An estimated five million illegal unsafe abortions are performed in Africa each year—with 25 percent performed on adolescent girls. As many as 36,000 of these women die from the procedure, while millions more suffer illness or disability. Nearly a quarter of all maternal deaths in Africa are the result of illegal unsafe abortions.These alarming statistics have catalyzed various forms of activism around the issue of abortion rights on the continent. However, the problem of unsafe abortion can only be adequately addressed by a holistic approach to sexual and reproductive health that goes beyond discretely addressing women’s rights to a safe abortion and contraception to include women’s rights to economic resources.
African states have a number of laws inherited from the colonial era—laws that almost invariably enhanced male authority at the expense of women’s. Colonial laws governing property rights, marriage, child custody as well as reproductive health often reflected colonial regimes’ preferences for patriarchal structures and rigidly defined gender roles. Under colonialism, abortion was a serious crime; generally, saving the life of a pregnant woman was the only permitted exception. Many (though not all) of the laws governing abortion in Africa today were originally imposed by European powers that have long since done away with restrictive abortion laws in their own countries.
However, highly restrictive abortion laws alone do not necessarily constitute the biggest barrier for women seeking to safely end an unwanted pregnancy. While the majority of African women of reproductive age continue to live under severely restrictive laws, South Africa and Ethiopia are two nations that have significantly liberalized abortion laws. South Africa’s post-apartheid legislature passed the first law in sub-Saharan Africa legalizing abortion without restriction in the first trimester. Evidence suggest that legalizing abortion had a limited impact on the rate of unsafe, illegal abortions in South Africa. The long waits, high costs and shaming of abortion patients in the public health sector cause women to continue to seek out illegal, unsafe alternatives. In Ethiopia, seven years after abortion law was liberalized, only a quarter of all abortions occur in safe and legal settings for many of the same reasons. Clearly, liberalizing abortion law is not the most meaningfully way to promote women’s reproductive freedom.
Yet many international women’s organizations continue to pour an enormous amount of energy and resources into defending abortion rights and promoting contraception. Unfortunately, many forge alliances with population control advocates who prioritize limiting births over women’s general health while callously dismissing resistance to “family planning” as evidence of Africa’s cultural backwardness.
Recently, The Gates Foundation partnered with the pharmaceutical company Pfizer, the maker of the injectable birth control Depo-Provera, in a mission to rescue African women from the burdens of childbearing. Melinda Gates describes this project as a crusade in the name of women’s reproductive health in Africa despite a decade of research suggesting that Depo-Provera may increase the likelihood of HIV/AIDS infections and breast cancer. Women using the shot have also shown to have a suppressed immunity and a decreased ability to absorb nutrients from food which caused health professionals in India to oppose injectable contraceptives. Yet it doesn’t take a health expert to understand how the potential for such adverse effects is particularly problematic for low-income women who are already at risk of being nutrient deficient and in poor health. Furthermore, when providers are incentivized to promote the use of Depo-Provera, women looking for birth control in African clinics are rarely provided with a range of choices or given all of the information on potential side effects. If contraceptives are to be instruments that allow women to make choices about their own fertility, then women have a right to access knowledge about the risks/benefits of any given method as well as information about alternatives. Family planning methods driven by political concerns about population control or providing pharmaceutical companies with lucrative business are not steps towards greater reproductive freedom for women and ultimately play into the hands of critics in countries like Uganda who hurl blanket accusations of “neocolonialism” at all women’s rights groups.
There are a number of historical reasons for people to be skeptical of external efforts to limit women’s fertility. In South Africa, the apartheid regime once used forced birth control methods on women as a political instrument to control the growth of the country’s African population. Women on white-run commercial farms in Zimbabwe (then Rhodesia) were often coerced into accepting Depo-Provera as a condition of employment. The forced and coerced sterilization of HIV positive women in various parts of Africa is a contemporary reality.
However, contraception and abortion are not new in Africa. Married women and mothers in many African societies historically practiced contraception. Prolonged breastfeeding and post-partum abstinence enabled women to appropriately space births and limit the amount of children they had. Also common throughout much of Africa was women’s use of anti-fertility and abortifacient herbs to regulate their own reproductive capacities. In short, it was not uncommon in much of Africa for women to exercise considerable physical autonomy; the fact that practices that limit this power have come to be known as “cultural” and “traditional” is misleading. However, when women’s reproductive capacities are institutionalized as the private property of their fathers and husbands, women are less empowered to make decisions about a wide range of issues—including sexual and reproductive health.
Today, women in Africa represent more than half of the total population, contribute approximately 75 percent of the agricultural work, and produce 60-80 percent of the food. Yet they earn only 10 percent of African incomes and own just one percent of the continent’s assets. The notion that poor, sub-Saharan African women are victims of their own fertility—as opposed to victims of an inequitable economic order—contributes to a troubling conflation of externally imposed fertility limits with “voluntary family planning.” It makes pregnancy the enemy of women’s reproductive freedom, not poverty exacerbated by gender discrimination. When women lack financial security they are forced to choose a sexual partner or marriage out of economic necessity, effectively surrendering control of their reproductive capacities. This makes women vulnerable to early marriage, sexual violence and exploitation—all of which increase the likelihood of unwanted pregnancy. Hence, the only successful path toward greater sexual and reproductive rights for women in Africa is one that is committed to a broader agenda of women’s economic empowerment.
Rachael Hill is a PhD candidate at Stanford University interested in the history of health and medicine in Africa. Her current research focuses on the history of scientific research on Ethiopian medicinal plants and efforts to integrate traditional healing with biomedicine in 20th century Ethiopia.
(An earlier version of this post appeared in the 40th anniversary of Roe v. Wade edition of the Hairpin.)