CRR in the Field: Alisha Bjerregaard

Since 1992, the Center’s innovative legal work has fundamentally transformed the landscape of reproductive health and rights worldwide, and has already strengthened laws and policies in more than 50 countries. CRR in the Field is a personal look at the various ways Center staff interacts with plaintiffs, policy makers, governing bodies, and supporters at home and abroad to further the fight for reproductive rights.

Name: Alisha Bjerregaard
Position: Legal Fellow for Africa
Reporting from: Africa

Alisha traveled to Ghana to participate in a conference on unsafe abortion in Africa. More than 200 medical practitioners, researchers, community activists, lawyers and human rights advocates attended the conference and more than 20 countries in Africa were represented, including Kenya, Nigeria, Uganda, Namibia and Ghana.

Q: What are the major issues around unsafe abortion in Africa that were identified at the conference?
 

A: The conference addressed a range of issues preventing women from accessing safe abortion services and contributing to high rates of unsafe abortion in Africa. These include the legal and policy barriers to accessing safe and legal abortion services throughout the continent (abortion is criminalized except to save the woman’s life in many African countries), the inadequate numbers of healthcare providers trained to offer safe abortion and post-abortion care services, the lack of sufficient resources and political will to ensure appropriate supplies of abortion-related medical equipment and medicines in public health facilities, the lack of access to safe abortion and post-abortion care in rural areas, and the strong stigma associated with abortion, which affects both women’s access to care and the quality of the care they may ultimately receive from healthcare providers when seeking abortion-related services.

Conference participants also identified key areas to focus on in future work around unsafe abortion in Africa. Most important was the acute need to hold governments accountable to their international, regional and national legal obligations and commitments in the realm of reproductive health and rights. Monitoring governments’ budgetary allocations towards reproductive health was seen as especially crucial, as most governments fail to sufficiently fund this area of health in particular. Special emphasis was also placed on ensuring ratification and implementation of the Protocol on the Rights of Women in Africa, the first international human rights treaty that explicitly articulates a woman’s right to abortion under certain circumstances.

Q: What are the challenges to addressing these issues?
 

A: Perhaps the single, greatest challenge to addressing unsafe abortion in Africa is the lack of principled commitment on the part of governments to promote, protect and respect women’s reproductive rights, including the right to access safe and legal abortion services. This lack of political will affects the availability, accessibility, and quality of abortion-related care.

In some African countries, governments deliberately allocate very limited resources for critical abortion-related medical equipment, medication, training and guidelines for healthcare providers. The lack of transparency regarding budgetary allocations in many countries further frustrates efforts to hold governments accountable to their health-related commitments. Law reform is also challenging. Many policymakers are unwilling to address access to safe abortion services, fearing the potential political repercussions of tackling such a controversial issue. In their recent ratification of the Protocol on the Rights of Women in Africa, for example, both the Kenyan and Ugandan governments exempted themselves from the provision dealing with access to safe and legal abortion.

Finally, the pervasive criminalization of abortion in Africa is a serious obstacle to improving access to safe and legal abortion. In some countries, such as Kenya or Uganda, criminalization goes hand in hand with a lack of clarity about the law, adding confusion and misinformation to the barriers women face in accessing safe and legal abortion services. This opaque legal framework also leaves many providers understandably reluctant to offer, or even be trained to offer, abortion-related services. Women, in turn, fear arrest for procuring an abortion or obtaining treatment for complications of unsafe abortion.

Women also face the added challenge of abortion stigma. In Kenya, for example, women have died in their homes from complications from unsafe abortion because they are too fearful of community condemnation to seek emergency medical care. Further, many healthcare providers, particularly in restrictive legal regimes, are key perpetrators of stigma. As a result, they may be physically or verbally abusive towards women in need of abortion-related services or seriously delay their care. Understandably, this community- and provider-based stigma makes women reluctant to speak out and publically advocate for change.

Overcoming these considerable barriers requires governments to sustain a firm commitment to women’s human rights and to ensuring access to safe and legal abortion services.

Q: What is the Center doing to address unsafe abortion in Africa?
 

A: In March, the Center launched one of the first human rights fact-finding reports on abortion in Africa. The report, In Harm’s Way, documents the impact of Kenya’s restrictive abortion law on women, healthcare providers and the healthcare system. The report reveals the human rights abuses stemming from the criminalization of abortion and throws into sharp relief the need to comprehensively address the toll of unsafe abortion in Kenya.

The report’s launch was timed to inform the constitutional reform process then transpiring in Kenya, in which abortion was one of the most controversial issues. During that process, anti-choice advocates were pushing to even further restrict Kenya’s abortion law in the text of the proposed constitution. The report was used by our Kenyan partners in advocacy with government officials and policymakers and helped to inform media coverage of the issue.

Ultimately, the constitution passed in August and the final language on abortion actually increases access to abortion under the law. The Center is now using the report findings and recommendations to advocate for access to safe abortion and post-abortion care services as a human right.

The Center also launched Broken Promises in 2008, which looks at maternal mortality in Nigeria and highlights unsafe abortion as a major cause of these preventable deaths. The report identifies the primary factors that have contributed to high rates of mortality from unsafe abortion and how the Nigerian government’s failure to fulfill its human rights obligations under national, regional and international law is in large part responsible for this situation. Finally, the Center has worked extensively with the African Commission, hosting briefings and side events and submitting shadow letters drawing attention to unsafe abortion in Africa and calling for government accountability to ensure access to safe and legal abortion.