Challenging ignorance: why reproductive rights matter so much in Africa

It has been a worrying month for women’s reproductive rights across the globe. In this editorial I want to take some time to think through how the resurgence of right wing politics in America may play out to the detriment of women in Africa.

The new sustainability goals promise global and focused commitment to improve the lives of women and girls in the world’s poorest countries, many of which are in Africa. Rights based discourses have influenced and shaped the language of aid and development in such a way that women’s movements and organisations in Africa have been able to make significant and positive changes. For example, legislation criminalising domestic violence, harmful practices, and child abuse; interventions offering greater access to justice through advocacy and support services; and a better quality of life and opportunities sustained through improved health systems, access to education for girls and micro finance schemes. Whilst I aired a cautionary note in my last editorial that such transformative programmes must be driven by local communities, I believed we were on a positive and exciting path that could in fact bring lasting positive change in the lives of many African women.

What difference a few months can make. On 24 January 2017, President Trump signed a presidential memorandum reinstating the ‘Mexico Policy’ (also known as the ‘global gag’) first instigated by Ronald Reagan in 1984 which prevents US Aid from being used to promote and offer abortion services overseas. Whilst the withdrawal of and reinstatement of the Mexico Policy is common in the first few weeks of a new presidency, the reality of Trump’s decision will bring misery and pain to the lives of many women in Africa.

Making safe abortions available to vulnerable women in Africa is a global health issue. Withdrawing this access renders many of the world’s most marginalised at high risk of a range of life threatening health complications. The link between poverty and high levels of maternal and child mortality is a reality this ban fails to understand and acknowledge. Pro-life campaigners may see this as a victory for their particular ideology of rights, but for many who have worked in the global health sector for decades this ban represents a gruesome inhuman withdrawal of basic rights.

Abortion services are never offered on their own and are entwined with a number of reproductive health issues and treatments. Shutting down facilities that offer abortions means removing, for many poor families, their only means of accessing primary medicine. In rural Africa for example, medical facilities that offer family planning (including abortion) also provide ongoing care and screening to women and their families. For example cervical screening, HIV prevention, testing and counselling, STI prevention and treatment, pre and post-natal care and even new-born care. These services often also act as training facilities ensuring a local supply of midwives and community health workers. Health workers are crucial and already in undersupply. In developed countries health professionals represent 33 per 10,000 people, in most developing countries this drops to 2 for the same number of people (Bendavid, Avila, & Miller, 2011).

Women seek abortions for many reasons. Let us take instances of conflict in which women become the target for unspeakable brutal violence. Conflict rape leaves many women pregnant with babies they cannot afford and cannot emotionally and medically cope with giving birth to. For example the 1994 genocide in Rwanda resulted in 5000 children born as a result of rape. In more recent conflicts, reports have estimated that around 1.8 million women and girls have been raped during the protracted series of wars in the Democratic Republic of the Congo (Howard, 2014).

Howard (2014) reports that few women who fall pregnant as a result of rape in conflict receive safe abortions. The study conducted between 2003 and 2006 in the Democratic Republic of the Congo found that the proportion of women raped in the conflict who sought medical care within 72 h of the attack ranged from 0.6 to 3.2%, rendering emergency contraceptive care, for most, impossible. In the absence of access to safe abortion, many women resort to unsafe methods. Although figures on unsafe abortions that result from rape in conflict are unreliable, because of under-reporting and women’s lack of access to the police and medical services, we can say 25–30% of all maternal deaths among refugees from conflicts were related to unsafe abortion, in reality the figure is likely to be much higher.

In short, it is widely agreed across international organisations that the denial of abortion to rape victims can be and should be defined as torture. Such denial, some reports go on to state, is cruel, inhuman and degrading (e.g. see the Report published by the Centre for Reproductive Rights, 2010).

Banning abortions will not stop women from seeking them and finding a way that likely means putting themselves at even greater risk. A study in 2011 showed that under Reagan’s ban women in African countries such as Nigeria and Kenya were 2.73 times more likely to seek abortions (Bendavid et al., 2011). The figures recorded shot up because the removal of abortion facilities also removes access to family planning. The Guttmacher Institute conducting research in 2016 showing that if $US607.5 million is cut from family planning and reproductive health services, this then prevents 27 million women and couples from receiving family planning services. In turn this leads to 6 million more unplanned pregnancies and 2.3 million more abortions, two million of which will be unsafe (Hasstedt, 2017).

A further earlier study explored the relationship between the Mexico City Policy and abortion rates in sub-Saharan Africa. The study found robust empirical patterns suggesting that the Mexico City Policy is associated with increases in abortion rates in sub-Saharan African countries. Although the report researchers were unable to draw definitive conclusions about the underlying cause of this increase, the complex interrelationships between family planning services and abortion looked to be the likely explanation. In particular, if women consider abortion as a way to prevent unwanted births, then policies curtailing the activities of organisations that provide modern contraceptives may inadvertently lead to an increase in the abortion rate ().

To return to where I started, in 2000, 189 countries including the United States committed to the Millennium Development Goals. These included a commitment to improving maternal health by reducing maternal mortality and providing access to reproductive health services by 2015. This was one of the least successful Millennium Development Goals, falling short by half. This means the global gag rule seriously threatens the UN Sustainable Development Goal of reducing maternal mortality to less than 70 per 100,000 live births by 2030. It also threatens the goal of ensuring access to sexual and reproductive health-care services, including family planning, information and maternal and child nutrition advice (Bendavid et al., 2011).

Hasstedt’s briefing paper (2017) ends with the following warning; ‘With growing international emphasis on reducing maternal mortality, in keeping with Millennium Development Goal 5, our findings suggest that this United States policy may have unrecognized – and unintended – health consequences.’ (Hasstedt, p. 8).

The evidence is clear; this ban strikes at the heart of women’s rights in Africa and across the globe – at the core is a woman’s right to control her own destiny and in particular how her body is used. We need to make sure that Trump’s ignorance is quickly replaced by an even firmer and stronger global commitment to improving reproductive health in Africa.

Notes on contributor

Tamsin Bradley is a reader in International Development Studies, School of Languages and Areas Studies, University of Portsmouth. She has researched and published on violence against women and girls in Asia and Africa for 15 years.

Tamsin Bradley
Faculty of Humanities and Social Sciences, University of Portsmouth, Portsmouth, UK
[email protected]