Africa Check has fact-checked several claims about abortion in Africa.
In 2018 a member of South Africa’s African Christian Democratic Party claimed there were 200,000 abortions in the country every year. She went on the say that “many of these are repeat abortions; not a second, but a third, sometimes even a fourth”. We found these claims to be unproven.
In 2021 we looked into the topic twice.
A Kenyan radio celebrity was mostly correct to claim that “500,000 abortions hizo uhappen Kenya [happen in Kenya] nationwide”. And the head of a global reproductive health nonprofit stated that unsafe abortions caused 11% of the pregnancy-related deaths of women in Nigeria. But this was also unproven.
In this factsheet, we look at the available data on the topic and the countries where access to abortion is limited.
1. What is an abortion?
An abortion is the deliberate termination of a pregnancy. Safe abortions are administered by trained medical professionals in a way that meets minimal medical standards and are appropriate for the stage of the pregnancy. There are two types of abortion.
A medical abortion uses two pills (mifepristone and misoprostol) to end a pregnancy. Mifepristone blocks the production of progesterone, a hormone that supports pregnancy. Misoprostol is then used to soften the cervix and contract the uterus. This method can be used up to 11 weeks of pregnancy.
A surgical abortion is performed in clinic by a licensed medical practitioner. They remove the foetus from the uterus using suction tools.
2. When is an abortion unsafe?
According to the World Health Organization (WHO), an abortion is considered unsafe if it meets one of the following criteria:
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It is performed by someone who does not have the required medical training.
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It is not performed in a sterilised environment using the correct medical techniques and medication.
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It is performed in a manner that is not recognised by the WHO. This includes taking harmful substances or the insertion of dangerous objects into the body.
Unsafe abortions can cause a range of life threatening complications such as heavy bleeding, damage to the uterus and genitals, and infection.
3. What laws govern abortion in different African countries?
The Guttmacher Institute is a US-based research and policy institute for sexual and reproductive health. The institute estimates that 92% of women of reproductive age in sub-Saharan Africa lived in countries with “highly or moderately restrictive laws” in 2019.
According to a 2018 factsheet, abortion was not legal for any reason in 10 out of 54 African countries. These are Angola, the Democratic Republic of the Congo, the Republic of the Congo, Egypt, Gabon, Guinea-Bissau, Madagascar, Mauritania, São Tomé and Príncipe, and Senegal.
Abortion was allowed for any reason, up to a certain stage of pregnancy, in four African countries: Cape Verde, South Africa, Tunisia and Mozambique.
Benin recently legalised abortions up to 12 weeks in cases where the pregnancy would “aggravate or cause a situation of material, educational, professional or moral distress incompatible with the interest of the woman and/or the unborn child”.
South African abortion law
A woman may terminate her pregnancy for any reason before the 13th week of pregnancy. From 13 to 20 weeks a woman may terminate a pregnancy for the following reasons:
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Her own physical or mental health is at stake.
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The baby will have severe mental or physical abnormalities.
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She is pregnant because of incest or rape.
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She is of the personal opinion that her economic or social situation is sufficient reason for the termination of pregnancy.
After the 20th week of pregnancy a woman may only have an abortion if her or the foetus’s life is in danger. A termination is also permitted if the foetus is likely to have serious birth defects.
The rest of Africa has varying laws controlling abortion access.
Some countries only allow abortion when it is necessary to save the life of the mother. They include Malawi, Nigeria and Somalia. In Nigeria, a person can face a 14 year prison term for helping a woman perform an illegal abortion. And a woman who has an illegal procedure to end her pregnancy can be imprisoned for seven years.
Other African countries allow abortion in cases of rape and incest, and when there is something wrong with the foetus. They include Botswana, Mozambique and Sierra Leone.
4. What other barriers limit access to abortion?
Laws restricting access to abortion are not the only barriers African women face. According to the WHO, any woman who can’t access a safe abortion is at risk of an unsafe abortion. Poor women and women living in low-income countries face the highest risk.
A lack of knowledge about abortion laws in countries like Zambia and South Africa leads to many seeking unsafe abortions. And in places with a shortage of doctors, laws that require abortions be authorised by medical practitioners can also be a barrier.
Lengthy delays in getting a legal and safe abortion can result in a woman being so far along in her pregnancy that an abortion becomes illegal. This situation can be made worse when medical practitioners refuse to provide abortions because terminating a pregnancy goes against their beliefs.
5. Is there an estimate for abortions performed in Africa?
Dr Margaret Giorgio is a senior research scientist at the Guttmacher Institute. She told Africa Check it can be difficult to estimate the number of abortions that take place across Africa.
“One way to measure abortion would be to ask women directly if they’ve had an abortion. However, because abortion is so heavily stigmatised – and in many countries it is under almost every circumstance illegal – women tend to underreport abortion,” she said.
“Another way you can do it would be to use medical records. However, in cases where women can’t legally obtain abortions, most of the abortions are happening outside of the formal healthcare system and so that’s not going to be a useful way.”
The institute’s researchers use the Abortion Incidence Complication Method, which estimates abortions using data on the number of women who have turned to health services for complications relating to miscarriages and then measure what share of those miscarriages were likely to have been induced.
In December 2020 the institute released a report titled From Unsafe to Safe Abortion in Sub-Saharan Africa: Slow but Steady Progress. It includes estimates of both the rate of abortion and the number of abortions in the region.
The report cites data from a July 2020 study in the Lancet medical journal. The authors estimated the global and regional abortion rates using country-based surveys, official statistics, studies and live birth data.
Based on this analysis, the Guttmacher Institute reported that “despite an initial increase between 1990–1994 and 1995–1999, the [sub-Saharan African] abortion rate has remained virtually the same over the past 25 years”. It has stayed steady at between 31 to 33 abortions per 1,000 women since the period 1995 to 1999.
But population growth has caused the total number of abortions in sub-Saharan Africa to increase. The institute estimates that while there were 4.3 million abortions in the five years from 1995 to 1999, by the period 2015 to 2019 this had risen to 8 million.
Giorgio said abortion was becoming more difficult to measure as the medical abortion pill has become more accessible across the continent. This means more women are able to have safe abortions at home.
6. What role does the USA play in abortion access in Africa?
Abortion accessibility in Africa was pushed into the spotlight in January 2017 when former US president Donald Trump expanded the Mexico City Policy. This slashed funding to Africa-based NGOs that performed reproductive health services.
The Mexico City Policy was first implemented in 1984 by US president Ronald Reagan. The policy prohibits funding for foreign non-government organisations in USAid recipient countries (including those in Africa) that provide or promote abortion services or provide financial support to other organisations that do.
The policy was withdrawn under president Bill Clinton in 1993, reinstated by George Bush in 2001, and quashed again by Barack Obama in 2009.
Trump expanded the policy to include all global health assistance programmes. It had previously only applied to family planning services. The expansion also meant that organisations had to certify that they did not use their own non-US funds to provide abortion services, abortion related counselling, or advocate for abortion laws. Because of these restrictions, the policy became known as the Global Gag Rule.
The policy was lifted in 2021 by president Joe Biden.
7. How has the policy affected African countries?
Some research has shown that the policy led to reproductive healthcare centres in Africa that were dependent on US funding being shut down.
In 2017, after Trump reinstated and expanded the policy, Human Rights Watch interviewed reproductive healthcare providers from 21 organisations in Uganda and 24 organisations in Kenya. It found that the policy had led to reductions in key sexual health services, including clinic closures and crucial services such as cervical cancer screening and family planning counselling being cut.
That same year family planning and women’s healthcare provider Marie Stopes International announced they had ended their partnership with USAid because of the Mexico City policy, stating that it had put the lives of “millions of women” at risk.
The organisation said several of their programmes providing contraceptives to women in Africa were forced to close. These included a programme supporting over 100 public and 90 private healthcare clinics in Madagascar and five outreach teams serving remote and poor communities in Uganda.
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