Let's Talk About It: Abortions In Africa
This is one of the hardest blogs I have ever written. While my American and lawyer selves are at ease with discussions about this topic, as an African woman it would be foolhardy to not approach this topic in this forum with caution. First off, I definitely cannot claim to speak for all African women, or all Nigerian women for that matter. Secondly, this is not an issue with which I have personal experience. More importantly, there are many things that my Nigerian culture has taught me are better left unsaid. I will never forget an aunt pulling me aside after witnessing me get into a debate with someone, rubbing my stomach, and saying something that roughly translates from Hausa to this: “Your stomach isn’t just for storing food. It’s for storing secrets. Not everything must be said...”
So why have I decided to write about something so controversial? Because I can never erase from my memory, the rumors in secondary school about students using hangers on each other to rid themselves of unwanted pregnancies. Because I will forever be scarred by the story a friend told me of her experience with a back alley butcher— she now battles infertility. Because I’ve done enough academic research over the years to know that if you are reading this and live (or have lived) in a developing country, you or someone you know well has a similar story. Because western voices tell the stories of third world bodies too often. Because secrets are destroying millions of stomachs and wasting far too many precious lives.
I do not have all the answers—I just hope to shed a little light. My goal here is not to debate rights, but to provide information about health (what good are rights or choices to dead bodies?). Furthermore, because it is the context with which I am most familiar, Nigeria will be my primary focus here. File this, under things better left discussed. In case you haven’t surmised: this is a blog about abortion.
Abortion is an extremely emotive and sensitive issue around the world. With certain exemptions, it is illegal across the African continent (except in Cape Verde, South Africa and Tunisia). In Nigeria for example, abortion is illegal, except where two doctors have certified that the pregnancy poses a serious threat to the life of the woman. Breaking this law in Nigeria can lead to up to 14 years of imprisonment. While such laws are intended to discourage abortions, statistics from the United Nations and other sources show that women in countries like Nigeria seek unsafe abortions instead.
The World Health Organization (WHO) defines an unsafe abortion as a procedure for terminating an unwanted pregnancy that is performed by someone lacking the necessary skills, or in an environment lacking minimal medical standards, or both. 97% of abortions in Africa are performed under unsafe conditions. According to a recent report by WHO in partnership with the Guttmacher Institute, 1.25 million abortions occurred in Nigeria in 2012. Put differently, more than half (56% to be precise) of unintended pregnancies in Nigeria were resolved by abortion that year. Women in countries like Nigeria have abortions in dodgy clinics, with the assistance of “traditional doctors,” or using various self-induced abortion methods.
The long-term health consequences of unsafe abortions include incomplete abortions (failure to remove all of the pregnancy tissue from the uterus), damage to the genital tract or internal organs (caused by inserting dangerous objects such as sticks, knitting needles, or broken glass into the vagina or anus), infection, infertility, psychological trauma, and death. WHO reports that of the 6 million unsafe abortions that occur each year in Africa; 29,000 result in death and a further 1.7 million in hospitalizations. According to conservative estimates, more than 3,000 women die annually in Nigeria as a result of an unsafe abortion.
Who are the women at risk? Married women. Between 2010-2014, 73% of all abortions worldwide (or 41 million annually) were obtained by married women. Most married women who seek unsafe abortions do not have access to contraceptives or adequate information about how to use contraceptives. For example, a report published by the African Population and Health Research Center this year showed that 64 % of married Kenyan women had an abortion at least once in their lifetime—more than 70 % of those women said they did not use contraception. Young and uneducated women. In Nigeria, a study showed that 43.4% of women with no education got pregnant before age 20, compared to 6.9% of women with seven years of education. Poor and rural women. Across the developing world, girls are still forced to sell their bodies to pay for basic necessities like schoolbooks and food. Abused women. While statistics on rape and other forms of sexual assault are hard to come by in Nigeria, out of a sample of 295 female students from a southeastern university, 32.4% had been raped at least once on campus. Mothers, daughters, sisters, friends…
The most effective thing any country can do to reduce the number of abortions—both safe and unsafe—is to help prevent unintended pregnancies in the first place. Few African women are receiving the education and the tools they need to prevent unintended pregnancies: about 60% of women in Africa who want to avoid a pregnancy are not using family planning, or rely on a less effective traditional method. Our education and health care systems are failing us. Our culture of silence is failing us too.
I have heard some argue that education about contraception is “un-African” because it promotes promiscuity. Personally, this brings to mind a sermon my father (a pastor) preached in his church in Abuja in the mid-1990s. After laying out the biblical foundation for abstaining from premarital sex, he said something along the lines of: “I am not encouraging you to have sex outside of marriage! But I know that no matter what I say, some of you will. So if you must, please I beg you—use a condom.”
If you are a sexually curious or active woman reading this and you are not planning to get pregnant, I urge you to please research the full range of pregnancy prevention alternatives available to you, and to consult with a doctor and trusted counselor on the best option for you. An ounce of prevention is a worth a pound of cure. In a country like Nigeria, prevention could spell the difference between life and death. Also, if you are aware of any helpful resources that Nigerian (and other African) women can access legally (e.g. licensed counselors, NGOs, sex education facilitators, contraception providers, family planning centers, adoption agencies, pregnancy shelters, healthcare services), please comment below.
As long as cultural taboos, insufficient access to proper health care, and a lack of information remain, African women will continue to be faced with unwanted pregnancies, and will continue to choose unsafe abortions when they are. The underlying factors contributing to unintended pregnancies need to be addressed.The laws and policies governing abortions across Africa are also important components of this conversation. To save African women’s lives, we need to bring dialogue about abortions out of the shadows. We need to talk about it more.