Women Urgently Need Safe Abortion Services in Africa

The field team has been crisscrossing the country this fall, making stops at campuses and communities to talk with hundreds of individuals who are committed to expanding access to reproductive health care for women around the globe.

In mid-September, we traveled to Columbus, Ohio, to host a screening of the documentary film Vessel, which chronicles the journey of Rebecca Gomperts, a Dutch abortion doctor and activist, and her mission to provide abortion services to women who live in countries where the procedure is illegal or heavily restricted.

Dr. Gomperts is the founder of the organizations Women on Waves, which provides medication abortion to women on a ship in international waters, and Women on Web, a website that provides instructions for using medication abortion and a mail order service for prescribing and ordering the pills.

Over 60 people—ranging from college students to middle-aged activists—joined us at the Gateway Film Center, a non-profit theater near Ohio State’s campus, for a rich discussion about the state of reproductive rights here in the United States and abroad. We organized the event with Columbus arts and reproductive rights activists.

According to Amanda Patton, one of the event organizers, “The Vessel screening was wonderful—the group of attendees were very enthusiastic and the reception afterwards was a great opportunity to network with women from all walks of life.”

Not Yet Rain Panel

In October, we joined Karen Hampanda, a PhD candidate at the University of Colorado Denver, and Jordan Rief, an independent researcher at Emory University, on a panel organized by the Center on Rights Development at the University of Denver. We screened the documentary film Not Yet Rain, and each panelist shared her response to the film.

Not Yet Rain, directed by Lisa Russell (the author of the article that begins on page 30 of this issue), shares the stories of women struggling to access abortion care in Ethiopia, before and after the country liberalized its abortion law in 2004.

During the presentations, and the thoughtful discussion that followed, panelists and audience members discussed how the denial of safe abortion care for rape survivors victimizes them a second time; how the political struggle around abortion in the United States affects low-income American women and women who live in countries that receive U.S. aid; and how outrageous it is that unsafe abortion in the developing world kills 47,000 women each year.

As a follow-up to our work together on the panel, I asked Karen to write a short piece sharing her reflections from her public health work in Zambia.

Karen Hampanda on Abortion in Sub-Saharan Africa

Due to restrictive abortion laws and a lack of trained providers, more than 97 percent of abortions received by African women are unsafe. Up to 5 million unsafe abortions are performed in the region every year, and 1.7 million women are hospitalized annually for complications arising from those procedures.

Ironically, the abortion laws governing African countries are remnants from the colonial era, imposed by European countries that long ago abandoned such restrictive laws for themselves. In 14 African countries (Angola, Central African Republic, Congo-Brazzaville, Democratic Republic of the Congo, Egypt, Gabon, Guinea-Bissau, Lesotho, Madagascar, Mauritania, Mauritius, São Tomé and Principe, Senegal, and Somalia), abortion is not permitted for any reason, including to save the woman’s life or in cases of rape or incest. Of course, when abortion is illegal, women simply resort to unsafe methods to terminate pregnancies, such as inserting chemicals/herbs into the vagina, attempting to puncture the fetus with objects through the cervix, and ingesting toxic chemicals.

My public health work in Zambia over the past six years has provided me with a unique perspective on this issue. Zambia actually has one of the most liberal abortion laws in sub-Saharan Africa—abortion is permitted to save the woman’s life, to preserve physical health, to preserve mental health, and on socioeconomic grounds.

Unfortunately, however, this does not always translate into real access. In Zambia, a woman must first get the approval of three physicians before she can go to one of the few facilities that perform abortions. (Keep in mind that there are fewer than two physicians per 10,000 people in Zambia.)

As a result of this and other barriers, women who find themselves with an unwanted pregnancy often resort to self-induced abortions. One common method in Zambia is to swallow large amounts of an anti-malarial medication called chloroquine. Chloroquine may end a pregnancy; however, overdose of this medication may also cause convulsions, coma, cardiac arrest, and even death.

In addition, such restrictive abortion policies result in health disparities by socioeconomic status within countries. In countries with restrictive laws, wealthier women can often pay to find a qualified provider willing to perform an abortion; however, the vast majority of women in Africa are too poor to benefit from such underground networks. For example, in Uganda, where 97 percent of the population lives on less than $2 a day, the price of an abortion from a professional health care provider ranges from $6–$58.

Only three countries (Cape Verde, South Africa, and Tunisia) have laws that allow induced abortion for any reason—laws that have had a hugely positive public health impact.

In 1997, South Africa made abortion legal for any reason and available on request. In the years after this policy shift, abortion-related deaths dropped by over 90 percent.

A newer example is that of Ethiopia. After the law was liberalized in 2004, abortion complications per 100,000 live births at one large hospital decreased by about 70 percent.

The deaths and injuries that result from unsafe abortions are entirely preventable through two key measures: increasing access to modern family planning and improving access to safe abortions. Currently, there is no method of birth control that is 100 percent effective (excluding abstinence), and few people use birth control perfectly. Furthermore, 1 in 5 women globally suffer rape or attempted rape in their lifetime.

I frequently see reports discussing access to safe abortion within the limits of existing law; although this is a critical immediate goal, a longer-term, more impactful goal would be to instigate policy changes surrounding restrictive abortion laws.

Karen Hampanda is a Doctoral Candidate and National Institute of Mental Health (NIMH) Pre-doctoral Fellow in the Department of Health and Behavioral Sciences at the University of Colorado Denver. She is also an adjunct professor at the University of Colorado Denver and the University of Denver, teaching courses in Gender and Health and Human Sexuality and Public Health.

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