The impact of liberalized abortion policies in select sub-Saharan African countries: A synthesis of the literature and proposals for future directions Open Access

Dumas, Erin Files (2016)

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Background: Unsafe abortion is known to be a contributing factor to maternal mortality and morbidity in sub-Saharan Africa. Yet, reproductive health laws and policies surrounding provision of safe abortion are generally restrictive. Between 1996 and 2013, ten sub-Saharan African countries liberalized their abortion policies to comply with one or more of the conditions for safe abortion set forth by the African Union's Maputo Protocol: when there is risk to the mental or physical health of the woman, when there is risk to the life of the woman or the fetus, in cases of rape, and in cases of incest. To understand the public health impact of abortion policy liberalization, a comprehensive study of the published literature was undertaken.

Methods: All relevant published literature from the PubMed research portal was reviewed on these ten countries from the time period spanning 1997-2015. This published literature was reviewed both by country and by theme to determine any apparent impacts that the liberalized abortion policies had on safe abortion service provision.

Results: Ethiopia, which expanded conditions for abortion provision beyond those of the Maputo Protocol to include all pregnancies in females under age 18, was the only country where providers were documented as successfully performing safe abortions as a result of a liberalized policy.

Recommendations: Advocates in sub-Saharan African countries that may liberalize their abortion policies in upcoming years should utilize this body of literature to demonstrate to their policy makers that conditions for safe abortion should be expanded to beyond those of the Maputo Protocol.

Table of Contents

Tables and Figures iii

Chapter 1: Introduction

A. Abortion in sub-Saharan Africa 1

Chapter 2: Methods

B. Who changed their abortion law? 3

C. Where are the studies? PubMed search 7

Chapter 3: Results

D. What do the studies show? Findings by country 8

i. Benin 8

ii. Burkina Faso 10

iii. Chad 15

iv. Ethiopia 15

v. Kenya 29

vi. Mali 46

vii. Niger 47

viii. Rwanda 48

ix. Swaziland 49

x. Togo 50

Chapter 4: Implications

E. What does it mean? Discussing abortion themes across the continent 51

i. Unsafe abortion is equated with illegal abortion, and vice versa 51

ii. Unsafe abortion is underestimated 52

iii. Unsafe abortion measurement following legal change is limited to Ethiopia 52

iv. Women and girls procure unsafe abortions for social reasons 54

v. Youth bear a unique burden 55vi. Need for pregnancy termination supersedes fear of legal repercussion 55

vii. Accessibility and acceptability are barriers following liberalization 56

viii. Unsafe abortion is costly 56

ix. Medical innovations and personnel interventions work 57

F. Limitations of the literature 57

G. Policy recommendations 58

References 61

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