Behailu Shiferaw
I just came back from Accra, Ghana, where I attended a regional conference Keeping Our Promises: Addressing Unsafe Abortion in Africa.
When I got the invitation to attend and cover the conference, I was not sure if it was not just another conference discussing a ‘western agenda’. Seemingly, understanding that prevalent mentality, the media coordinator, Kirsten, prepared a pre-conference press briefing to help us explore our values about the issue. Then, there was Ambassador Dr. Eunice Brookman-Amissah, Ipas Vice President in Africa, who eloquently addressed how close the problem was to our heart. She quoted someone as saying, “Every African woman has walked through the grave at least once.” And I said to myself, “Really!? Every African? Well, my mom didn’t. My sister didn’t.”
And then, suddenly, I was reminded of what my mom once said to me when I beat my younger sibling. She said, “Boy, don’t you ever touch my little son again. I have breastfed you for three years that he will never be able to stand up to you.” I was not sure as to how long a baby should be breastfed under normal circumstances. I was, however, eager to know why I was breastfed longer than my brother. She told me that she had a miscarriage of an almost fully-developed fetus while I was still very young. And since her breast was already filled with milk, I was given a second round on it. As young as I was, I did neither know nor care about the miscarriage at all.
As I remembered that, while still in the press briefing room, I realized how rampant birth related complications really were. But then a series of questions surfaced: “If it is as prevalent as they say it is, why is the issue not accorded with the attention it deserved? Why is it never on top of the agenda? Why is it never as important an issue as it is in the West where it significantly shapes voter behavior?” May be it is a Western problem. May be it didn’t affect us, Africans, as much as it affected the developed world. May be safe abortion procedures are more expensive than treating post-unsafe abortion complications. May be…the list of the logical assumptions accounting for the issue’s lack of attention was endless. But they were all wrong.
First and foremost, unsafe abortion is definitely an African problem, too. Africa has been hit the hardest by the preventable pandemic. Ipas Africa handed out a flyer that summarized the state of abortion in Africa. Credit be to them.
Every year, the flyer shows, there are more than 5.5 million unsafe abortions in Africa. Half of the 67,000 global deaths from unsafe abortion occur in this continent and the risk of death from this practice is greater in Africa than anywhere else in the world. According to the World Health Organization, the number of deaths from unsafe abortion is rising in Africa – even as it decreases in other parts of the world. And the number of abortion cases is also increasing in Africa while it is decreasing in other parts of the world. In fact, unsafe abortion accounts for more than 13 percent of maternal deaths in Africa.
For African women who experience unsafe abortion and survive, short – and long-term injuries and disabilities, such as uterine perforation, chronic pelvic pain and secondary infertility, are all too frequent.
Are African governments not aware of that? It is difficult to think so. They have been to such conferences so many times. They have read such reports many, many times. And more than anything, they are Africans, too. Their parents, sisters or at least neighbors, as much as mine, have “walked through the grave at least once”. So what is all the silence about?
So in search of the “why?”, I set out, only to find that the blaming finger points to no one but me and my fellow African men who enact (or at least failed to liberalize), interpret and execute the restrictive laws; to men who constitute the majority in parliaments; to men who hold the seats at the ministries of health in our countries; to men who head most of our nations; to men who share all the excitement that is there in having sex but who externalize the pain and guilt attached to being with unintended fetus to women; to men who have headed our community and who have, thus, authored all the gender imbalances.
There is so much money flowing to causes such as AIDS, TB, malaria, climate change … yes, those are the problems of the men, too.
Dr. Haile Gebresillassie is an Ethiopian researcher with extensive experience in the reproductive health area in Africa. He recalls one recurring question which policy makers in Africa often ask whenever experts recommend intervention in the reproductive health sector: “Don’t you think we should first study the extent of the problem to determine whether it’s worth intervening?” And as a public health expert, he was never challenged with this question when dealing with other issues but reproductive health – ‘the women’s issue.’
This neglect is equally, if not more, reflected in our laws governing abortion. Indeed, the laws and policies governing access to safe abortion in Africa vary, ranging from very restrictive, such as in Kenya, where abortion is permitted only to save the life of the woman, to liberal, such as in South Africa, where abortion is permitted up to the 12th week of pregnancy or later, in certain circumstances. Ethiopia’s law is one of the most progressive as well. In Ethiopia, women can terminate pregnancies in cases of rape, incest, danger to the health or life of the pregnant woman and in case the pregnant woman is a minor – all without having to produce any proof to any of the claims. Hats off for South Africa, Tunisia, Ethiopia, Ghana and others who worked hard to save lives of their women.
We are talking about a continent with a huge burden of unmet needs for contraceptives. In Ethiopia, for example, over 30 percent of women in their reproductive age cannot still access contraceptives – a critical element in the ‘continuum of care’ for women and children. State of World Population 2010, annual report published by the United Nations Population Fund (UNFPA), states that when women and girls have the power to decide for themselves when and if they will become pregnant, they are more likely to have healthy pregnancies and to seek antenatal (before birth) care. Their children are more likely to survive infancy and early childhood. Likewise, girls whose mothers survive are more likely to continue their education and, in turn, are less likely to marry and have children before reaching their 20s. This, in turn, lowers their risk of dying from causes related to pregnancy and childbirth. Imagine the reverse scenario in resource limited settings like most African countries where the contraceptives are not yet adequately available. It is irrational and irresponsible not to provide contraceptives and then to fail to provide safe abortion options. It’s not moral to ask people (at least those in unions) not to have sex until the government is done away with other priorities and is able to provide them with contraceptives. In developing countries alone, State of World Population 2009 states, there are an estimated 106 million married women who have an unmet need for family planning even if they do not want to become pregnant now or within the next two years—the definition of “unmet need.” One participant at the Accra conference addressed the issue saying, “where there are men and women [with no family planning options], there is pregnancy; and where there is unintended pregnancy, there is abortion.” So the choice is a matter of making it safe or not.
In summary, abortion, yes, is a problem in Africa more than it is anywhere else. And women are dying from it needlessly. But, fortunately, unsafe abortion is preventable and so are the thousands of deaths from it. Making the choice economically viable, safe abortion procedures are much cheaper than treatments needed for treating complications arising from unsafe abortion. In Nigeria, for example, research presented by Dr. Ejike Oji, representative to Ipas Nigeria shows, providing safe abortion services costs health facilities 71 percent less than what treating post-abortion complications would have cost them.
Just take a moment and imagine this scenario. You and your lovely spouse have already had enough children. But who says sex is just a reproductive act. Sadly, you neither have family planning options nor safe abortion rights at your service (note that I am not recommending abortion as family planning option but as a last resort). Now, what would you do? Would you stop having sex in fear of becoming pregnant? Would you continue to bear children whom you will not be able to cater for? Or would you resort to unsafe abortion every time you are pregnant, which could probably mean every year? This is not a-scenario-of-the-improbable. There are millions of Africans who are living in such situations, and to your utter shock, yes – today.
