In Africa, abortion is subject to various national abortion laws. Most women in Africa live in countries with restrictive laws. Most countries in Africa are parties to the African Union's Maputo Protocol, the only international treaty that defines a right to abortion. Sub-Saharan Africa is the world region with the highest rates of unsafe abortions and abortion mortality. Most abortions in the region are unsafe. The region has the highest rate of unintended pregnancy, the primary motive for abortion. The most likely women to have abortions are young, unmarried, or urban. Post-abortion care is widely available.
Abortion-rights movements emphasize public health arguments about the maternal mortality rate. Anti-abortion movements argue that the practice of abortion was imposed upon Africa by foreign powers.
Many women keep abortions secret due to stigma. Medical abortion using misoprostol is available from health providers and pharmacies, and is usually safe. Surgical abortion is regulated by national guidelines in countries with legal abortion. Self-induced abortion is often unsafe. Traditional methods are common.
Abortion has existed in Africa since ancient times. Many bans on abortions were implemented during the colonial era. Since then, reproductive health laws, constitutional amendments, and judicial decisions have been passed to permit abortion under varying grounds. International treaties have influenced reform. United States policy has influenced the abortion debate.
Legal status
Constitutions, judicial decisions, health codes, and laws may mention abortion. Many countries' reproductive health laws specify legal grounds for abortion, often following the terms of international laws. Guidelines and codes of medical ethics may describe implementation of the law or may be contradicted by the law. Most African countries where abortion is legal do not implement them in a way that makes abortion broadly available.
Abortion is unconditionally legal in Benin, Guinea-Bissau, Cape Verde, São Tomé and Príncipe, South Africa, and Tunisia. Zambia allows abortion for any health or socioeconomic reason. As of 2019, 45% of women of reproductive age in Sub-Saharan Africa live in countries with highly restrictive laws, 47% are under moderately restrictive laws, and 8% in countries where abortion is broadly legal. Some countries with restrictive laws apply them inclusively. Ethiopia uses a broad interpretation of its law. Ghana states that no evidence is needed to prove grounds for legal abortion.
In countries where abortion is conditionally legal, abortion is not accessible in practice due to complicated legal processes. Many women think abortion is illegal, regardless of whether it is. Those who think abortion is illegal are more likely to undergo unsafe treatments, fearing legal issues of seeking professional care. In Ghana, Zambia, and Kenya, most women do not know the laws legalising abortion. Medical providers may be uncomfortable providing abortions out of fear of anti-abortion backlash. In some countries, unclear laws deter them from providing abortion.
International law The African Union's Maputo Protocol secures the right to abortion in the cases of rape, incest, or threat to the life or health of the pregnant woman. As of 2022, 42 out of 55 countries in Africa have signed it. Most countries in Africa have ratified the United Nations Convention on the Rights of the Child and African Charter on the Rights and Welfare of the Child, which provide a right to sexual and reproductive healthcare for minors. The Southern African Development Community has written policy frameworks to decriminalise abortion. Article 5 of its SADC Sexual and Reproductive Health Rights Strategy (2019–2030) aims to reduce unsafe abortion and teenage pregnancy rates.
History
Pre-colonial era From Ancient Egypt until the 15th century, women would consult a pharmacopoeia about herbs that worked as contraceptives or abortifacients. Abortion was practiced by over 400 cultures in pre-colonial Africa. The Malagasy people used it to limit the sizes of families. The Maasai people used it when women were impregnated by men who could not provide for the child. The Maasai and the Owambo people used it in cases of teenage pregnancy. The Efik people used it if they predicted birth defects. In South Africa, Cape Malays used red geraniums, Khoekhoe people used thorn bushes, and Zulu people used a shrub called .
Colonial era Laws banning abortion are inherited from colonial powers. All of the countries that colonised Africa have since decriminalised abortion. Colonial abortion laws were based on laws developed by European governments in the 18th century—civil law of France, Belgium, and Portugal, common law of England, and, in the case of South Africa's law, the Roman-Dutch law system. Laws were influenced by Christian and Islamic law. Islamic societies often practiced abortion. Islamic schools had differing opinions of it.
Post-independence era In 1985, Ghana legalised abortion under certain grounds. It reviewed the law in 2003 to develop a plan for implementation. In the 1990s, nearly three-quarters of emergency gynecological admissions in Africa were due to unsafe abortion. The rate of abortions resulting in hospitalisation was over two-thirds in Egypt and nearly one-quarter in Nigeria. Parties to the 1994 International Conference on Population and Development pledged to increase access to family planning services, safe and legal abortion, and post-abortion care, which influenced reforms in Africa. Before the conference, African governments had avoided the stigmatised topic of unsafe abortion.
In the late 1990s and early 2000s, post-abortion care (PAC) services were introduced in Egypt, Ethiopia, Ghana, Kenya, Malawi, Nigeria, Senegal, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Ipas led the Woman-Centred Abortion Care program, which addressed the use of MVA and the availability of providers. South Africa decriminalised abortion in 1996 through a political coalition. The African National Congress noted that unsafe abortion had a disproportionate impact on Black South Africans. Between 1996 and 2003, Burkina Faso, Mali, Guinea, Niger, Chad, and Benin revised their strict abortion bans from the Napoleonic Code to allow abortion in the cases of rape, incest, and fetal impairment. In 2004, lawmakers debated abortion in Kenya. Senegal and Madagascar are the only Sub-Saharan countries that have passed reproductive health laws without specifying legal grounds for abortion, .
Maputo Protocol
The African Union's 2003 Maputo Protocol is the only human rights treaty that provides criteria for abortion. Article 14(2)(c) of the Protocol says:
The Maputo Plan of Action calls to "compile and disseminate data on the magnitude and consequences of unsafe abortion." Since the Maputo Protocol, 21 African countries have expanded their legal grounds for abortion. As of 2023, 44 member states have ratified the it, 8 have signed but not ratified it, and 3 have not signed it. Of those that have ratified it, 12 exceed its provisions, 11 fully comply with the provisions, 16 partially comply, and 4 do not comply. Few countries in North Africa signed the protocol until the 2010s.
Some legal scholars have criticized the Maputo Protocol for listing specific grounds to allow abortion. Others have argued that the continent's human rights guidelines provide for the complete legalisation of abortion. The African Commission on Human and Peoples' Rights (ACHPR) has said, "Women must not be subjected to criminal proceedings and should not incur any legal sanctions for having benefited from health services reserved to them, such as abortion and post-abortion care," and has called for countries to "immediately place a moratorium on the prosecution and detention of women who have illegal abortions." The ACHPR interprets that Articles 3 and 4 of the Protocol, which guarantee rights to respect and dignity, includes the right to make personal decisions without government involvement.
In the Democratic Republic of the Congo, Article 14 was enacted after a 2018 ruling by the Constitutional Court invoked an article saying national treaties take precedence over national law. It was the first country in Francophone Africa to expand legal abortion. In 2019, Rwanda, which had removed its reservation to the Maputo Protocol in 2012, implemented the WHO's definition of health, which provides for the terms of Article 14.
21st century Abortion laws were liberalised in Ethiopia in 2006 and Ghana in 2006 and 2012. In 2008, the ACHPR decided in Institute for Human Rights and Development in Africa v. Angola that the ban on cruel punishment extends to "lack of access to medicine or medical care." The following year, Nigeria became the first country in the world to include misoprostol for PAC in its essential medicines list.
In the Gambia, the Women's Act 2010 provides for safe abortion if there is a risk to the life of the mother or fetus. Kenya's 2010 constitution, passed by a referendum, permits abortion if there is risk to life or health. In 2012, São Tomé and Príncipe changed its penal code from completely banning abortion to allowing it without restriction, and Somalia authorised abortion in emergencies in its new constitution. The same year, Mauritius reformed its law, influenced by a Mauritian member of the Convention on the Elimination of All Forms of Discrimination against Women.
Planned Parenthood created legal networks to advocate for safe abortion in East Africa. The program began in 2011; in the following decade, it trained 75 lawyers and brought seven cases to court, all of which succeeded. The International Federation of Gynaecology and Obstetrics's Advocacy for Safe Abortion project, launched in 2019, has partnered with OB/GYN societies of African countries. The MAMA network has worked to expand access to self-managed abortion. Malawi proposed the Termination of Pregnancy Bill in July 2015, but legislators have not yet debated it, . Sierra Leone's Safe Abortion Act was passed by its parliament in 2015 and 2016, but the president refused to sign it. In a 2015 joint statement, the United Nations, the Inter-American Commission on Human Rights, and the ACHPR said that criminalizing abortion is a form of gender discrimination. The ACHPR began a campaign for African governments to decriminalize abortion in 2016 and reiterated this goal in 2021.
The COVID-19 pandemic led to disruption in the supply chains of medical abortion and contraceptives. DKT International, a major provider of such products, ran low on its stock after manufacturing disruptions in Asia. MSI Reproductive Choices suspended its programs in Kenya and Uganda. Health workers predicted a rise in unsafe abortion cases.
Influence of United States policy
Several Presidents of the United States have instated the Mexico City policy, which bans federal funding for NGOs operating abroad from performing or advocating for abortion as family planning. It was introduced in 1984 by the administration of Ronald Reagan. Since then, Democratic presidents have rescinded the policy and Republican presidents have reinstated it. Organisations such as Planned Parenthood and Marie Stopes International have chosen to lose federal funding when it is in effect. The instatement of the policy by George W. Bush was strongly correlated with higher abortion rates in Sub-Saharan African countries affected by it. Countries that had lost more aid funding had higher pregnancy rates and lower contraceptive use than those less affected.