The majority of participants, particularly those from private clinics or NGOs, expressed satisfaction with the law, although they pointed out some shortcomings. They claimed that the main consequence of the law was that it reduced the frequency of unsafe abortions, thus saving women`s lives and significantly reducing the number of complications. As we celebrate International Safe Abortion Day today, the voices of African abortion activists and providers must be heard. We will not talk about American anti-choice activists who try to restrict women`s rights around the world. We know the dangers of following America`s example, and we know the progress that can be made by following the example of countries like Ethiopia, Benin, Mozambique and South Africa. Through discussions within the research team, institutions, organizations and key actors in the field of abortion were identified in each of the three contexts of the study. Recognising the important role that actors outside the governance structure play in policy design and implementation, we recruited actors from a wide range of organisations and institutions. These included ministries, non-governmental organizations, UN agencies, professional associations and religious organizations that took different positions in abortion debates. The list was expanded during the research. Overall, parallel organizations were recruited in all three countries (see table 2). However, as it has been deemed important to represent different positions and prominent voices in abortion debates in different countries, there are also some differences. We interviewed a total of 79 people in the following categories: ministries (MIN), religious organisations (RO), non-governmental organisations (NGOs), international non-governmental organisations (INGOs), United Nations (UN) agencies, professional associations (OPs), health workers (HW), journalists (J) and others (O).
See table below (Table 2). In the manuscript, we refer to the different actors who use these abbreviations with Z for Zambia, E for Ethiopia and T for Tanzania. In Ethiopia`s much more permissive legal context, coupled with the power vested in women`s rights, clinical guidelines have been developed to guide safe abortion procedures, health workers are increasingly being trained, and services are gradually being extended to the population. However, rather than encountering a context of easy access to safe abortion services for those who meet the criteria of the law, our material shows that a number of factors continue to severely restrict access. The government`s fear of informing the public about the law so as not to appear as a state promoting induced abortions that could cause upheaval at the local level has led to information withholding, limiting both knowledge of the law and the full deployment of services. Even when public services are available, women may refrain from using them for fear of disclosure in the community, while health workers act as guardians and may dismiss women on religious grounds. The increasing availability of safe abortion services therefore remains partly hidden, the law is not widely known, and large numbers of young women continue to resort to unsafe abortion procedures [47, 48]. Despite slow progress, a relatively liberal law has been in place for a long time, there is a cautious but steady introduction of abortion services, and there is acceptance of the increasing availability of misoprostol and emergency contraception. All of these factors point to continued but silent attempts to expand services amid massive anti-abortion sentiment. The 1994 International Conference on Population and Development stressed the need to prevent unsafe abortions and to provide safe abortion services where permitted by law [1]. After the conference, the liberalization of abortion laws in Africa was promoted. African leaders agreed to address the problems of unsafe abortion and lack of access to safe abortions by reforming national laws and policies, developing policies and regulations for service delivery, strengthening training programs, and expanding public relations programs.[2] Her friend told her about the Marie Stopes Clinic, which provides abortion care and contraceptive counselling.
“I`m very happy,” she said for the service. Yet Khadija says she won`t tell anyone, including her husband, what happened, and certainly not about abortion. This article explores the complex relationship between abortion laws, policy, and women`s access to abortion services, focusing on three different legal and policy contexts. It is generally accepted that legal frameworks are important tools for protecting the right to health [1,2,3], but as we will see in this paper, the relationship between law, health policy and access to health services is complicated and crucially depends on the socio-economic and political context of implementation. Unsafe abortions, which are closely linked to restrictive abortion laws, and lack of access to contraceptives and safe abortion services are a global problem of enormous proportions [3]. With an estimated 22 million cases per year, unsafe abortion is a major contributor to maternal mortality and morbidity [4], and it is estimated that between 4.7% and 13.2% of maternal deaths worldwide are due to unsafe abortions [5]. Another question is whether moral dilemmas and anxiety lead professionals to treat patients differently than if they had not felt moral concerns related to abortion, as suggested by several studies [14, 16]. The great challenge of finding entry points to make abortion rights more liberal in the current political landscape in Tanzania has been raised by whistleblowers; It is very difficult to find a point of view, because when other stakeholders are involved. There is a lot of resistance from religious groups because abortion is considered murder, so it is very difficult to argue (UN T).
Among the participants, there was a common view that life in the biological sense begins at conception. This was despite the fact that they all defended abortion, at least in some situations, for ethical, professional and legal reasons. Of course, this alone does not mean a contradiction. But it also showed that some participants contradicted themselves throughout the interview, perhaps suggesting that these were topics they hadn`t necessarily given much thought to, at least not in that regard. One interpretation of the contradictions and hesitations observed in some participants is that not all participants thought as much about the subject. Although abortion is controversial and hotly debated in Ethiopia, starting work in abortion services does not seem to have “forced” some participants to think critically about ethical dilemmas. Apparently, the “balancing act” needed to reconcile conflicting norms and duties was the one that each practitioner had to perform for himself. None of the participants mentioned a community consultation on the dilemmas they faced. In our view, health education should explicitly address the dilemmas of conflicting norms, values, and duties on abortion issues in order to help future practitioners develop their own perspectives. In addition, a safe forum for moral reflection and discussion could be useful for some professionals. Around the world, countries have been categorized by their abortion laws in different ways, usually along a continuum from “very restrictive” to “liberal” [33] or “completely forbidden” to “no restriction on reason” [34]. At the narrow end of the continuum are countries that ban abortion altogether or allow it only to save the mother`s life.
Tanzania, with its restrictive law that only allows abortion to save the life of the pregnant woman, falls into this category. However, the law contains an explicit provision in the penal code that exempts providers from punishment if they perform an abortion in order to save a woman`s life [35]. In the middle of the continuum is Ethiopia, which allows abortion to ensure maternal life and health, and for reasons related to age and ability to care for a child [36, 37]. Zambia is at the liberal end of the continuum that allows abortion for health and socio-economic reasons [38]. Countries that are at the very liberal end of the continuum and have laws that allow abortion with few restrictions are not represented in our material (see [33]). The table below (Table 1) summarizes the content of the abortion laws of the three countries and the main indicators of reproductive health. Just as the example of Ethiopia may serve as an inspiration to the United States and others, I naturally fear that the reversal of Roe v Wade will also embolden the anti-choice movement far beyond American borders. In 2020, openDemocracy estimated that right-wing Christian organizations in the United States spend about $280 million a year attacking abortion and LGBTQ rights around the world. These funds support anti-choice proxies across Africa and provide resources and support to politicians who want to overturn or further restrict abortion rights. Singh S, Fetters T, Gebreselassie H, Abdella A, Gebrehiwot Y, Kumbi S, Audam S. The estimated incidence of induced abortions in Ethiopia, 2008.
2010;36(1):16–25. There is strong evidence that restrictive abortion laws do not reduce the prevalence of abortions [8]. Nevertheless, abortion remains illegal in most sub-Saharan countries, except to save the life of the pregnant woman, and sanctions are often imposed for violating these restrictions [3]. Conversely, a liberal abortion law is not enough to guarantee access to safe abortion services. Political will and resources to finance, build and publicize services remain key elements [8].