In June 2013, Louise (not her real name), an 18 year old girl in junior high school, was four-months pregnant when she attempted to procure an abortion in Kigali, Rwanda.
Because of stigma around abortion in her community, she visited a private clinic outside Kigali where the doctor gave her some pills. When she returned to Kigali, she began haemorrhaging and sought assistance from her neighbours, who immediately informed the police after discovering that she had attempted to procure an abortion.
Louise was arrested and taken to hospital for treatment but was later charged in court for attempting to procure an abortion. She was found guilty and sentenced to six months in prison.
According to Louise, who is an orphan, she attempted to procure an abortion after she was abandoned by the man who had impregnated her. She lacked financial means to support herself and the child.
Due to the highly restrictive abortion laws and stigma, she sought clandestine abortion services outside her home district.
RETHINKING THE LOSSES
Louise’s story resonates with many in Africa. The World Health Organisation estimates that in 2008 alone, Africa lost about 29,000 young girls and women to unsafe abortion.
It is estimated that 60 per cent of all deaths from unsafe abortion in Africa occur among women and girls under the age of 25, and 14 per cent of all maternal deaths on the continent are related to unsafe abortion.
Many more women and girls suffer from disability, infertility and other long-term health consequences of unsafe abortion.
The highly criminalised nature of the procedure and related stigma in Africa has contributed to the high number of deaths and injuries from unsafe abortion.
Indeed, criminalising abortion is costly both to the individual and society at large. Governments spend billions to treat complications arising from unsafe abortion and to prosecute and punish women and girls who have allegedly procured illegal abortions.
The emotional and physical toll on families, friends and colleagues who have lost their loved ones cannot be quantified, while the psychological, social and professional cost on legitimate service providers, many of who are stigmatised, persecuted, and harassed for providing legal abortion services cannot be gainsaid.
PUBLIC HEALTH AND HUMAN RIGHTS
Commendably, unsafe abortion has been acknowledged as a major public health challenge on the continent. Various policy documents including the African Union’s policy framework and plan of action on sexual and reproductive health underscore the need to relax criminal abortion laws as part of the solution.
Moreover, the recent outbreak of Zika virus in a number of African states underlines the need to enable women to exercise their reproductive health rights by empowering them to enjoy freedom of choice over their bodies and providing them with necessary information, support and access to the full range of reproductive health services.
A number of countries including Malawi, Rwanda and Sierra Leone, have initiated legal reforms to their criminal abortion laws in an attempt to address unsafe abortion. However, in many African countries there is still a shocking level of official inertia in the face of this silent epidemic. States need to take action to bridge the gap between commitments and action.
Upholding a woman’s right to control her own body, including her right to safe and legal abortion, is key to addressing challenges arising from unsafe abortion. Recognition of a woman’s freedom of choice does not in any way conflict with upholding the right to life, but is essential in promoting the right to sexual and reproductive health of women as defined by various human rights bodies.
One year ago today, the African Commission on Human and Peoples Rights launched a continental campaign to decriminalise abortion in Africa, calling on African governments to repeal their criminal abortion laws, or at the very least, allow abortion to save the life or health of a woman in cases of rape, incest and sexual assault, or in cases of severe foetal abnormality.
This timely campaign provides a platform to leverage ongoing advocacy initiatives to decriminalise abortion in Africa.
Fortunately, there are many practical examples within the continent of what can be done to address unsafe abortion. Over the last two decades, countries including Ethiopia, South Africa and Tunisia have reformed their criminal abortion laws to expand the grounds under which women are permitted to seek abortion services.
In many of these countries, the reform of criminal abortion laws did not lead to a dramatic increase in the number of women seeking abortion services. On the contrary, it led to a drastic decline in incidents of deaths and disability due to unsafe abortion, as many women and girls got access to safe and legal abortion services without fear of arrest and prosecution.
Further, on December 9, 2016, His Excellency President Paul Kagame of Rwanda took the unprecedented step of granting presidential pardon to about 60 girls and women who had been convicted of abortion-related offences. This gesture is worth emulating by other States through a moratorium on enforcement of criminal abortion laws.
Abortion-related stigma remains a persistent challenge to progress. There is need for states to combat stigma in the society and health facilities in particular.
While country dynamics and social attitudes may dictate the pace of reforms, it is critical that the reforms are evidence-based, pragmatic, and consistent with realities on the ground.
For example, expanding the ground for abortion to include rape and sexual assault may not be adequate if it is proven that only a negligible number of women who seek unsafe abortion services are survivors of rape and sexual assault and that many women simply seek abortion services for economic or other social reasons.
In such a case, the society may need to critically consider the need for abortion on these other grounds as Zambia did in the 1970s. Additionally, controversial as it may seem, in cases of high teenage pregnancy that fuel unsafe abortion among girls, governments may consider expressly allowing minors to consent to abortion taking into account their evolving capacities, as Ethiopia did in 2004.
Further, progressive reforms must not be undermined by stringent policies and regulations that make it almost impossible for one to access safe abortion services.
While acknowledging the moral, religious and ethical concerns raised by those opposed to progressive abortion law reforms, it is important to critically reflect on the public health implications on women and girls’ sexual and reproductive health.
It is equally necessary to sustain constructive engagement with every section of society to find lasting solutions to preventable deaths and disabilities from the scourge of unsafe abortion.
Everyone, including religious leaders, has a role to play in demanding action from respective governments. Faith leaders from other African countries can learn from Malawi, where a section of church leaders have come out in support of progressive abortion law reforms to address the high rates of related maternal mortality and morbidity.
While these initial efforts are laudable, there is need to build consensus on the repeal of criminal abortion laws and treat abortion like any other medical procedure that is not criminalised. The moral, religious and ethical questions involved are best addressed outside criminal laws.
Liza M. Kimbo is the director of Ipas Africa Alliance.