall ensure universal access to contraception and maternal health care, including pre-and postnatal care for pregnant adolescents regardless of marital status.
PART V TERMINATION OF PREGNANCY
17. 1) A pregnancy may be terminated if a health care provider, in consultation with the pregnant woman, is of the opinion that
a) the continued pregnancy would pose a risk or injury to the woman’s physical or mental health.
b) there exists a substantial risk that the fetus would suffer from a severe physical or mental abnormality.
c) the pregnancy resulted from rape or incest
d) the pregnant woman, on account of being an mentally disordered person, is not capable of appreciating pregnancy.
2. The termination of a pregnancy may only be carried out by a trained and certified health care provider.
3) The surgical termination of a pregnancy may take place only at a health facility designated by the Minister by notice in the Gazette for that purpose.
4) The Minister may designate any facility for the purpose contemplated in subsection (1), subject to such conditions and requirements as he or she may consinder necessary or expedient for achieving the objects of this Act.
5) The Minister may withdraw any designation under this section after giving 14 day’s prior notice of such withdrawal in the Gazette.
18. The state promote the provision of non-mandatory and non – directive counselling, before and after the termination of a pregnancy. Consider adding pre abortion to women not falling under section 17 (1)
19. (1) Subject to the provisions of section 17(1) the termination of a pregnancy may only take place with the informed consent of the pregnant woman.
(2) Subject to the provisions of section 19 (1) in the case where the pregnant women is not capable of providing the consent, the termination of the pregnancy is allowed only after consultation with natural guardian, legal guardian or spouse, as the case may be, provided that the termination of the pregnancy shall not be denied if the natural guardian, legal guardian or spouse, as the case may be, refuses to consent thereto.
20. (1) The Ministry shall ensure health facilities prevent and manage consequences of abortion by providing post abortion care including
a) emergency treatment of complication of incomplete and unsafe abortion
b) post abortion counselling to assess the woman’s emotional andhealth needs
c) post –abortion family planning counselling and contraception services.
d) referral to reproductive and other health services
e) community linkages for appropriate support.
2) Any health care provider who violates section 17, 19, 20 hereof commits an offence and shall be liable upon conviction to a fine not exceeding one million shillings or imprisonment for a term not exceeding 6 months or both.
PART VI HIV/AIDS AND OTHER SEXUALITY TRANSMITTED INFECTIONS
21. (1) A health care provider attending to a pregnant to a pregnant woman shall provide her with information about HIV/AIDS, and specifically inform her about mother to child transmission of HIV.
2) Every pregnant woman and husband or partner attending a health facility shall be offered voluntary counselling and testing for HIV.
3) Any health care provider who compels a pregnant woman to undergo HIV testing or procures HIV testing to another person without the knowledge of that other person commits an offence.
4) The results of an HIV test shall be confidential and shall be released only to the pregnant woman and her husband or partner.
22. The Minister shall in conjunction with health regulatory bodies:
a) Regularly disseminate accurate and comprehensive information to the public about HIV/AIDS, including prevention of mother to child transmission and the options available to infected pregnant women.
b) Ensure access to continuous and regular treatment of HIV- infected mothers and children born with HIV.
c) Ensure counselling of pregnant women and their spouses or the man responsible infected with HIV or suffering from AIDS on how to sustain their reproductive health and rights.
23. (1) Any health care providers and any other person attending a pregnant woman shall be encouraged to undergo HIV testing.
(2) Any health facility that attends pregnant women has a duty to ensure
a) The provision of post exposure prophylaxis
b) The provision of necessary tools such as gloves, goggles andgowns.
c) Appropriate handling and disposition of used syringes, materials used in blood testing and body fluids or wastes of persons known or believed to be infected with HIV.
(3) Any person who contravenes the provisions of this section commits an offence and upon conviction shall be liable to a fine of not less than five hundred thousand shillings.
PART VII HARMFUL PRACTICES AFFECTINGSEXUAL AND REPRODUCTION HEALTH.
24. All harmful practices such as female genital cutting, early or forced marriages, wife inheritance, and nutritional taboos, that negatively affect reproductive health, conducted for religious or cultural reasons, are prohibited by law.
25. (1) No person shall marry who, being male and female, has not attained the apparent age of eighteen years.
(2) Any person who is a party to a ceremony purporting to be a marriage knowing or having or having reason to believe that the other party is below the minimum age for marriage shall be guilty of an offence and shall be liable on conviction to a fine not exceeding five hundred shillings.
26. Any person found conducting or aiding the performance of the above practices shall be quality of an offence.
27. The government, in conjunction with relevant institutions, shall
a) Conduct educational and informational campaigns on the dangers of harmful practices.
b) Train health care providers to respond to the specific reproductive health needs of women needs of women who have undergone harmful practices.
PART VIII
IMPLEMENTING AND ENFORCEMENT MECHANISM
28. (1) The Ministry shall serve as the lead agency for the implementation of the Act and shall establish Safe Motherhood board whose members shall include
a) Ministry of Health RCH
b) Pharmaceutical Board
c) Tanzania Law Society
d) Parliamentarians for safe Motherhood
e) propose any other
(2). The Safe Motherhood board shall be corporate with perpetual succession and a common seal, and shall in its corporate name, be capable of suing and being sued.
(3).The functions of the Safe Motherhood board shall be:-
a) Coordinate implementation of the Act.
b) In conjunction with other relevant bodies carry out regular research in areas of reproductive and sexual health and recommend best practices to the Ministry.
c) Propose, formulate and ensure the passing of rules, guidelines and policies for the implementation of this Act.
d) Monitoring and evaluation
e) Annual MSRH service delivery review
f) Conduct maternal deaths audits
g) propose any other
29. (1) There is hereby established a Tribunal to be known as the Safe Motherhood and Health Rights Tribunal.
(2) The tribunal shall consist of the following members who shall be appointedby the minister.
a) A chairperson nominated owing to his/her knowledge, skill, expertise, experience and advocacy for Reproductive Health and Rights.
b) The Attorney General or his representative
c) One advocate of the High Court of Tanzania nominated by the Tanzania Laws Society.
d) Three representatives of medical professional bodies being specialists in matters of reproductive health of which one must be from the medical professional body not represented in above.
e) Two persons having such specialized skill or knowledge necessary for the discharge of the functions of the Tribunal.
f)The Tribunal shall consist of not more than seven members.
(3) At least four of the members of the Tribunal be women
(4) The quorum of the Tribunal shall be three members.
(5) All matters before the Tribunal shall be determined by the decision of the simple majority of members of present.
(6) There shall be paid to the members of the Tribunal such remuneration and allowances as the Minister may in consultation with the Treasury determine.
(7) The Chief Executive Officer of the Board shall be an Ex officio member of the Tribunal with no voting rights.
30. The office of a member of the Tribunal shall be become vacant –
a) At the expiration of three years from the date of his/her appointment; stagger the terms of continuity limited to 2 terms
b) If the member ceases by any reason to be such an advocate or medical practitioner as referred to in subsection (1).
c) If the member is removed from membership of the Tribunal by the minister for failure to discharge the functions of the office whether arising from infirmity of the body or mind or from other cause or for misconduct; and
d) If the member resigns the office of member of the Tribunal. Provided that the minister shall be at liberty to reappoint any member of the Tribunal for a further term provided that no one person shall serve for more than 2 consecutive terms and the minister shall stager the appointment dates so that no more one third of the members shall leave at the same time.
31. (1) The Tribunal shall have jurisdiction
a) To hear and determine complaints arising out of any breach of the provisions of the Act;
b) To hear and determine any matters as may be to it pursuant to the provisions of this Act;
c)To perform such other functions as may be conferred upon it by this Act or any other written law being in force.
(2) On hearing a complaint the Tribunal shall have all the powers of a subordinate court of the first class to summon witnesses, to take evidence upon oath or affirmation and to call for the production of books and other documents.
(3) The Tribunal shall within fourteen days of receipt of a complaint, give a notice of complaint to the respondent in writing; informing him to file a response thereto within twenty eight days of that notice.
( 4) Where the Tribunal considers it desirable, it may receive evidence by affidavit and administer interrogatories and require the person to whom the interrogatories are administered to make full and true reply to the interrogatories within the time specified by the Tribunal.
(5) In determining any matter the Tribunal may take into consideration any evidence which it considers relevant to the subject of the matter before it, notwithstanding that the evidence would not otherwise be admissible under the Evidence Act.
(6) The Tribunal shall have power to summon expert evidence as may be necessary for the discharge of its functions under this Act.
(7) The Tribunal shall have power to award the costs of any proceedings before it, and shall direct that costs delete: shall be taxed in accordance with the scale prescribed for suits before the High Court, or delete: “to” award a specific sum of costs.
(8) All summons notices or other documents issued under the hand and seal of the chairperson shall be deemed to be issued by the Tribunal.
(9) Upon any complaint being made to the tribunal under this Act, the Tribunal may:-
a) Consider the complaint on merit and make such orders as it may consider just and fitting.
b) Recommended cancellation, suspension or reprimand a Practitioner’s certificate
c) Make such order as may be appropriate in the circumstances.
10) Any party aggrieved by the decision of the Tribunal shall have a right of appeal to the High Court within thirty days of the decision.
32. Any person summoned by the Tribunal to attend and give evidence or to produce any records, books of accounts, statements, or other documents or required to answer interrogatories and who, without sufficient cause :-
a) Refuses of fails to attend at the time and place mentioned in the summons served upon him;
b) Refuses or fails to answer, or to answer fully and satisfactorily, to the best of his knowledge and belief all questions lawfully put to him by or with the concurrence of the Tribunal; or
c) refuses or fails to produce any records, books of account, statements or other documents which are in his possession or under his control mentioned in any summons served on him;
Commits an offence and shall be liable upon conviction to a fine not exceeding twenty thousand shillings, or delete: “to” imprisonment for a term not exceeding six months, or to both.
33. (1) Where the Tribunal awards damages or costs in any matter before it, it shall, on application by the person in whose favour the damages or costs are awarded , issue to him a certificate stating the amountof damages or costs.
(2) Every certificate issued under subsection (1) may be filed in the High Court by a person in whose favour the damages or costs have been awarded and upon being so filed, shall be deemed to be a decree of the High Court and may be executed as such.
34. Except as otherwise provided in this Act, the Chief Justice may in consultation with the chairperson of the Tribunal, and by Notice in the Gazette make rules governing the practice and procedure of the Tribunal having regard to the object purpose of the Act.
PART IX MISCELLENOUS PROVISIONS
Paternity leave
Infertility issues
Maternal health rights
Maternal /reproductive health in the workplace
Maternal health rights for women prisoners
Maternal health rights for mentally disturbed person