This is the second in a series of articles from Keeping Our Promise: Addressing Unsafe Abortion in Africa this week. The conference has brought together more than 250 health providers, advocates, policy makers and youth participants for a discussion of how to reduce the impact of unsafe abortion in Africa.
She walks mumbling inaudible words to herself on the streets of Lagos, Nigeria. Passersby take her for a mental case. But they are wrong. Ejieke (not real name) has just lost her daughter to complications from an unsafe abortion. But she is not willing to talk about the tragedy publicly. Reason? Abortion is a criminal offence in the country whose current laws are a replica of the old British colonial rules.
A friend reveals that Ejieke visited a traditional healer who devised an unsafe method to extract the foetus from her daughter’s womb. In the end, the abortion went bad and the girl bled to death.
Patrick Ezie, a medical student at the Imo state University in Nigeria says abortion has claimed many women’s lives in Nigeria, especially in the Islam-dominated northern part of the country. On average, he says the maternal mortality rate is over 800 deaths per 100,000 births although the figures go up to over 1,000 deaths in the north where the practice of the Sharia law is very strict.
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“Unlike other countries where abortion can be allowed when a woman’s life is in danger, we do not have any law providing for abortion in Nigeria. What we have is a Criminal Act where anyone found procuring abortion, selling abortion-inducing drugs, or discussing how abortion can be procured is arrested,” Ezie says.
Ezie is one of about 25 African youth participants attending a regional conference on unsafe abortion in Accra, Ghana. The particular impact of unsafe abortion on youth is a theme running throughout the conference, called Keeping Our Promise: Addressing Unsafe Abortion in Africa. Young people in Africa are disproportionately affected by unsafe abortion. In Nigeria, it is estimated that 80% of women who seek treatment for complications of unsafe abortion are under the age of 25.
In a region with restrictive abortion laws and low contraceptive prevalence broadly, young women face significant barriers to preventing unwanted pregnancy and to safe abortion care. Young people lack access to comprehensive sexual health information and may be unable negotiate safer sex; they may also be denied access to reproductive health services themselves – Innocent Kommwa, 31, of the Pakachere Institute of Health and Development Communication reports that in many locations, married women receive preferential treatment at health centers.
Ezie has started a campaign to sensitise the masses about safe abortion, starting with university students. He has so far visited the 30 medical schools in Nigeria, together with Ipas, an international NGO advocate for women’s health rights. He has also held four demonstrations in Ghana to project the plight of unsafe abortion in Nigeria.
Most African countries share similar experiences with regards to abortion care. Eunice Brookman-Amissah, Ipas Vice President for Africa reveals that access to contraceptives is one of the issues that can stop unsafe abortion. But, she adds, the average contraceptive intake in Africa is still low at 15% compared to countries like Thailand where it is at over 70%. She adds that more than half of the 65,500 global deaths from unsafe abortion occur in Africa. “More than half of those who die from unsafe abortion in Africa are younger than 25 years.”
Queen Masaka Mbao, a programme officer for Planned Parenthood Association of Zambia says abortion is regarded as a taboo in her country and that once a woman has aborted, they are regarded as social outcasts. “A victim of abortion is isolated and they are not allowed to prepare food for the family because it is culturally believed that such a person is unclean and once they put salt in food and people eat, they can develop prolonged cough.”
Mbao’s colleague, Vivien Bwembya, a programme assistant for young women in action in Zambia says there is too much stigma against women who have had abortions and ignorance about the practice, yet there is a Pregnancy Termination of Act of 1972 which provides for abortion in a number of circumstances. “Many people including doctors and politicians are ignorant about this law,” she says. There is a significant impediment, however: a woman seeking an abortion has to be approved by at least three medical doctors. This, Bwembya notes, has resulted in unsafe abortions and deaths of young women. “Some professional practitioners now carry out abortion stealthily for fear of being arrested because securing the three signatures is not an easy task.”
Even obtaining the needed signatures brings its own challenges, she says. “Some doctors want to be tipped to sign for victims.”
Gustav Quayson, a communications and advocacy officer with Ghana’s Health Foundation, says much as Ghana’s abortion law is liberal and adequatelyflexible to respond to the needs of women, too many people are ignorant about the law and many still use crude methods to abort. Quayson is of the view that addressing sex education among youths would help to sensitise the young people about safe abortion.