Abortion remains a taboo subject in most African countries. Across the continent, a total of five countries have legalized the practice, eleven have banned it outright, and the rest restrictively allow it. In Benin, the issue has been causing a stir since December 2021 with the vote on Law 2021-12 amending and supplementing Law 2003-04 of 03/03/2003 on Sexual and Reproductive Health (SSR) with regard to the Pregnancy Termination Volunteer (IVG). The new law enriches Benin’s legal environment and expands the conditions for women’s access to abortion services. It is now expected that the decree implementing the law will give health professionals full rights to work to limit the damage caused by clandestine abortion to the health, well-being and development of women in the community.
According to the results of a new World Health Organization (WHO) study published on October 25, 2019, 74 million women in low- and middle-income countries around the world experience unplanned pregnancy every year. This results in 25 million unsafe abortions and 47,000 maternal deaths each year.
In Benin, deaths related to induced and unsafe abortions account for 15-20% of maternal deaths according to the “Strategic Assessment on Unintended Pregnancy, Abortion and Contraception in Benin” conducted by the Ministry of Health in 2019. Due to legal and social restrictions, abortion is stigmatized, young girls and women who become pregnant unintentionally resort to unsafe practices, putting their health and lives at risk. The amendment to the old law includes new conditions that women must meet in order to use abortion services.
Abortion access conditions in Benin: Some relief
Before December 2021, safe abortion in Benin was regulated by the March 2003 Law on SSR in Article 17 for three specific reasons, namely:
if the pregnancy is the result of rape or an incestuous relationship;
if the continuation of the pregnancy endangers the life and health of the pregnant woman;
at the request of the woman if the fetus has a serious malformation.
Since December 2021, the situation has changed with the vote on the new law. Today, abortion with a doctor’s prescription is allowed if:
the continuation of the pregnancy endangers the life and health of the pregnant woman;
the pregnancy is the result of rape or an incestuous relationship and that the request is made by the pregnant woman if she is of legal age, or by her legal guardian if she is a minor;
the unborn child is in a particularly serious condition at the time of diagnosis;
at the request of the pregnant woman, if the pregnancy is likely to worsen or cause a situation of material, educational, professional or moral need incompatible with the interests of the woman and/or the unborn child;
the planned voluntary abortion cannot take place after 12 weeks of amenorrhea.
SRH legislation now gives Benin the right to a safe abortion for all women who meet one or other of these conditions.
Disparate situation of abortion in Africa: between prohibition and surveillance
Abortion is outright banned in a minority of countries around the world, but is still widely practiced in unsafe conditions. While Ireland votes in a referendum on abortion, decriminalization of abortion is slow in many countries, particularly in Africa. Access to abortion remains very restrictive or even illegal in several countries on the African continent. According to an April 1, 2010 Population Reference Bureau data sheet, nearly one in ten pregnancies worldwide ends in an unsafe abortion, and each year there are 75 million unsafe pregnancies (about a third of all pregnancies) among women in less developed countries.
Only Tunisia, South Africa, Cape Verde, Mozambique and Benin have legalized it. Everywhere else the situation remains deadlocked, despite the not very good WHO figures on maternal death rates linked to clandestine abortions in Africa.
With the new law, Benin joins Tunisia, South Africa, Cape Verde, Mozambique and Zambia to form the family of African countries that have reformed their laws to exceed the African Union’s legal criteria for safe abortion.
The African Union encourages states to authorize abortions when there is a threat to the life or physical or mental health of the woman, and in cases of rape, incest and serious fetal deformities. This decision dates from July 11, 2003 and is implemented through a convention: the Maputo Protocol, adopted and signed by 42 countries of the continent. Among these countries, 28, including Guinea, Burkina Faso and Togo, authorize abortion under certain conditions and not all listed in the protocol. It should be noted that seven countries including Madagascar, Djibouti, Egypt, Guinea-Bissau, the Democratic Republic of the Congo, Senegal and Sierra Leone have laws that conflict with the Maputo Protocol.
Clandestine abortions, source of several early deaths
Between 2015 and 2019, the WHO reports that an annual average of 73.3 million abortions (safe or not) were registered worldwide. 39 induced abortions per 1000 women aged 15-49. 3 out of 10 pregnancies and 6 out of 10 unwanted pregnancies end in an abortion.
It is estimated that between 2010 and 2014 about 45% of all abortions were unsafe. Almost all of these unsafe abortions took place in developing countries.
The risk of infection from clandestine abortion in Africa remains among the highest in the world. The WHO figures published in September 2020 on this topic are eloquent. Each year, 4.7-13.2% of maternal deaths can be attributed to unsafe abortions. About 7 million women are hospitalized each year after unsafe abortions in developing countries.
And the consequences of the practice are many: incomplete abortions, infections, uterine bleeding, sterility, rupture of the walls of the uterus, death. The harm caused by clandestine abortion affects the affected young girl or woman and has tremendous repercussions on her family, her work and her country.
Simple and practical solutions to experiment with
All women have the right to safe abortion, if necessary, under the conditions laid down by law. There is an urgent need to promote the adoption of implementing regulations to monitor the application of the provisions of the law.
It is still important to make it known that abortion cannot be considered a contraceptive method. The population must be sensitized to observe responsible sexuality and to systematically and correctly use a method of family planning to protect against unwanted pregnancy.
It is important to organize more community behavior change communication sessions so that people understand that having a safe abortion is good, but having a responsible sexuality and exploring it in a safe, healthy and enjoyable way is better.
Communities and various social groups in society need to avoid the stigma attached to abortion because it unknowingly encourages women in need to resort to it secretly at the cost of their lives.
Access to SRH information and services is a right for adolescents and young people. And we must enable them to enjoy it to the fullest by establishing socio-educational centers throughout the country, adapted to offer them a safe environment for healthy leisure and responsible parenting education.