To Save Women’s Lives in Africa, Bring Abortion Out of the Shadows

Approximately 26,000 African women die as a result of unsafe abortion every year. Another 1.7 million are hospitalised, and many others also suffer serious health complications, but never seek treatment.  We can save these women.

Last week, in collaboration with Ipas, we published several in a series of articles on unsafe abortion coming out of Keeping Our Promise: Addressing Unsafe Abortion in Africa, a conference held in Accra, Ghana.  The conference brought together more than 250 health providers, advocates, policy makers and youth participants for a discussion on how to reduce the impact of unsafe abortion in Africa. Dr. Camp’s article was published separately in the, and we republish it here with permission from the Guttmacher Institute.

More than 250 health professionals, advocates and parliamentarians from countries throughout Africa and other regions gathered in Accra, Ghana, last week to address the issue of unsafe abortion, one of the continent’s biggest threats to women’s health.

While abortion is very safe in countries where it is legal and provided by trained medical professionals, clandestine abortion – the norm in most of Africa – can lead to death and serious injury. Approximately 26,000 African women die as a result of unsafe abortion every year. Another 1.7 million are hospitalised, and many others also suffer serious health complications, but never seek treatment.

Over 90 percent of African women of childbearing age live in countries with limited or no access to safe abortion procedures. According to the most recent data available, of the 5.6 million abortions carried out in the region every year, only 100,000 are performed under safe conditions.

Here’s another way to think about that statistic: every year, about 5.5 million women in Africa risk their lives when they decide to terminate a pregnancy. Drinking bleach or inserting sharp objects into their cervix are only two of the horrifying methods they use. These are not risks any woman should be forced to take.

The terrible toll of unsafe abortion goes well beyond the individual woman. Losing their mother and care-giver devastates the lives of children and families, and losing a healthy woman’s many contributions to society weakens her community. Unsafe abortion is also a serious drain on very limited public health resources. African governments spend, on average, $114 per case to provide care for illness and disability associated with unsafe abortion, yet per-capita spending on healthcare averages just $48.

While some African nations have loosened abortion restrictions, 14 countries still prohibit it under all circumstances – even to save the pregnant woman’s life. This flies in the face of considerable evidence that legalising abortion saves lives and reduces persistently high maternal mortality rates. One good example is South Africa, where – just six years after the country liberalized its abortion laws – the number of women dying from unsafe abortion dropped by 50 percent, and the number of women suffering serious complications fell dramatically as well.

Restrictive abortion laws are also not very effective at achieving their purported goal – stopping women from obtaining abortions. Evidence from around the world shows that abortion happens at about the same rate in regions where it is highly restricted and where it is broadly legal. The key difference is safety.

If a country’s leaders want to reduce abortion, punitive laws clearly are not the way to go. Rather, they should focus on reducing the number of unplanned pregnancies. The single biggest thing a country can do to reduce the number of abortions, both safe and unsafe, and to improve women’s overall health is to make sure all women have access to and information about effective contraceptive methods.

But in Sub-Saharan Africa today, about 60 percent of women who want to avoid a pregnancy are not using family planning or are relying on a less effective traditional method.

Research by the Guttmacher Institute shows that expanding the availability of family planning in Sub-Saharan Africa, so that all women who want to delay pregnancy have access to effective contraception, would reduce the number of unsafe abortions from 5.2 million to 1.2 million per year. The number of women needing care for complications of these unsafe procedures would fall from 2.2 million to 500,000. Achieving these reductions will require significant financial investment from African governments and donor countries alike, but one with far-reaching benefits: fewer unplanned pregnancies, fewer unsafe abortions and fewer maternal and newborn deaths.

The evidence is clear and compelling, but if it falls on deaf ears women will continue to die and suffer from unsafe abortions. But as last week’s conference in Accra shows us, people are listening. There are dedicated individuals from all over the continent working together to take the evidence and translate it into action that will save the lives of African women. Government leaders must also start paying attention to the evidence that will help guide them toward laws, policies and programmes that will better protect women and build stronger families, communities and, ultimately, nations.