Addis Ababa, Ethiopia

During the last decade, women in Africa have made progress in achieving greater gender equality, financial security and access to health care. Women have assumed positions of leadership and governance in international forums, national offices and at community levels. Young African women and men have grown more vocal in their support for women’s equality.

But throughout the region, women and girls are still denied the ability to control their reproductive lives. In many places, reproductive health care, including safe abortion care, is inaccessible—particularly for young, rural, poor, displaced and uneducated women—for a variety of reasons including legal restrictions, cost and cultural stigma. This stigma extends to health care providers who may not provide abortion care as a result.

In Africa, more than eight million women have abortions each year, many of them unsafe. Each year, about 1.6 million women are treated for complications from unsafe abortion, and thousands more suffer complications but do not receive the treatment they need. Because so many abortions in the region are unsafe, roughly 16,000 maternal deaths annually are due to unsafe abortion. The consequences of unsafe abortion for women and their families, and for society as a whole, are significant and enduring.

Approximately 90% of African women of childbearing age live in countries with restrictive abortion laws. Even where the law allows abortion under certain circumstances, few women, including survivors of sexual violence, are able to navigate the processes required to access a safe and legal procedure.

There has been progress in the last decade, and progress continues to be made. Some African nations are working to reform their abortion laws. The body of credible research has grown, and we know more about the magnitude and consequences of unsafe abortion. We know more about women’s and adolescents’ pathways to abortion, and attitudes and stigma around abortion. And we know more about the costs of unsafe abortion to women and their families and to health care systems, and the cost savings associated with safe and comprehensive abortion and contraceptive care.

We—more than 260 researchers, advocates, policymakers and donors—commit ourselves and call on others to build, share and act on the evidence. Furthermore, remaining gaps in evidence must be filled. Our agenda for research and action in Africa going forward will focus on:

  • Holding African governments accountable to prioritize the elimination of unsafe abortion in the next decade through:
    • Honoring existing human rights treaties and regional agreements, including the Addis Ababa Declaration on Population and Development in Africa Beyond 2014 and the Maputo Plan of Action 2016–2030, both of which call on countries to ensure access to safe abortion to the extent allowed by national laws and policies
    • Reforming restrictive abortion laws and outdated policies and aligning them with the provisions in Article 14 (2)(c) of the Maputo Protocol
    • Ensuring that all women, regardless of age, marital status, ethnicity, economic circumstances or geographic location have full access to high-quality abortion and contraceptive care
    • Committing national resources for abortion care and providing all women with information, counseling and the full range of modern contraceptive methods
    • Supporting the work of civil society to expand safe abortion access
  • Expanding the evidence base to inform better policies and programs, particularly in countries with restrictive abortion laws and high rates of unsafe abortion, but also in countries that have liberalized their abortion laws. Remaining research gaps include:
    • Conducting national-level studies of abortion incidence, safety and morbidity, and health system costs of unsafe abortion, where such studies have not been done
    • Understanding the root causes of abortion stigma and the social and economic barriers women face in accessing safe abortion
    • Building the evidence that supports making abortion available to all women who need it, particularly through the use of medication abortion
    • Bolstering the evidence around provision of abortion by diverse providers, such as midwives and community health workers
    • Defining and assessing clinical and interpersonal quality of abortion services
    • Evaluating health system and community-based interventions to enhance women’s ability to access safe, high-quality abortion care, including for survivors of sexual violence and those in humanitarian settings
  • Incorporating the voices of young women into policy reform, program design and conversations about their preferences and needs.
  • Ensuring wide dissemination of research and promoting its utilization by policymakers, civil society organizations, health care providers and other stakeholders to facilitate policies that improve the quality and availability of safe abortion and treatment of unsafe abortion complications.
  • Securing the resources and political commitment needed at the national level and within the regional and global community to build the evidence, share the findings and replicate programmatic and policy successes.

When women and girls are able to make their own sexual and reproductive health decisions, they can safeguard their health and achieve their educational, childbearing and career goals. We pledge to come together as a community of experts who share the commitment to expanding access to comprehensive and high-quality reproductive health care, including safe abortion. We will trust the women and girls of Africa so that they can fully realize their reproductive rights and achieve their potential.

Signatories:

African Federation of Obstetricians and Gynecologists (AFOG)

African Population and Health Research Center (APHRC)

Center for International Reproductive Health Training (CIRHT) Ethiopia

Centre of Excellence in Reproductive Health Innovation (CERHI) at the University of Benin, Nigeria

Ethiopian Public Health Association (EPHA)

Ethiopian Society of Obstetricians and Gynecologists (ESOG)

FEMNET

Guttmacher Institute

Gynuity Health Projects

Ibis Reproductive Health

Institut National D’Études Démographiques (INED)

International Planned Parenthood Federation, African Regional Office

Ipas

Malawi Human Rights Resource Centre

Marie Stopes International

Population Council

Women’s Health and Action Research Centre (WHARC)